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Factors Related to Return to Sport After ACL Reconstruction: When Is It Safe?

Authors: Clare L. Ardern, Julian A. Feller, Kate E. Webster,

Publish Date: 2013
Volume: , Issue:, Pages: 169-181
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Current clinical practice permits patients to return to sport at between 6 and 12 months postoperatively. There is high-quality evidence to indicate that most patients (93 %) do attempt some form of sport after surgery. However, it appears that, at best, only approximately 60 % return to their pre-injury level of sports participation. There are many factors that may influence when it is safe to return to sport, and many criteria have been used to guide the patient and treating health professional. However, the validity of such criteria remains to be established. Similarly, there may be aspects of graft healing that influence safety in return to sport, but these are yet to be fully explored in vivo. The health of other structures in the knee must also be considered when making return-to-play decisions. The clinician should ask the following: Is it safe for the ACL graft, and is it safe for the health of the whole knee for the patient to return to sport at this time?A 23-year-old male elite professional Australian Football League (AFL) player suffered a tear of the posterolateral bundle of the ACL in his left knee. Australian football is a fast-moving contact game involving frequent abrupt direction changes, cutting, and jumping and landing. The player had injured his preferred kicking leg.The player underwent a single-bundle reconstruction, leaving the anteromedial bundle of the native ligament intact. A quadrupled semitendinosus tendon graft was used, with suspensory fixation on the femoral side and metallic interference screw fixation on the tibial side. The articular surfaces and the menisci were intact, and there was no associated collateral ligament injury.The player commenced a routine rehabilitation program with a view to returning to play at his pre-injury level, in the starting team, at around 6 months. Initial rehabilitation involved restoration of active terminal extension, weight bearing and flexion as tolerated, and no bracing. He progressed satisfactorily and was riding a stationary bicycle at 3 weeks. Subsequent rehabilitation was routine, and he commenced running at 10 weeks, along with balance and landing drills. This rehabilitation program was supervised and progressed by the physical therapy staff of the team.At 5 months, the player had no effusion, a full range of motion, normal stability of the knee, and good quadriceps and hamstring strength. He was undertaking noncontact training. In order to improve the understanding of his functional ­status with a view to him returning to play, he underwent laboratory-based three-dimensional motion analysis testing.An eight-camera Vicon (Oxford, UK) MX3 motion analysis system and two in-ground force plates were used. The player was assessed during comfortable-speed walking, single-limb landing from a horizontal hop, and running. The data were compared to previously collected data from an active control group, with the exception of the sagittal plane knee moment during running, which was compared to data obtained from the contralateral knee.



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