Arthroscopic MAT in professional soccer players allowed a return to play at the same level (Tegner score of 10) in 75% of the cases at 36-month follow-up.
Background:Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated.Study Design:Case series.Hypothesis:A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery.Methods:Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests.Results:The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation.Conclusions:Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.
Study Design: Case report. Background: To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery. Case Description: The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity. Outcomes: The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee. Discussion: This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises. J Orthop Sport Phys Ther 2005;35:52-66.
After ACL reconstruction, accelerated rehabilitation allows professional soccer players to return to official matches within 4-6 months of surgery, but in many cases accelerated rehabilitation is impossible. This retrospective study investigated the variables that affect the time to return to competition of professional soccer players after ACL reconstruction. Between October and December 2002, a questionnaire designed for this study was administered to the players competing in the Italian First Division (Series A) who previously reported an ACL reconstruction. Among 479 players surveyed, we identified 38 cases of arthroscopic ACL reconstruction (8%). The mean time to return to competition was 232±135 days from surgery (range, 76-791). In 12 cases (31.6%; group A), there was an isolated ACL rupture and these players returned to competition within 163±44 days after surgery (range, 76-231). Twenty cases were associated with one or more lesions (52.6%; group B), and these players returned to competition within 203±56 days after surgery (range, 146-329). Six cases reported complications after surgery or during rehabilitation (infections, swelling; 15.8%; group C) and returned to competition within 456±203 days after surgery (range, 233-791; p<0.001compared to groups A and B). In this study, a fast (<4 months) return to competition was achieved only in three cases of isolated ACL rupture (8%). Accelerated rehabilitation (<6 months) seems to be possible only in cases of isolated ACL reconstruction or when only the medial meniscus is involved as an associated lesion. The time to return to competition after ACL reconstruction was independent of the surgical technique used and must be considered the consequence of the complexity of the injury to the knee.
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