Rehabilitation After Anterior Cruciate Ligament Reconstruction: Criteria-Based Progression Through the Return-to-Sport Phase

Abstract

Rehabilitation following anterior cruciate ligament (ACL) reconstruction has undergone a relatively rapid and global evolution over the past 25 years. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safe return to sport. Return-to-sport rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back into sport participation. The purpose of the following clinical commentary is to introduce an example of a criteria-driven algorithm for progression through return-to-sport rehabilitation following ACL reconstruction. Our criteria-based protocol incorporates a dynamic assessment of baseline limb strength, patientreported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility, and technique with sport-specific tasks. Although this algorithm has limitations, it serves as a foundation to expand future evidence-based evaluation and to foster critical investigation into the development of objective measures to accurately determine readiness to safely return to sport following injury.

Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

“…To evaluate muscular recovery, 2 main types of tests are performed: an isokinetic test 6 and functional tests. 6,7 The uninjured limb (UL) is used as a reference, and the goal of rehabilitation is to increase side-to-side symmetry. 6,[8][9][10] The isokinetic test helps to quantify muscular recovery by measuring peak muscle torque of the extensor and flexor muscles of the knee joint.…”

Orthopaedic sport biomechanics – a new paradigm

“…For ACL patients, the concerns are the time to return to sport, the re-injury risk, the prevalence of the development of osteroarthritis, and lastly, the time to quit . The objective biomechanics measurements include dynamic assessment of baseline limb strength, patient-reported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility and technique with sport-specific tasks (Myer et al, 2006). For monitoring the rehabilitation progress of ACL patients, performance of gait and physical activities could help determining the recovery progress, i.e., normal gait was restored in 3-4 months after ACL reconstruction, but single-leg hopping, being a more challenging task, could only be restored 5 months post-operation (Button et al, 2005).…”

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

“…This phase is usually a little more vague in regards to appropriate exercise progressions with less detail in regard to clinical guidelines as to when it is safe to introduce more highrisk or high-load activities [11,97]. Presently there is little agreement as to when it is safe to return to sports participation [98][99][100]. Determining return to play is often dictated by several forms of assessment.…”