Return to Official Italian First Division Soccer Games Within 90 Days After Anterior Cruciate Ligament Reconstruction: A Case Report

Abstract

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.

Early Application of Negative Work via Eccentric Ergometry Following Anterior Cruciate Ligament Reconstruction: A Case Report

“…Roi et al 27 recently described an impressive case report of returning an elite soccer player to competition 77 days after ACL-R. In the current case, the goal of ECC intervention was not to hasten return to sport; rather, it was to facilitate a rapid return of the quadriceps size and strength.…”

“…Effusion was rated on a 0-to-3+ scale, as described by Roi et al 27 A more comprehensive examination was performed preoperatively, 3 months and 1 year postsurgery. This included knee joint and thigh circumference measurements, KT1000 knee arthrometry, isokinetic quadriceps and hamstring testing (60°/s), functional testing (hop for distance test), 3 and completion of the Activity of Daily Living Scale-Knee Outcome Survey (ADLS-KOS) 11 ( Table 2).…”

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

“…This may improve successful early (2-3 months) return to sport and good long-term outcomes. 76 Concomitant with decreased biomechanical strength of the ACL graft relative to the native ligament, athletes may demonstrate decreased muscular strength, joint position sense, postural stability, and force attenuation (significant limb-to-limb landing ground reaction force differences during bilateral tasks) for 6 months to 2 years after reconstruction. 19,25,51,62,71 Deficits evident in the early stages of rehabilitation (unique to the patient and possibly to the graft type), if left unaddressed, will likely persist beyond the late rehabilitative stages.…”

Return to Sport after Anterior Cruciate Ligament Reconstruction: A Literature Review

“…Consequently, patients have to go through each phase of ACL rehabilitation, and move from one phase to the other by setting specific criteria and not by time. A well designed late phase rehabilitation and return to sports training program can reduce the risk of reinjury, prepare the athlete to perform at the same preinjury level [6,41,75,108,109] and secure the safe transition of the player from physiotherapy to normal training [104]. On-field rehabilitation programs must be based on measurable outcomes and in that way the complete functional recovery of the individual can be reassured [71,110].…”

“…The acceptable deficit on muscle strength before returning to sport as described by different authors varies from study to study but rates between 10% to 35% [41, 68,[72][73][74][75]. Ekstrand [71] suggested that the athlete before return to team training should have regained at least 90% of the muscle strength.…”