Return to Play After Anterior Cruciate Ligament Reconstruction

Abstract

The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.

Predictive simulation of single-leg landing scenarios for ACL injury risk factors evaluation

“…A post-effect of a complete ACL tear is the higher risk of osteoarthritis development on the knee cartilage, especially when the meniscus is also damaged [6,7]. ACL reconstruction is a complex surgery that depends on a plethora of parameters and requires long periods of rehabilitation, that can span a 6-12 month range [8,9]. Moreover, graft failures are common and full restoration of knee kinematics is not always achievable.…”

Influence of type I collagen polymorphisms and risk of anterior cruciate ligament rupture in athletes: a case-control study

“…The treatment after an ACL rupture is mainly surgical, and the rehabilitation process is a time-consuming effort, which can endure up to 9-12 months for complete healing and return-to-sport [14,15]. Nevertheless, even when treated properly there are odds for a second rupture, and development of concomitant and chronic degenerative articular injuries (e.g., meniscus tears, osteoarthritis) [16].…”