ACL surgery provides a functionally stable knee and reduces the risk of subsequent injury, but rehabilitation is needed to safely return to sports. Rehabilitation is fundamental to a successful recovery. A carefully considered return-to-sport strategy is crucial for long-term success. It’s a decision made between patients and surgeons. The aim of any ACL rehabilitation protocol is to recondition athletes to function optimally by targeting neuromuscular deficits to minimise rates of re-injury.
Factors Influencing Return to Sport
Returning to unrestricted activity following ACL surgery is a complex decision. Orthopaedic surgeons consider many factors before deeming it safe for patients to return to sports.
- Timeframe: While individual progress varies, full return to sports typically occurs between 6 and 12 months. Young athletes may benefit from waiting at least nine months before returning to athletics. Research indicates that returning to full play before nine months significantly increases the risk of re-injury. Studies show that waiting at least 6 to 9 months before returning to your pre-injury sports level is wise.
- Sport-Specific Demands: The demands of the chosen sport are a key consideration. High-level sports that require lots of pivoting of the knee requires full rehabilitation. The surgeon and physical therapy team will evaluate progress and determine when one can return to sports and the types of sports. The timeline will be longer for those that require twisting motions and full contact.
- Physical Performance: The ability to perform the movements necessary in the sport without pain or elevated risk is essential. Physical performance is a common measure used to help determine whether players can safely return to their sport.
- Psychological Readiness: Patients may also exhibit fear of movement. A battery of varying tests examining different psychometric properties (state of mind influences return to play success).
Criteria-Based Return to Sport
The biggest takeaway is that the multidisciplinary health care team should be looking at a criteria-based return to sport, rather than just strictly time since surgery. Although the initial phases will be similar, it is important to have criteria that the patient meets to be cleared to return to sport. To enter this phase of rehabilitation, the athlete must have met the following criteria:
- Full knee ROM
- No pain or swelling
- Limb symmetry of 75% to 85% with handheld dynamometry, isokinetic testing, or 10-repetition maximum testing (depending on available equipment) of the quadriceps, hamstrings, gluteus maximus, and gluteus medius
- 10 repetitions of a single-leg squat through 60° ROM and/or a single-leg stork balance test
- Y-balance test with 90% limb symmetry
Reducing Re-Tear Risk
It is possible to exert sufficient stress on your ACLs to cause a tear, even in the absence of contact. Minimising the danger of tears or re-tears can be achieved by training to land and alter direction with reduced force. As you advance in your return-to-sport regimen, the applicability of ACL studies diminishes for your particular decisions.
Conclusion
Returning to sport after ACL surgery requires a gradual and measured approach. It is important to prioritise the gradual reintroduction of sports-specific activities while concentrating on enhancing strength, stability, and technique. Collaborating closely with your surgeon, physiotherapist, and athletic trainer can enhance your prospects of a secure and successful return to your preferred activity level. The indication that you are prepared to resume play is a guideline rather than a certainty.
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