Why an ACL injury doesn’t have to end your days in sports

BY SHELLBOURNE KNEE CENTER

Less than half of athletes return to competing in their sports after ACL reconstruction, according to a review of studies involving almost 6,000 patients, published in the British Journal of Sports Medicine.

Two physical therapists wanted to understand this issue, so they studied 120 school-age competitive athletes who underwent ACL reconstruction using a procedure called contralateral patellar tendon graft, at Shelbourne Knee Center. Scot Bauman and Bill Claussen aimed to see how patients at the center fared in rehabilitation post-surgery compared with the patients in the review. The 76 female and 44 male participants mostly played high school soccer, basketball and football.

Before surgery, the teens completed a rehab program designed to help them improve range of motion, minimize swelling, normalize walking patterns and achieve sufficient control and strength in their legs.

The type of surgery used in these patients involved taking a tendon from the uninjured knee to graft into the injured knee. Rehab after surgery focused on returning both knees to normal function. In the injured knee, the goal was to regain full range of motion and reduce swelling. In the knee that was used as a tendon donor, rehab focused on strengthening exercises to regenerate the tendon.

The athletes continued their rehabilitation until both knees achieved symmetry, meaning they performed at the same level. At that point, the athletes were allowed to gradually return to their sports.

Bauman and Claussen found that 80 percent of these 120 athletes — nearly double the percentage in the British Journal review — were able to get back to the same level of sport or higher. While not all the athletes went back to competing, all were able to return to playing at a recreational level.

The Shelbourne therapists also found female athletes had a higher rate of return to sport than male athletes, 83 percent compared with 75 percent.

The higher rate of young women returning to competition in this study contradicts conventional thinking that females are less likely to return to sport than males. It’s unknown why this is the case, but Bauman says, “it may have to do with increasing the size of the ACL in females during the reconstruction.”

The physical therapists at Shelbourne Knee Center plan to study this phenomenon in the future.

A key to helping these athletes return to their competitive sports is helping them achieve symmetry between the two knees, the one that was injured and the one used as a tendon donor.

“All athletes want to feel normal and function normally,” Bauman says. “If you don’t have symmetry between the knees, it will be impossible for them to succeed in progressing their activities and returning to sport.”

Having rehab before surgery and using the contralateral PTG in the ACL reconstruction are both essential in achieving the symmetry that allows athletes to get back to their sports. But many orthopedic surgeons don’t realize that it’s important to gain symmetry before surgery.

Bauman and Claussen reported their findings in the poster session at the 2018 Indiana American Physical Therapy Association and Kentucky American Physical Therapy Association Joint Conference, held in September 2018 in Louisville, Kentucky. They also gave a presentation on the study at the Combined Sections National Meeting of the American Physical Therapy Association in January 2019 in Washington, D.C.

In addition, the two physical therapists presented results of their study about strengthening the quadriceps after ACL reconstruction at the regional meeting.

For more information about ACL rehabilitation, visit fixknee.com or call 888-FIX-KNEE.

Cathy Carmode Lim is the founder of RatedReads.com, a website that reviews books and gives them ratings according to content. She is also a copy editor and writing coach and blogs at LifeandLims.com.

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