In early 2019 Cristiani et al published an article showing < 20% of patients met rehabilitation goals of having > 90% limb symmetry in strength (isokinetic quads and hamstrings at 90deg/sec) and single hop for distance tests at 6 months post-op.
This study had a very large sample size (4093 patients), comprising 45.7% females, with a mean age of 28 years (+/-10 years). 86.5% of participants completed the full test battery at 6 months post-op.
So, in blog 1 we noted that although cleared for Return to Sport by their surgeon, and having passed certain physical measures, almost 1/5 of individuals following ACLR aren’t returning to any sport, and over 1/3 of individuals aren’t returning to their pre-injury level of sport, despite RTS being a commonly cited reason for undergoing ACLR in the first place.
One of the most important goals for an athlete following ACL reconstruction, and one of the main markers of a successful Return to Sport is prevention of reinjury. But how good are we at helping our patients achieve this goal? And how do we know when a player is at a suitably low risk to RTS?
To answer this question we first need to understand the stats regarding reinjury risk and how this differs between populations.
This is the first blog in a 4 part series looking into successful outcomes following ACL injury.
An ACL injury is generally a stressful time for an individual. Upon seeking professional advice, some people decide that surgical ACL reconstruction is the best option for them whereas others decide to undertake conservative rehabilitation of their knee. Often, entering ACL reconstruction, individuals have a few goals and expectations in mind. These commonly include…
Ardern et al’s (2016) consensus statement on Return to Sport (RTS) following ACL reconstruction notes that the goal of the athlete (along with other stakeholders eg, coach, club, medical team) is a successful ‘safe and timely’ return to sport.
This highlights the importance of balancing three key components
-Minimising time away from play
-Minimising reinjury risk
-Maximising sporting performance upon return to play
Filbay et al (2017)
Delaying ACL reconstruction and treating with exercise therapy alone may alter prognostic factors for 5-year outcome: an exploratory analysis of the KANON trial.
5year follow up of a prospective RCT comparing 3 groups
1) Exercise therapy plus early ACLR (Surgery within 10 weeks)- 62 people
2) Exercise therapy with delayed ACLR (Median 867 days to surgery)- 30 people
3) Exercise therapy alone - 29 people
All participants (age 18-35, males 73%) had injured their ACL <4weeks ago; Excluded professional sports people and those less than moderately active.
Wellsandt et al (2017) Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury
Comparison between single leg hop and quad strength – in two different ways.
Who - Non professional cutting athletes, 14-55 yrs old(Excluded other significant injuries).
Limb Symmetry Index (LSI) = comparison between Left and Right during an assessment.
Estimated pre-injury capacity (EPIC) = measuring uninvolved limb pre-operatively then comparing to the involved side at 6 months post-op.
SUMMARY
Summary
For every 10% loss of HS/Quads ratio = 10.6 x likelihood of graft rupture
This ratio is increased if quadriceps strength is not fully regained to pre operative level
Meeting the 6 criteria - 116 athletes Discharged (73%) – (12/116 had a graft rupture) = 10%
