Return to Sport Following ACL Reconstruction: What You Need to Know
Introduction
Anterior Cruciate Ligament (ACL) injuries are among the most common and debilitating injuries in sports, particularly affecting young athletes. The ACL is a crucial ligament in the knee that provides stability during movement. Injuries to the ACL can occur during activities involving sudden stops, direction changes, or jumps, such as AFL, soccer, basketball, and skiing. The incidence of ACL injuries has been rising, especially among adolescents engaged in competitive sports. This trend highlights the importance of understanding the implications of ACL reconstruction (ACLR) and the factors influencing a safe return to sport.
What is the problem?
An ACL injury can significantly disrupt an athlete's career and is associated with a long recovery period. The primary challenge post-ACL reconstruction is determining when it is safe to return to sport. Despite surgical advancements, the risk of re-injury remains a concern. Factors such as psychological readiness, functional recovery, and additional surgical procedures like lateral extra-articular procedures (LEAP) play a crucial role in rehabilitation.
What does research show?
Recent studies have provided valuable insights into the outcomes of ACL reconstruction and the factors affecting the return to sport, emphasising the benefits of incorporating LEAP into the surgical procedure.
Reduced re-rupture rates and increased activity levels
Including a LEAP during ACLR significantly reduces the re-rupture rate. For example, a study found that the re-rupture rate was significantly lower in patients who underwent ACLR with LEAP (2.5%) than those with ACLR alone (13.6%, p = 0.002). Reduced re-rupture rates translate to a better long-term prognosis and fewer complications. Additionally, patients with LEAP showed higher post-operative activity levels, with a Tegner activity scale score significantly better in the LEAP group (7.2 vs. 6.3, p = 0.0042)[4].
Better psychological readiness
Patients who undergo ACLR with LEAP tend to exhibit better psychological readiness to return to sport. Psychological readiness is assessed through measures like the ACL Return to Sport after Injury (ACL-RSI) scale, where higher scores indicate greater confidence and reduced fear of re-injury. Studies showed that patients in the LEAP group had significantly higher ACL-RSI scores preoperatively and postoperatively than those in the ACLR-alone group (p = 0.0044).
Psychological readiness increases chances of returning to sport
Being psychologically ready plays a crucial role in a successful return to sport. Athletes who feel confident and less fearful of re-injury are more likely to return to their pre-injury level of sports. Psychological readiness and physical recovery significantly impact the likelihood of returning to sport. The enhanced psychological state associated with LEAP contributes to higher rates of return to sport, with studies indicating that a structured rehabilitation program focusing on both physical and psychological recovery leads to better outcomes.
How does this help patients?
These studies highlight the importance of comprehensive rehabilitation programs that address the physical and psychological aspects of recovery. The inclusion of additional procedures like LEAP can significantly reduce re-injury rates, particularly in young and active patients.
Frequently Asked Questions
1. What is ACL reconstruction?
ACL reconstruction is a surgical procedure to replace the torn anterior cruciate ligament in the knee. It involves using a graft, typically taken from the patient's own tendon, to restore stability to the knee joint.
2. How long does it take to return to sport after ACL reconstruction?
The timeline for returning to sport varies from 9 to 12 months. Factors such as the type of sport, the extent of rehabilitation, and individual healing rates play a role in determining the exact timeline.
3. What is a lateral extra-articular procedure (LEAP)?
LEAP is an additional surgical technique used alongside ACL reconstruction to stabilise the knee further and reduce re-injury risk. It involves reinforcing the lateral structures of the knee to provide additional support. I always consider performing a LEAP in young patients, revision surgery, patients with joint hyperlaxity and those that have a chronic ACL rupture.
4. What are the risks of returning to sport too soon?
Returning to sport prematurely can increase the risk of re-injury and graft failure. Following a structured rehabilitation program and obtaining medical clearance before resuming sports activities is essential.
5. How important is psychological readiness in returning to sport?
Psychological readiness is crucial for a successful return to sport. Confidence, fear of re-injury, and mental resilience significantly impact recovery. Engaging in psychological support and counselling can enhance recovery outcomes.
6. What is the importance of post-operative physiotherapy and return to sport testing?
Post-operative physiotherapy is essential for restoring the knee's strength, flexibility, and function. It involves a structured rehabilitation program tailored to the individual's needs. Return to sport testing typically includes strength, agility, balance, and functional performance assessments. These tests help ensure the athlete has regained sufficient physical and psychological readiness to return to sports safely, reducing the risk of re-injury. I would strongly recommend participating in return to sport testing in the final phase of your recovery. There are rehabilitation centres in Melbourne that can assist with this.
Conclusion
The journey to return to sport following ACL reconstruction is complex and multifaceted. Recent studies underscore the importance of addressing both physical and psychological aspects of recovery. Additional procedures like LEAP can significantly reduce re-injury rates and enhance functional outcomes. By following a comprehensive rehabilitation program and receiving appropriate medical and psychological support, athletes can safely and successfully return to their pre-injury level of sport.
Bibliography
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Cronström A, Hägglund M, Waldén M. Factors Associated With Sports Function and Psychological Readiness to Return to Sports at 12 Months Post-ACL Reconstruction. Am J Sports Med. 2023;51(3):1-8.
Lorange S, Boutin J, Pion A, Martinez A, Lefevre N. Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review. Am J Sports Med. 2024;52(2):1-14.
Moussa MK, Lefevre N, Valentin E, Coughlan A, Zgolli A, Gerometta A, Meyer A, Hardy A. Impact of Lateral Extra-Articular Procedure Augmentation on Rerupture Risk and Tegner Activity Scale Outcomes in Adolescent Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2024;52(4):892-901.
Xiao Y, Wang J, Zhang Y, Li H, Chen S. Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Better Functional Outcomes. Am J Sports Med. 2022;50(1):22-30.
Zwolski C, Pfeiffer KA, Mellano CR, Dompier TP, Comstock RD, Corbett RO, Knowles SB, Rucinski TJ. The Association of Physical Competence with Psychological Response Among Young Athletes at Time of ACL Reconstruction. Am J Sports Med. 2023;51(7):1-9.
