We rehabilitate all types of sport injuries, today we are going to talk about Anterior Cruciate Ligament (ACL) injury presentations.

ACL rehabilitation pre and post surgery

We rehabilitate non-surgical people who want to get back to their goals without surgery whatsoever. We rehabilitate pre-surgical people who want to get their body in the best possible condition before their operation. Finally, we rehabilitate post-surgical people who want to get back to their best after their operation. Under the latter umbrella we rehabilitate many different presentations. We have people who attend with different graft sites. The graft site is the part of the body where the soft tissue required to help the injured ACL is taken from. Most often we see the hamstring being used or patellar tendon and an essential consideration with this presentation is the rehabilitation of the graft site itself as well as the obvious ACL.

Rehabilitation modifications will also depend on concomitant injuries e.g., meniscus debridement, meniscal repair, MCL repair, bone bruising, tibial plateau fracture and multi- ligament injuries.

Issues after ACL injury

The predominant dysfunction with an ACL injury is knee instability. Successful management must include an accurate assessment of this impairment and establishing realistic and yet specific individual goals. Most common seen are

1. Muscle strength deficits
2. Altered movement patterns
3. Decreased joint proprioception (the joints sense of self movement, force and position)
4. Lack of trust or knee confidence

Rehabilitating your ACL

Rehabilitation follows a generic to very individualized format depending on end goal e.g. pain free walking versus return to elite sport. Initially, we aim to recover range of movement, reduce swelling and initiate basic strength and gait. This then progresses to neuromuscular control training, increasing strength and power training and then possibly sport specific, running and agility drills. If return to sport is the goal this will involve specific testing and gradual exposure and load management and continued injury prevention as with any injury.

Re-injury and returning to sport after an ACL tear

Re injury rates must be discussed especially with all people returning to sport or exercise

• Players who returned to sport greater than 12 months post-injury had the highest per game re-injury risk and played the fewest games post-injury (Chaker Jomaa et al, 2020)
• 50% return on a regular basis and 1/3 do not return to pre injury performance levels
• 28-30% of AFL players who returned to sport post-operation sustained a second ACL injury (Liptak MG, Angel KR, 2017 and Lai CCH, Feller JA, Webster KE.J 2018).

We will discuss our rehabilitation principles and the intricacies that go along with it in a later blogpost.