Anterior Cruciate Ligament (ACL) Reconstruction Rehabilitation Considerations

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One of the most common injuries amongst athletes is damage to the anterior cruciate ligament (ACL) of the knee. Sudden changes in direction (cutting/pivoting), jumping (particularly the landing phase) and sudden changes in acceleration and deceleration, cause a huge amount of stress to be placed on the ACL. In contrast to popular belief, ¾ of ACL injury are with minimal or no contact at all. Rehabilitation of ACL injuries is an arduous process, requiring months of intense work in order for an athlete to return to their given sport.

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Here are some factors to be considered by the therapist in order to better gauge whether the athlete is fully prepared to return to full contact sports:

  1. Planned vs Unplanned cutting/pivoting movements

A recent study looked at the knee loading comparisons between planned and unplanned cutting in 6 month post operative ACL knees. Significantly greater knee flexion, abduction and rotation moments were recorded in unplanned cutting movements in comparison to pre-planned actions. This signifies that the increased demands required of the post-op joint should be taken into consideration before returning to full contact sports and should be integrated into the rehabilitation program, along with the well established best practices already being widely used.
(King. E. et al., 2016).

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2.  Knee loading in double vs single leg drop jumps post-op.

The mechanics of the double leg drop jump have been shown to increase the risk factor of ACL injuries, yet as ACL injuries occur most commonly during movement or landing on a single leg, this study aimed to identify the differences between the two. As suspected, the results showed higher demands being placed on single leg landing in comparison to double. Yet another consideration that should be implemented into a rehabilitation program in addition to being used as an assessment tool to gauge an athlete’s readiness to re-enter full competition in the their given sport.

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