Most football players who rupture their anterior cruciate ligament (ACL) undergo ACL reconstruction (ACLR) to restore knee stability and allow for return to play. However, outcomes after ACLR are often not ideal, in particular, there appears a high risk of re-injury while many players do not return to previous performance levels. This FastFact presents the main points from a review paper published in Sports Medicine discussing how to optimise the late-stage rehabilitation and RTS training and testing process after ACLR1.
The aim of the paper was discuss important factors related to the late-stage rehabilitation and RTS training and testing process that have either received limited attention within the research or are not typically implemented within the functional recovery process after ACLR. The author then goes on to present how this can be translated into practice, providing a new 5-stage late-stage rehabilitation and RTS preparation program and RTS criteria.
The author discuss six key aspects which are often neglected after ACLR, which may impact player outcomes. These include:
i) Deficits in explosive neuromuscular performance
ii) Deficits in sport-specific movement quality
iii) Inability to tolerate fatigue
iv) A lack of sport-specific training (on-field rehabilitation) prior to return to play
v) Insufficient intensity and volume of training prior to return to play.
vi) A lack of focus on restoring the players sport-specific fitness profile
The author recommends that these important variables (categorised as neuromuscular function, movement quality, sport-specific conditioning and training load) need to be effectively implemented into a RTS training framework. They present a 5-stage late-stage rehabilitation and RTS preparation model incorporating on-field rehabilitation, gym-based re-conditioning and novel movement re-training services. Furthermore, they provide specific entry criteria, as well as progression criteria through the program. Finally, they recommend that RTS testing, particularly in elite players, needs to be more comprehensive, incorporating more novel aspects such as assessment of explosive neuromuscular function (rate of force development), movement quality (pre-planned and reactive sporting type movements), cardiovascular conditioning and assessment of training workloads (measurement of training load with GPS technology). The model would be expected to support many practitioners working with players after ACLR, to provide a more structured program to bridge the gap between rehabilitation and return to performance. Furthermore, the newly proposed criteria may provide better confidence in players ability to safely return to play after ACLR.
1. Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Med. 2019. 49(7): 1043-58. doi: 10.1007/s40279-019-01102-z.