ACL being one of the essential ligaments in the knee joint as it stabilizes the knee joint. ACL restricts anterior translation/movement of tibia over femur which is the main role of this ligament. It also prevents varus and valgus motions during knee flexion. It attaches to anterior portion of tibia and travels posterosuperior to attach to posteromedial surface of lateral condyle of femur. Anteromedial bundle and the Posterolateral bundle are two bundles mainly consisting of Type 1 collagen fibres that make up the ACL.
ACL is injured commonly by non-contact mechanism. It mostly occurs when landing from a jump (landing with an extended hip and knee, the knee in valgus, internally rotated tibia, and a pronated foot), cutting, accelerating and change of directions.
Risk factors for ACL injuries are divided into (Smith et al., 2011; Dai et al., 2012)
Intrinsic risk factors such as gender (female having higher risk of injury), genetics or family history of injury, previous history of ACL injury, lower extremity alignment, femoral intercondylar size, muscle strength and posterior tibial plateau slope.
Extrinsic risk factors such as climate, pitch type and condition, playing ability, athlete’s shoe and type of competition
Return to sport training is very important part of the protocol as it prepares the player to make those vital change of directions with activities like jumping and running post the surgery. Ardern et al suggests that although 83% of players return to sport, only 63% of them are able to be at the pre-injury level and even less that is 44% are able to participate competitively. Also, it decreases the risk of having recurrent ACL tears. Hence it is very important that the sport specific training be divided into phases that should be sport specific as demands of every sport/player is different.
ACL return to sport rehabilitation is divided into phases where last two phases are termed as restricted return to sport and unrestricted return to sport. Return to sport criterias should be used more rather than just be looking at time post-surgery. Criterias are very important to be met in the protocol as we can introduce patients to stimulus too early or the stimulus itself can be too heavy which can lead to further injuries.
Some of the criterias that need to be ticked off post both the phases are as follows:
Also, Melbourne ACL rehab guide 2.0 published in 2022, can be used too as a guide to rehabilitation. Criterias, questionnaire and testing sheets can be used to determine at what level the player is at and make an informed decision of return to play.
References: