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Returning to sports after an ACL injury: is it possible?

Bryn Mawr Rehab Hospital March 4, 2016 General Wellness By Donna Merkel, PT

Knee injuries in athletes are the second highest among all sports-related injuries and account for the most surgeries. The anterior cruciate ligament (ACL) is a major ligament that helps stabilize the knee and is at risk for injury during both contact and non-contact sports participation that requires running, pivoting, jumping and landing. More than 120,000 ACL injuries occur each year.

The burden of ACL injuries can be a serious concern for the athletes, coaches, parents and the health care practitioners that care for them. The majority of ACL tears require reconstruction for the athlete to return to the same level of athletic participation they enjoyed prior to an injury. Some athletes are able to continue playing without surgery, but they are in the minority. The success stories in the media of a quick return to sports by professional athletes often produce unrealistic expectations of ACL reconstruction. In reality, less than 50 percent of athletes return to their sport within one year of surgery and, if the rehabilitation process is prolonged, the desire and dedication of the athlete often declines in the process.

ACL rehabilitation and returning to athletics

A successful return to athletics requires a team approach. The healing process begins with a skilled orthopaedic surgeon. Seek out a surgeon who performs more than 20 ACL reconstructions a year and has prior experience with sports-related injuries. For younger athletes, consult with a pediatric orthopaedic surgeon.

Following surgery, athletes with an ACL injury should undergo rehabilitation conducted by an athletic trainer or physical therapist that specializes in sports and orthopaedic injuries, and frequently treats athletes with ACL injuries.

This rehabilitation phase should focus on restoration of strength, range of motion, balance and quality of movement during squatting, running, jumping and hopping activities. The athlete should perform both one-legged and two-legged activities while their muscles are fresh and fatigued. Additionally, athletes recovering from an ACL injury should practice exercises such as running, biking and swimming to build both cardio and muscular endurance.

During the recovery and rehabilitation period, pressure from parents and coaches to return to sports quickly should be discouraged, as a return to sports is based on the athlete’s performance during specific tests—not on a timeline of weeks or months.

Preventing ACL injuries

The seriousness of ACL injuries has facilitated the need for ACL injury reduction strategies. There are a number of ACL injury prevention programs which coaches, trainers and sport therapists can implement to assist athletes in the reduction of an ACL injury.

Common components of an ACL injury prevention program include leg and core strengthening exercises, plyometrics, and proper landing technique. Athletes are taught to land softly on the balls of their toes, with their hips and knees bent, keeping their hips, knees, and feet facing forward.

These programs can be integrated into team practice and be performed as a group, or used as performance enhancement and injury reduction exercises for individual athletes. Whether an athlete has a history of knee injuries or is recovering from ACL reconstruction, injury reduction strategies should be a part of their training.

As one of the leading centers for physical medicine and rehabilitation in Pennsylvania, Bryn Mawr Rehab Hospital delivers innovative services for patients need inpatient or outpatient treatment in the Philadelphia region and western suburbs. Visit our website to learn more about Bryn Mawr Rehab’s rehabilitation services.