Is the career of a young athlete over when ACL reconstruction surgery is performed? In many cases yes – even when the surgery was successful and the athlete is cleared to return to their game.
Doctors from the Ohio State Medical Center, Boston Children’s Hospital, and the Harvard Medical School found that after undergoing ACL reconstruction, 96% of skeletally immature athletes (14 years old or less) were are able to return to sports at the same skill level. The average time it took was 9 months postoperative, with most athletes returning to sports (85%) by 12 months. However in this research, many young patients did not want to return. The patients cited physical limitation, loss of interest in sport, and fear of reinjury as reasons for not returning to the game.
These doctors speculated that Return To Sport (RTS) or that the desire to return to the sport may be improved by better understanding and communication of sports-specific training and rehabilitation in these young athletes. 1
The right health care professionals are obviously paramount to keeping your player playing
This is confirmed by research that looked at 55 teenagers (40 adolescent girls, 15 adolescent boys: (average age almost 16). Of these patients, 59% achieved 85% or better strength in fewer than 6 months, with 50% returning to full athletic activity in 6 months.
Despite the numerous challenges in the rehabilitation of children and adolescents, ranging from their potentially limited focus and attention span to the adult size of most exercise equipment, successful rehabilitation is possible when managed by those who are familiar with the physical, mental, and emotional challenges of these patient groups. Maintaining motivation over time can be important in enabling them to maximize their great physical potential.2
The realities of surgical repair or non-surgical options in treating the ACL
Doctors writing in Current Reviews in Musculoskeletal Medicine had this to say when describing the ACL injury treatment expectations to parents and the idea of returning to their sport.
“Once the diagnosis of ACL injury is made the parents and youth should be counseled on the risks and benefits of operative and non-operative therapy.
The natural history of the ACL deficient knee in children generally results in recurrent instability episodes and progressive intra-articular injury (eventual osteoarthritis). Most children attempting to return to high risk activities with an ACL deficiency (non-surgical repaired or non-healed ACL) suffer from knee instability and functional decline. (And higher risk of injuries).3
Extended preoperative rehabilitation prior to ACL Reconstruction shows significant results in getting athletes back to the game.
A team of doctors from the University of Delaware, Norwegian School of Sport Sciences, Oslo, Norway, and Vanderbilt University collaborated on new research that stressed the importance or extended preoperative rehabilitation in getting patients back to their sports following ACL reconstruction surgery.
Writing in the American Journal of Sports Medicine, the doctors say their research shows that a significantly higher percentage of patients returned to preinjury sports in the extended preoperative rehabilitation group than in the group that did not receive the extended rehabilitation prior to surgery.4
The importance of extended rehabilitation after ACL Reconstruction
One of the reasons to stress the preoperative rehabilitation is that doctors cannot come up with an accurate determination of when an athlete can return to play following the surgery:
This is what a combine team of doctors from Italy, the Netherlands, Luxemburg and the University of North Carolina had to say:
“There is a lack of consensus regarding the appropriate criteria for releasing patients to return to sports (RTS) after anterior cruciate ligament reconstruction.” So what the doctors did was come up with a test battery (a group of tests to help make a “safe determination” in returning the athlete back to their sport).
They took Twenty-eight patients (22 males and 6 females). Following the ACLR the performed a group of tests consisting of Isokinetic testing. (Isokinetic testing is an objective way to evaluate dynamic stability of the knee joint that estimates the quality of rehabilitation outcome after ACL reconstruction.5). Three hop tests and a jump landing test.
The evidence emerging from this study suggests that the majority of patients who are six months after ACLR require additional rehabilitation to pass the RTS (Return to Sports) criteria. The goals of the test was to optimize the decision-making regarding RTS after ACLR with the aim to reduce incidence of second ACL injuries.6
1 Chicorelli AM, Micheli LJ, Kelly M, Zurakowski D, MacDougall R. Return to Sport After Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Athlete. Clin J Sport Med. 2016 Jul;26(4):266-71. doi: 10.1097/JSM.0000000000000275.
2. Wojtys EM, Brower AM. Anterior Cruciate Ligament Injuries in the Prepubescent and Adolescent Athlete: Clinical and Research Considerations.Journal of Athletic Training. 2010;45(5):509-512. doi:10.4085/1062-6050-45.5.509.
3. McConkey MO, Bonasia DE, Amendola A. Pediatric anterior cruciate ligament reconstruction. Current Reviews in Musculoskeletal Medicine. 2011;4(2):37-44. doi:10.1007/s12178-011-9076-9.
3 Failla MJ, Logerstedt DS, Grindem H, et al. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. Am J Sports Med. 2016 Jul 14. pii: 0363546516652594. [Epub ahead of print]
4. Cvjetkovic DD, Bijeljac S, Palija S, et al. Isokinetic Testing in Evaluation Rehabilitation Outcome After ACL Reconstruction. Medical Archives. 2015;69(1):21-23. doi:10.5455/medarh.2015.69.21-23.
5. Gokeler A, Welling W, Zaffagnini S, et al. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016 Jul 16. [Epub ahead of print]