Non-operative management after ACL injury
This review provides an evidence-based path through a non-operative course of rehabilitation after ACL injury for patients returning to pivoting and cutting sports.
If the patient has no concomitant injury and successfully passes a screening tool (including >80% limb symmetry on all hop testing and on the KOS-ADLS, >60 on the self-report of knee function, and ≤1 giving way episode), they are considered “potential copers” and may proceed to rehabilitation.
Conservative management in the acute phase involves utilisation of exercise and modalities to manage joint effusion, facilitate normal quads activation, normalise knee ROM and strength deficits.
Both open and closed kinetic chain exercises are recommended. Open chain knee extension in an ACL-deficient knee should be limited to an arc of motion from 100° to 30° of flexion to reduce anterior shearing.
Once achieved, the neuromuscular phase begins including dynamic weight-bearing exercise, advanced balance and proprioception and perturbation training.
The final phase of rehabilitation prior to returning to pivoting and cutting sports is focused on a sports-specific re-integration into the desired level of activity. A functional performance brace is also recommended to enhance stability.
Prior to return to sport, each athlete needs to pass >90% limb symmetry of isokinetic quadriceps and hamstring strength as well as symmetrical functional movement patterns, hop testing and proven psychological readiness to return to sport.
> From: Paterno, Curr Rev Musculoskelet Med 10 (2017) 322-327. All rights reserved to Springer Science+Business Media, LLC. Click here for the online summary.