When can I return to play?

I’ve just had a Knee Reconstruction…

Ryan Edwards, Physiotherapist

Anterior cruciate (ACL) injury can be heart breaking for both the professional and amateur athlete. For those who choose to undergo surgical reconstruction of the ACL lengthy periods of time on the sideline, hours of rehabilitative exercises and commitment of
time and money are required to restore the knee to
full pre injury function…

and after all that….
up to 30% of young active patients who undergo reconstruction suffer a second ACL rupture in the first three years after surgery.

If that isn’t enough…
In addition to this, within 5 years up to 50% of patients undergo meniscus surgery further increasing their risk of knee osteoarthritis.

With all of this it is vitally important
physiotherapists and athletes have a tool to
answer one of the most difficult questions in the
rehabilitative process.

Norwegian researchers followed 106 patients participating in pivoting sports for 2 years after undergoing a knee reconstruction (hamstring and patella grafts).

All of the patients underwent a fairly typical rehabilitation protocol and were required to pass a battery of tests to help inform the decision of returning to sports participation. Patients returned to sport anywhere from 3 to 23 months after surgery. Time was found to be a significant factor in returning to level 1 pivoting sports (think football codes, netball, basketball).

During the first 9 months after surgery a later
return to sports was associated with a 51%
reduction in re­injury rate.

Still 20% of these patients who did return after 9 months suffered knee injury so time alone will simply not do it.

The authors concluded that combining a time based approach >9 months and matching quad strength within 10% of the uninjured side as well as equal hops tests reduced the risk of reinjury by 84%!

This emerging evidence helps patients and physiotherapists to make informed decisions to ensure a successful return to sport after what can be a heart breaking injury.

Grindem, H., Snyder­Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016).
Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the
Delaware­Oslo ACL cohort study. British journal of sports medicine, bjsports­2016..