COMPARATIVE EFFECTIVENESS OF SUPERVISED AND HOME-BASED REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN COMPETITIVE ATHLETES
Syed Rehan Iftikhar Bukhari
Clinical Medicine
Dr. Reusz György
SE Szemészeti Klinika, Tanterem
2024-11-22 09:00:00
Physiology and Pathology of the Musculoskeletal System
Dr. Szőke György
Dr. Berkes István
Dr. Bejek Zoltán
Dr. Mintál Tibor
Dr. Szendrői Miklós
Dr. Szerb Imre
Dr. Pánics Gergely
This study underscores the importance of post-surgical rehabilitation for competitive athletes with ACL injuries who undergo ACLR. To maximize surgical and post-surgical outcomes, structured pre-surgical rehabilitation is essential. A comprehensive, criteria- based rehabilitation program should be developed to guide athletes through both pre- and post-surgical rehabilitation, ensuring they can safely return to their pre-injury level of sports without complications or re-injuries.
Rehabilitation programs should focus on several key areas. First, they should aim to restore muscle strength and minimize neuromuscular deficits, with the goal of achieving a less than 10% strength deficit in the operated leg compared to the non-operated leg. This involves building muscle strength and squat ability above 90% on the operated side.
Additionally, rehabilitation should work on improving static balance and gait symmetry in dynamic sports activities. It's also important to address psychological readiness for sports participation, as lack of motivation and poor psychological preparedness can negatively affect recovery. Rehabilitation programs should consider individual physical and psychosocial attributes for both male and female participants.
To determine when athletes can safely RTS, objective biomechanical tests and a comprehensive evaluation of physiological and psychological factors should be used. A test battery for athletes recovering from ACLR is recommended, incorporating various assessments. Muscle strength measurements, both isometric and isokinetic, should indicate a maximum strength deficit of less than 10% between the operated and non- operated sides. Balance and stability should be assessed through anteroposterior and mediolateral stability tests, with the dispersion in the results not exceeding 2mm.
Squat analysis, both unilateral and bilateral, using force plates should show a mean squat strength deficit of less than 5% for safe RTS. Gait symmetry should be analysed on a treadmill, with a mean load symmetry difference between 3-5%. Psychological readiness should also be evaluated, with a minimum score of 80% on the ACL-RSI subjective evaluation form at least six months post-ACLR.
A criteria-based rehabilitation program for ACL-injured athletes is divided into several distinct phases, each with specific goals for effective recovery. The first phase, "Prehabilitation," focuses on regaining painless full range of motion, optimizing muscular strength, and preventing episodes of knee instability.
The second phase, "Acute Recovery," starts from the day of surgery and lasts about six weeks, concentrating on wound healing, minimizing swelling, restoring joint mobility, and establishing muscular control. The third phase, "Strength and Coordination," aims to build muscle control, balance, and proprioception, introducing strength work and dynamic exercises. The fourth phase, "Proprioception and Agility," emphasizes running and jumping skills, as well as advanced strength training and agility exercises. The fifth phase, "Sports-Specific Skills," seeks to perfect jumping, landing, and abrupt direction changes, with sports-specific training tailored to different sports.
Return to competitive sports typically begins around nine months’ post-op and focuses on achieving over 90% on patient-reported outcome scores, as well as muscle strength, while also meeting all other physical and psychological criteria.
For successful rehabilitation, additional recommendations include focusing on individual needs and sports-specific skills, with equal attention to male and female athletes' attributes. Consistent monitoring by supervising physiotherapists and effective communication among surgeons, physiotherapists, and athletes is crucial. Proper dissemination of information to patients is the key for informed decision-making and adherence to treatment plans. By following these recommendations, athletes can safely navigate the recovery process and return to their sports with confidence and reduced risk of re-injury.
