Rehabilitation of ACL surgery has gained increased attention of late, particularly with the increased incidence of ACL tears in younger athletes as year-round single sport participation grows, in the hopes of reducing the risk of reinjury. The risk of re-injury is roughly 4-8% in general but may be higher in the female athlete, particularly in the soccer player. The concomitant risk of reinjury to the opposite knee seems to be higher than previously recognized. Approximately half the re-injuries seem to occur in the first 6-12 months postoperatively. Reaching the 9-12 month mark post-surgery before returning to play appears to be protective; a recent study by Dr Darren Johnson and associates demonstrated that the re-injury rate drops off precipitously once the individual has passed the two year mark postoperatively. Obviously waiting two years to return to activity is impractical, so as treating physicians we are attempting to identify specific risk factors for re-injury and improve our assessment of patients prior to clearing them to return to sports. Core and hip strength, balance, and endurance are areas of increased focus in evaluating athletes post-surgically before a return to sport. Sufficient hip abduction strength appears to be particularly important in all ACL patients, particularly females, in ensuring a safe return to sports and performance while minimizing the risk of future injury to either knee. A combination of strength tests and functional movement screens, simulating sport-specific activities, can be utilized in determining the athlete’s readiness to resume a sport; single leg hops for time and distance and the Y-balance test are examples of screening tools currently used.
The prevalence of ACL tears in sport has also led to renewed interest in ACL prevention programs. FIFA ’11 is a European initiative which demonstrated the effectiveness of ACL prevention programs across soccer athletes; similar programs are being developed across other sports. The challenges are obtaining the funding to implement these plans throughout leagues and across sports and to carve out sufficient off-season and practice time to make the intervention effective. Lastly the trend across the US towards increased sports specialization - meaning athletes are participating in a primarily a single sport, essentially year-round, without appropriate time off for rest, strengthening, and conditioning - at an earlier age is a definite factor in the increased incidence of ACL injuries. Research clearly demonstrates the value in taking breaks from an individual’s sport throughout the year in lowering injury rates in general. It also has demonstrated the benefits of playing multiple sports throughout the year to develop different skill sets.
Dr. B. Rodney Comisar is a board certified, fellowship-trained orthopedic surgeon who specializes in sports medicine related injuries. He has a sub-specialty certification in Sports Medicine. Dr. Comisar offers a full spectrum of sports medicine surgery, including arthroscopy and minimally invasive procedures. Dr. Comisar’s special areas of interest include: multi-ligamentous knee injuries/dislocations; ACL injuries/reconstruction; rotator cuff injuries/tears; patellar instability/dislocation; proximal hamstring ruptures; shoulder instability; and shoulder arthritis including total shoulder replacement and reverse total shoulder replacement.
Sports Injury? Schedule an appointment with Dr. Comisar today! Call his direct line at 614-839-2108 or click the button below to request an appointment online.