Return to sport after ACL injury

15th May, 2023

Key Points

  • Increased risk of reinjury: Young athletes returning to sport before 9 months after ACL reconstruction are at a 7-fold higher risk of a second ACL injury.
  • Importance of recovery time: Adequate recovery time, ideally 9 months or more, is crucial for reducing the risk of reinjury.
  • Muscle symmetry not sufficient: Achieving muscle symmetry alone does not sufficiently mitigate the risk of reinjury, indicating the need for a more comprehensive approach to recovery.
  • Clinical recommendations: Clinicians should emphasize a time-based recovery approach rather than solely focusing on muscle function tests.
  • Implications for athletes and coaches: The findings highlight the need for careful planning and monitoring during the rehabilitation process to ensure a safe return to sport.

Overview of the article

The article “Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return” examines the risk of reinjury in young athletes who return to sports too soon after ACL reconstruction. The study emphasizes that returning to sport before 9 months significantly increases the risk of a second ACL injury, and it questions the effectiveness of relying solely on muscle symmetry as a criterion for return-to-sport readiness.

Introduction

ACL injuries are common among young athletes (15-30 year olds), particularly those involved in high-risk sports like football, basketball, and handball. The challenge of returning to sport after ACL reconstruction is significant, as athletes are eager to resume their activities, but doing so prematurely can lead to severe consequences. The study discussed in this article provides critical insights into the risks associated with early return to sport and offers valuable guidance for both athletes and healthcare providers.

Understanding ACL injuries

An ACL injury involves the tearing of the anterior cruciate ligament, one of the key ligaments stabilizing the knee. Such injuries are prevalent in sports that require rapid changes in direction, jumping, or sudden stops. ACL reconstruction surgery is a common treatment, where the torn ligament is replaced with a graft, typically from the patient’s own hamstring or patellar tendon. The surgery is followed by a lengthy rehabilitation process aimed at restoring knee stability and function.

The dangers of returning to sport too early

The key findings of the study highlight the dangers of returning to sport before the knee has fully recovered. Athletes who resumed sport before 9 months post-surgery were found to have a 7-fold increased risk of sustaining a second ACL injury compared to those who waited longer. Despite improvements in muscle strength, the knee may still be vulnerable to injury due to incomplete healing of the ligament and surrounding tissues.

The role of muscle symmetry in recovery

The study found no significant correlation between achieving symmetrical muscle function and a reduced risk of reinjury. This suggests that while muscle symmetry is important, it should not be the sole determinant of an athlete’s readiness to return to sport. Time-based criteria and comprehensive functional assessments should be prioritized to ensure the knee is fully prepared for the demands of high-risk sports.

Clinical recommendations

Clinicians should advise young athletes to delay their return to high-risk sports for at least 9 months post-ACL reconstruction. This time-based approach allows for adequate healing and reduces the risk of a second injury. Additionally, clinicians should conduct thorough assessments of both physical and psychological readiness before clearing athletes for return to sport.

Implications for athletes and coaches

Athletes and coaches must understand the importance of patience during the recovery process. Rushing back to sport can have long-term consequences, including a higher risk of reinjury. Practical tips for athletes include following a structured rehabilitation program, being honest about their physical condition, and avoiding high-risk activities until fully cleared by their physiotherapist.

Conclusion

Delaying return to sport until at least 9 months after ACL reconstruction is essential to prevent reinjury. A well-monitored rehabilitation process that goes beyond just muscle strength is crucial for ensuring long-term success and safety for athletes. By prioritizing recovery over immediate return to sport, athletes can safeguard their future in their chosen sports.

References

Beischer, S., Gustavsson, L., Hamrin Senorski, E., Karlsson, J., Thomeé, C., & Samuelsson, K. (2020). Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. Journal of Orthopaedic & Sports Physical Therapy, 50(2), 83-90. https://doi.org/10.2519/jospt.2020.9071

Frequently Asked Questions

What are the risks of returning to sport too early after ACL reconstruction?

Returning to sport too early, especially before 9 months post-surgery, significantly increases the risk of reinjury, with a 7-fold higher chance of a second ACL injury.

How long should I wait before returning to sport after ACL surgery?

It is recommended to wait at least 9 months before returning to high-risk sports to ensure sufficient recovery and reduce the risk of a second ACL injury.

Is muscle strength enough to ensure I’m ready to return to sport?

No, muscle strength alone is not sufficient. A time-based approach and comprehensive functional assessments are essential to determine if the knee is fully prepared for the demands of sport.

What precautions should be taken during the recovery period?

Follow a structured rehabilitation program, avoid high-risk activities, and have regular check-ups with your physiotherapist to monitor progress and ensure the knee is healing properly.

How can I prevent a second ACL injury?

Adhere to the recommended 9-month recovery period, engage in consistent strength and conditioning exercises, and ensure you are fully cleared by your healthcare provider before returning to sport.

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