And we’re off running with Ortho Hub! Let’s dive into who may be ready to run and who may be holding back on you with 2 studies on ACL reconstruction recovery.
Criteria for Return for Running After Anterior Cruciate Ligament Reconstruction: a Scoping Review
British Journal of Sports Medicine, May 2nd, 2018
Rambaud Et.Al
Without fail, our patients always ask, “When can I run?!” The answer we usually give them is: “When you’re, ready.” We’re going to dive into what established criteria actually exist for telling our ACL reconstruction (ACLR) patients when it’s okay to start running again.
Over 200 studies on return to running after ACLR (hamstring autograft only) made the cut for the review. The median time suggested for beginning running is 12 weeks post-op with 8 weeks being on the more aggressive side and 16 weeks being on the more conservative end. Despite all these studies talking about time, only 1/5th (18%) of the studies suggested any type of actual structural or functional criteria for instructing our patients back to running.
Combining the evidence from all the return to running literature, several of the criteria suggestions from the study for giving the green light to running include:
Time:
- 12 weeks (median time)
Appropriate load capacity of the knee:
- <2/10 pain
- >95% knee flexion range of motion
- Full knee extension range of motion
- No effusion
Functional tests they should be able to do:
- Hamstring and quadriceps limb symmetry index of > 70% (uninvolved compared to the involved side) with handheld dynamometry (could possibly use isokinetic testing if you have it).
- Hop testing > 70% of the uninvolved side
- Utilizing repeated step ups or single leg squats to see their quality of movement.
The American Journal of Sports Medicine, May 2nd, 2018
Webster Et.Al. La Trobe University
We’ve all had cases when our patients ace their clinical and functional testing, but as soon as you suggest getting back to playing, you see their expression dampen and the walls go up (usually the opposite individual of the one begging to run as we talked about before). At the end of the day, in the sports medicine world, the ultimate goal for most athletes is getting back to playing. So how can we predict which of our athletes will be at most risk for being hesitant to return-to-sport? What factors are associated with readiness to get back in action? Webster Et. Al look at what factors are associated with psychological readiness to return-to-sport after ACL reconstruction.
The study looked at 635 athletes that were cleared to begin playing sports who all filled out the ACLR-RSI (to measure psychological ‘readiness’) with most being about 12 months out from surgery. The ACLR-Return to Sport Index is a validated outcome measure that’s helpful for providing an objective way to quantify an athlete’s readiness for return-to-sport. Various factors and qualities were looked at to see which were associated with better scores on the ACLR as well as likelihood to return to sports.
From this, your most eager patient will most likely be a younger male with less time between injury and surgery, higher pre-injury sports participation, greater limb symmetry index, and a higher IKDC (a subjective report of function). Not a huge shocker on these, but helpful to know. On another note, knee laxity did not seem to make a difference so you can put away the KT-1000 if you’re hoping it’ll decide how ready your athlete will feel.
Alright, so what do we do? If you want to increase the likelihood that your athletes feel ready to return-to-sport, first start by getting some objective data on the ACLR-RSI and the IKDC. Based on the study, know that your older, female athletes with lower pre-sport participation may feel a little more underprepared so you can tailor your dialogue and expectations accordingly. Of the things you can change, definitely make sure you improve their strength, power, and function as measured by the LSI with hop and strength testing as well as to improve their overall physical function that should appear in their IKDC.
There we have it, some helpful tidbits to give to our over-excited and our over-worried patients on their long road of ACLR rehab.
Forever Disclaimers:
1): Readers – If any of these articles peak your interest, please click the link to the original source to read the full text! It’s important to interpret research for yourself and as it pertains to you and your practice. Not to mention, we should support our journals and authors that provide this content.
2): Journals and authors – I do my best job to help promote the message from the research you provide to help clinicians improve. This is not a platform to try and promote my own individual views. I can promise you that I will not always have everything right, so please, if you have any feedback for me or if I misinterpreted anything then let me know!
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