RETURNING TO SPORTS AFTER ACL SURGERY

Key Points:

  • Most surgeons will like to see at least 90% strength in the operated knee and 100% motion compared to the normal knee before allowing a return to sports
  • We often use “functional testing” such as hops or 3-D motion analysis to provide more data on readiness
  • High school aged athletes will typically take at least 9 months after surgery before they are successfully able to pass all the tests and return to cutting, pivoting, or power based sports

Last week we wrote about the timing of ACL surgery for high school age athletes, and in the post one of us (Dr. Mishra) stated that he hasn’t seen a high school age athlete be truly ready to return successfully to sports participation until at least 9 months after surgery. That statement was based on his experience gained performing more than 3000 ACL reconstructions in athletes over a 20 year period, and carefully evaluating those athletes along with their physical therapist, rather than through scientific study. ACL hop test

In an effort to evaluate the science behind return to play decisions, Dr. Abrams wrote a paper on the topic in the Orthopaedic Journal of Sports Medicine. You can access the full text of the paper here.

One of the main reasons we wait until the knee is truly ready for return to sports is to protect the new ACL from a retear. There is huge variability in published medical studies about retear rates after ACL reconstruction, with a range from 3% to about 49%. Such a wide range may be due to the fact that little agreement exists on criteria for return to sports.

Generally speaking, we look at knee range of motion, strength, and movement based tests (also known as “functional testing”) when attempting to judge an athlete’s readiness for return to sport. Other factors to consider are the demands of the sport, the playing level of the athlete, and even the young athlete’s own assessment of their readiness. We will typically ask the physical therapist to assess motion and strength (quadriceps, hamstrings, hip rotators) and compare the operated knee to the opposite normal knee. Most surgeons like to see the operated leg at 90% or more strength and 100% motion before they will allow a return to sports.

Recently there is more emphasis on movement-based tests, since these tests might be better at assessing the types of movements the knee will face during sports activity. A variety of hop tests are the most commonly used type of functional exams used to determine readiness for return to play, and more sophisticated testing with 3-D motion analysis is occasionally used. Regardless of the type of functional test used, we have found that these tests are an important part of determining the athlete’s ability to safely and effectively return to sports.

When we put all the factors together we’ll almost always see a 9 month or longer timeframe for the high school aged athlete to pass all of the tests and return to cutting, pivoting, or power based sports.

Why is it that we frequently hear of professional athletes returning to their sport at 6 months, or even as soon as 4 months after surgery? There are many factors involved here. A professional athlete’s job is to get themselves ready to play after surgery, and they literally are able to access help 24/7 through trainers, therapists, and other professionals. Additionally, their bodies are more mature than the high school athlete’s body, which often makes it possible for the professional athletes to push themselves harder in rehab.

If you’re a high school athlete, you’ll be going to class, studying after school, and you may even want a social life J. You’ll work really hard on your rehab, and when you pass your tests for knee motion, strength, and function you’ve got a great chance to return successfully to your sport. Just count on that taking at least 9 months.

By: Geoffrey Abrams, M.D., Assistant Professor of Orthopedic Surgery, Stanford University And Dev Mishra, M.D., President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University

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