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ACL Injury/Surgery: Criteria for Return to Play

How to know when the player can return?

For the Team Physician
American Academy Consensus Statement

'Asymmetries in vertical ground reaction force are a potential means of determining an athlete's readiness to safely return to sport. Therefore, one should assess a patient's ability to demonstrate symmetry in vertical ground reaction force during landing maneuvers prior to return to sport.

The vertical jump exercise has been show to demonstrate a high level of reliability in normal subjects. An athlete prepared to return to sport should be able to perform three successive vertical jumps with high repeatability (eg, ± 15%) of their median maximum jump. An athlete who fails to perform at this level may be affected by residual pain or a neuromuscular deficiency that warrants further training prior to return to play.'

For the Patient
GOALS:
1. Minimize side to side difference (left leg vs. right leg) in muscle mass and strength.
2. Minimize asymmetries with athletic maneuvers.


Symmetry and balance should be maintained with this Sports Injury Test by Sportsmetrics:

1. Be able to repeat three successive vertical jumps and go as high as one average jump.
2. One legged hopping
3. Skipping rope
4. Trampoline jumping
5. Balance board (wobble board) Neuromuscular control
6. Stair climbing and descent

Objective Tests/Exam:
1. Lachman and Pivot shift exam are normal, and stable
2. Isokinetic / CYBEX strength and endurance testing are at least equal to 90% of the uninjured leg
3. KT-1000 instrumented Arthrometric testing with normal results


Additional References:

Sports Metrics Injury and Return to Play Assessment

Comprehensive ACL Rehab, Exercises and Recovery after ACL Surgery

ACL Injury Recovery Issues. Powerpoint presentation

Research: Attempting Return to Play after ACL injury, but WITHOUT SURGERY.

Be careful with regard to re-injury or re-tear of your ACL graft. You've worked hard for it! A bad effort at rehab after injury or after surgery can land you back in the doctor's office.

Remember, your ACL graft is a TENDON, not a ligament, like the original ACL. The graft can fail by stretching or loosening over time, or by re-tear/re-rupture.



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