This section describes the techniques to try and optimise return to sport following ACL reconstruction. The first section summarises the overall principles of getting back to sport, and this is then followed by more in-depth concepts for specific sports. Various different rehabilitation experts have contributed to this section.
Getting an individual back to their previous level takes specific rehabilitation tailored to the particular sport. Whilst the goal is clearly to get back to playing the same sport at the same level as before the injury there are various factors that need to be integrated including expectations, confidence, relearning old skills and learning new skills. These need to be identified and discussed.
We outline the main phases of returning to sport, coping with the mind of the athlete and discuss what has been learnt from analysis of why the female is more at risk of rupture of the ACL.
Four key factors
The factors are as follows and these need to be individualised.
There may have been a long downtime between injury and finally undergoing surgery such that other events such as age, business or family commitments may alter the ability to get back to sport at the same intensity.
It can take a long time for an individual to regain the confidence in putting their knee and their body in to such a situation where it may be reinjured again. For the footballer, for example, though they may get back playing at nine months, it may not be until a year after surgery before they have fully forgotten their knee. It seems to be a natural human tendency that after a while injuries are forgotten and the confidence seems to return.
c) Relearning Old Skills
Each sport can be broken down in to the specific drills and processes that are needed to perform well and these need to be identified along with the time intervals and goals before proceeding to the next specific skill. The phases follow a progression through regaining strength and then regaining functional knee control.
d) Learning New Techniques
Sometimes the reason why the ACL ruptured in the first place was because of a poor technique such as poor landing control after jumping, leading to buckling of the knee. This is especially true for the female athletes who have a higher risk of rupturing their ACL as described in the next section. Individuals may need to unlearn some aspects of their sport and relearn new techniques in order to prevent reinjury.
Return to Sport Phases
For every sport the return to activity can be discussed under the following headings:
- Understanding the specific skill of the sport
- Ranking the specific skills by difficulty and risk to the knee
- Drills and techniques to achieve each target
- Understanding other activities that are safe to perform during rehab
Detail for various sports are given in the full rehabilitation booklet obtainable from Mr Spalding.