Article Review: Returning to Sport After ALC Reconstruction Surgery

In a recent article published in 2019, Yonatan Kaplan (DPT, PhD) and (Erik Witvrouw DPT, PHD) highlighted the current literature surrounding ACL reconstruction surgery and the rehabilitation leading up to the athlete’s return to sport. This systematic review examined a medical database and identified nearly 400 articles relating to ACLr and rehabilitation programs to explore which therapies yielded the greatest results.

After a specific selection process, Kaplan & Witvrouw reviewed 83 articles on ALCr to identify 5 specific criteria relating to an athlete’s return to sport (RTS). These criteria have been cited hundreds of times as the established protocols that must be met for an athlete to safely RTS. However, there has been much discussion on which criteria are most important.

ACL reconstruction often requires arthroscopic surgery and reparation of the ligament using an autograft from the patient’s patellar tendon or a portion of their hamstrings tendon. Following surgery, the most important rehabilitation goals include generating weight-bearing stability, functional range of motion, and loading capability. Most of these therapies are conducted by a physical therapist using standardized treatments including Open/Closed Kinetic Chain exercises, neurological training, and eccentric training.

Unfortunately, very little attention has been placed on the psychological factors surrounding an ACL reconstruction. Instead, most RTS criteria take place in the form of battery tests (drop-jumps, single-leg hops, and change-in-direction exercises) and active strength tests. Kaplan & Witvrouw aimed to identify additional criteria needed to safely RTS from the psychological perspective.

Psychological components for athletes to RTS after an ACLr surgery included fear of re-injury, confidence in their knee, and feeling 100% compared to their pre-injury performance.

I highlight this article not because you will need to rehabilitate a client’s knee, but instead to shed light on the value of psychological aspects your client may face when dealing with an injury. Remember: progressing your client through higher loads and greater intensities requires not only their physical capabilities but also their psychological readiness. Keep this in mind during your training sessions. Remember: thou shall not harm.