ARTS – ACL RETURN TO SPORTS

Health Sense Group, in conjunction with The Knee Clinic (The City Baths Spinal and Sports Medicine Clinic) has developed this evidence based ACL Reconstruction Rehabilitation Program. Timeframes are soft tissue healing dependent and individual’s progress based on function, allowing a safer return to vocational and sports related activities as soon as the patient is ready.

ACL Return to Sports (ARTS) is a criteria based 4 phase rehabilitation program. In order to progress to the next phase, the patient must achieve the goals outlined at the end of each phase. The patient will be encouraged towards self-managing their rehabilitation with regular reviews with their therapist to ensure they are progressing accordingly and performing the set exercises with correct technique. It will be possible to complete most of the exercise programs at home; however access to gym facilities may facilitate and improve compliance.

ACL Program

Individual variations will occur depending on surgical technique, age, pre-injury health status, rehab compliance, tissue quality and injury severity.

The following factors will be taken into consideration:

  • Teenage patients may be progressed more slowly due to their physiological immaturity and an apparent higher risk of re-injury (Lind, Menhert& Pederson, 2012)
  • If a meniscus repair is performed in conjunction with the ACL reconstruction, other restrictions including the use of a post op brace may be required and a slower progression initially is often necessary
  • Secondary complications of patello-femoral pain, hamstring strain, neural pain, persisting swelling, etc.

Broad goals of the program are:

  • Controlled loading of graft/joint
  • Addressing deficits of muscle activation and strength throughout rehabilitation
  • Reduce biomechanical risk factors such as:
  • Dynamic valgus during impact on landing, walking, squatting
  • Leg strength imbalance
  • Lumbo-pelvic control
  • Quadriceps/hamstring imbalance
  • Ensure dynamic stability of the trunk, pelvis, hips, knees and ankles
  • Build the patients confidence in their ability to safely return to their chosen activity/sport
  • We will achieve these goals through:

  • Targeted individual muscle activation and strengthening
  • Regular testing and progression of functional exercises
  • Neuromuscular and proprioceptive training
  • Training and education regarding proper landing and cutting techniques
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    There are a total of four phases of rehabilitation to complete before a return to competition can be considered. Estimated time frames are not outlined as not all patients will progress equally as there may be complicating factors that may hinder or accelerate rehabilitation. Progression will be based on the achievement of functional and objective goals.

    PREHAB

    Aim:

    • Decrease swelling with use of Rest Ice Compression Elevation
    • Achieve full knee extension with heel strike with every step when walking
    • Achieve an excellent quad set. A good quad set is achieved when you can see the kneecap move up and down when the quad is contracted and relaxed.
    • Achieve good kneecap mobility. A kneecap that becomes stiff will limit your ability to bend and straighten your knee as much as you would like
    • Progress off crutches once good quadriceps/knee control is achieved
    • Educate the athlete about what is expected of them from their rehabilitation program with or without surgery

     

    As the inflammation, swelling, and knee ROM are improved, neuromuscular re-training is initiated. Patients are taught leg control activities like quad sets and leg raises, and instructed how to walk with a normal gait pattern. Patients may resume low impact activities and weight training if they desire, but these activities are not required pre-operatively.  Both single leg hop and unilateral leg press are measured preoperatively and used as post-operative strength goals as well. The strength measures obtained on the uninjured knee are utilised as a post-operative goal for both knees.

     Knee function is measured with the International Knee Documentation Committee (IKDC), Tegner activity grading scale, and the Tampa scale for kinesiophobia subjective outcome instruments. Each patient is given these instruments pre-operatively and at regular intervals post-operatively.  The IKDC is used as a hurdle requirement for progression to the following phase, while the Tegner and Tampa are collected for research into the ability of athletes to return to sport following ACL rehabilitation.

     

    To receive the full ARTS program or for more information on how you or a patient can benefit from the ARTS program, please contact us below