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Current practice: postoperative and return to play trends after ACL reconstruction by fellowship-trained sports surgeons

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

Advances in anterior cruciate ligament (ACL) reconstruction have allowed for many progressions in postoperative management. However, there is no standardized protocol for immediate postoperative management or return to play. Our objective was to evaluate current trends in immediate postoperative and return to sport practices after ACL reconstruction.

Level of evidence

Cross sectional study, Level IV.

Methods

Surveys were obtained from four large sports fellowship alumni networks. Demographics included years of practice and ACLs performed per year. Postoperative questions included weight bearing status, brace use and continuous passive motion (CPM) use. Return to play included time for return, brace use and metrics used for clearance to sport.

Results

A total of 143 surveys were completed (32% response rate). Average years in practice were 15.1 years. Average ACL reconstructions performed per year was 20–50 in 44% and 50–100 in 29%. 26% used CPM in all patients, 8% if concomitant meniscal repair and 66% never. Bracing after surgery was used in 84% and 48% after return to play. Return to play was allowed at 6–9 months in 67% and overall 94% from 6 to 12 months. No consensus on return to play metrics was used, with the hop test being most important followed by specific time point after surgery.

Conclusion

Immediate weight bearing after surgery is commonplace with intermittent CPM use. Bracing is common postoperatively and half the time with return to play. Return to play is typically allowed after at least 6 months with no consensus on return to sport metrics. Years after fellowship and ACLs performed yearly had no correlation with postoperative practices.

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Author information

Authors and Affiliations

  1. Kerlan Jobe Orthopaedic Clinic, 6801 Park Terrace Dr., Los Angeles, CA, 90045, USA

    N. E. Marshall, R. A. Keller & O. Limpisvasti

  2. The Hospital for Special Surgery, 541 E 71st St., New York, NY, 10021, USA

    J. Dines

  3. Midwest Orthopedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA

    C. Bush-Joseph

Authors
  1. N. E. Marshall
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  2. R. A. Keller
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  3. J. Dines
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  4. C. Bush-Joseph
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  5. O. Limpisvasti
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Corresponding author

Correspondence to N. E. Marshall.

Ethics declarations

Conflict of interest

N. E. Marshall and R. A. Keller declare that they have no conflict of interest. J. Dines served in editorial or governing board of American Journal of Orthopedics, as board or committee member in American Shoulder and Elbow Surgeons, as paid consultant, paid presenter or speaker and research support in Arthrex, Inc., as paid consultant in CONMED Linvatec, in editorial or governing board of Journal of Shoulder and Elbow Surgery, and as paid consultant in Trice, received IP royalties from Linvatec, and received publishing royalties, financial or material support from Wolters Kluwer Health—Lippincott Williams & Wilkins. C. Bush-Joseph served in editorial or governing board of American Journal of Sports Medicine, as board or committee member in American Orthopaedic Society for Sports Medicine, and gave stock or stock options to Cresco Lab. O. Limpisvasti served as paid consultant in Arthrex, Inc. and received IP royalties from CONMED Linvatec.

Ethical approval

IRB approval was obtained from our institutional review board.

Appendix

Appendix

  • Are you a sports medicine fellowship-trained orthopaedic surgeon?

    • Yes, CAQ

    • Yes, no CAQ

    • No

  • How long have you been practicing orthopedics (post training)?

  • Approximately how many ACL reconstructions do you perform a year?

    • 0–20

    • 20–50

    • 50–100

    • > 100

  • What is your weight bearing status after an uneventful ACL reconstruction assuming no cartilage or meniscal repair was performed?

    • Weight bearing as tolerated

    • Weight bearing as tolerated locked in extension

    • Partial weight bearing

    • Non-weight bearing

  • Do your patients use a Continuous Passive Motion (CPM) machine post-operatively after ACL reconstruction?

    • Yes

    • Yes, if there was a concomitant meniscal or cartilage repair

    • No

  • Is it your practice to have patients wear a knee brace immediately post-operatively after ACL reconstruction?

    • Yes

    • No

  • If your patients wear a knee brace immediately post-operatively, what type of brace do you use?

    • Knee immobilizer

    • Hinged knee brace, locked

    • Hinged knee brace, unlocked

    • Compression sleeve

    • N/A

  • Is it your practice to require patients to wear an ACL brace for sports participation after return to sport?

    • Yes, for the first year back to sport

    • Yes, for the rest of their playing career

    • Yes, but only for specific sports

    • No

  • What do you use for deciding when a player is able to return to sport after ACL reconstruction? (Check all that apply) (For each selection, rate from 1 to 5 with 1 being least important and 5 being most important)

    • Specific time point after surgery (ex: 9 months after ACL reconstruction)

    • General clinical appearance during office visit

    • Clearance by their physical therapist

    • One-legged squat test

    • Hop test

    • Biodex testing

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Marshall, N.E., Keller, R.A., Dines, J. et al. Current practice: postoperative and return to play trends after ACL reconstruction by fellowship-trained sports surgeons. Musculoskelet Surg 103, 55–61 (2019). https://doi.org/10.1007/s12306-018-0574-4

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  • DOI: https://doi.org/10.1007/s12306-018-0574-4

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