Advertisement

Rehabilitation and Return to Sports After Anterior Cruciate Ligament Reconstruction in the Young Athlete

  • Mark V.  PaternoEmail author
  • Alyson Filipa
Chapter

Abstract

Rehabilitation after ACL reconstruction in the young adult is focused on preparing the patient to return to pre-injury levels of activity while minimizing the risk of future ACL injury. Current evidence suggests low return to sport rates (Br J Sports Med. 48(21):1543–1552, 2014) and high second ACL injury rates (Am J Sports Med. 42(7):1567–1573, 2014) in this population. Successful rehabilitation of the pediatric patient after ACL reconstruction is focused on addressing common impairments seen after surgery while focusing on the unique needs of the child. The following chapter will focus on presenting these unique factors necessary to consider when successfully rehabilitating this population.

References

  1. 1.
    Frosch KH, Stengel D, Brodhun T, et al. Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy. 2010;26(11):1539–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Kaeding CC, Flanigan D, Donaldson C. Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy. 2010;26(11):1530–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Moksnes H, Engebretsen L, Risberg MA. Management of anterior cruciate ligament injuries in skeletally immature individuals. J Orthop Sports Phys Ther. 2012;42(3):172–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42(7):1567–73.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50(10):3145–52.CrossRefPubMedGoogle Scholar
  7. 7.
    McCarroll JR, Shelbourne KD, Patel DV. Anterior cruciate ligament injuries in young athletes. Recommendations for treatment and rehabilitation. Sports Med. 1995;20(2):117–27.CrossRefPubMedGoogle Scholar
  8. 8.
    Shelbourne KD, Klootwyk TE, Wilckens JH, De Carlo MS. Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program. Am J Sports Med. 1995;23(5):575–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 1990;18(3):292–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Wilk KE, Arrigo C, Andrews JR, Clancy WG. Rehabilitation after anterior cruciate ligament reconstruction in the female athlete. J Athl Train. 1999;34(2):177–93.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Wojtys EM, Brower AM. Anterior cruciate ligament injuries in the prepubescent and adolescent athlete: clinical and research considerations. J Athl Train. 2010;45(5):509–12.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Greenberg EM, Albaugh J, Ganley TJ, Lawrence JT. Rehabilitation considerations for all epiphyseal acl reconstruction. Int J Sports Phys Ther. 2012;7(2):185–96.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756–69.CrossRefPubMedGoogle Scholar
  14. 14.
    Vavken P, Tepolt FA, Kocher MS. Concurrent meniscal and chondral injuries in pediatric and adolescent patients undergoing ACL reconstruction. J Pediatr Orthop. 2016; In print. Google Scholar
  15. 15.
    Failla MJ, Logerstedt DS, Grindem H, et al. Does extended preoperative rehabilitation influence outcomes 2 years after ACL reconstruction? A comparative effectiveness study between the MOON and Delaware-Oslo ACL cohorts. Am J Sports Med. 2016;44(10):2608–14.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50:1506.CrossRefPubMedGoogle Scholar
  17. 17.
    Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):283–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg Am. 2003;85-A(7):1255–63.CrossRefPubMedGoogle Scholar
  19. 19.
    Guide to Physical Therapist Practice 3.0. Alexandria: American Physical Therapy Association; 2014.Google Scholar
  20. 20.
    Irrgang JJ, Harner CD. Loss of motion following knee ligament reconstruction. Sports Med. 1995;19(2):150–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Risberg MA, Grindem H, Oiestad BE. We need to implement current evidence in early rehabilitation programs to improve long-term outcome after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2016;46(9):710–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Eitzen I, Holm I, Risberg MA. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009;43(5):371–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Lepley LK, Palmieri-Smith RM. Pre-operative quadriceps activation is related to post-operative activation, not strength, in patients post-ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):236–46.CrossRefPubMedGoogle Scholar
  24. 24.
    Kartus J, Stener S, Kohler K, Sernert N, Eriksson BI, Karlsson JI. Bracing after anterior cruciate ligament reconstruction necessary? A 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace. Knee Surg Sports Traumatol Arthrosc. 1997;5(3):157–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Shelbourne KD, Freeman H, Gray T. Osteoarthritis after anterior cruciate ligament reconstruction: the importance of regaining and maintaining full range of motion. Sports Health. 2012;4(1):79–85.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Gerber JP, Marcus RL, Dibble LE, Greis PE, Burks RT, LaStayo PC. Effects of early progressive eccentric exercise on muscle structure after anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2007;89(3):559–70.PubMedGoogle Scholar
  27. 27.
    Gerber JP, Marcus RL, Dibble LE, Greis PE, Burks RT, Lastayo PC. Safety, feasibility, and efficacy of negative work exercise via eccentric muscle activity following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2007;37(1):10–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Snyder-Mackler L, Ladin Z, Schepsis AA, Young JC. Electrical stimulation of the thigh muscles after reconstruction of the anterior cruciate ligament. Effects of electrically elicited contraction of the quadriceps femoris and hamstring muscles on gait and on strength of the thigh muscles. J Bone Joint Surg Am. 1991;73(7):1025–36.CrossRefPubMedGoogle Scholar
  29. 29.
    Lepley LK. Deficits in quadriceps strength and patient-oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Sports Health. 2015;7(3):231–8.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Beynnon BD, Fleming BC, Johnson RJ, Nichols CE, Renstrom PA, Pope MH. Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med. 1995;23(1):24–34.CrossRefPubMedGoogle Scholar
  31. 31.
    Davies G, Riemann BL, Manske R. Current concepts of plyometric exercise. Int J Sports Phys Ther. 2015;10(6):760–86.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Gardner K, Lavagnino M, Egerbacher M, Arnoczky SP. Re-establishment of cytoskeletal tensional homeostasis in lax tendons occurs through an actin-mediated cellular contraction of the extracellular matrix. J Orthop Res. 2012;30(11):1695–701.CrossRefPubMedGoogle Scholar
  33. 33.
    Paterno MV, Schmitt LC, Ford KR, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38(10):1968–78.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Myer GD, Ford KR, Hewett TE. Tuck jump assessment for reducing anterior cruciate ligament injury risk. Athl Ther Today. 2008;13(5):39–44.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(12):1697–705.CrossRefPubMedGoogle Scholar
  36. 36.
    Barber-Westin SD, Noyes FR. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed. 2011;39(3):100–10.CrossRefPubMedGoogle Scholar
  37. 37.
    Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med. 2004;34(4):269–80.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Occupational Therapy and Physical TherapyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations