No one needs to be reminded that anterior cruciate ligament (ACL) tears are one of the most debilitating injuries in sports today. This year in the United States alone, approximately 200,000 ACL injuries will occur, roughly half of which will require reconstructive surgery.
That’s the bad news. The good news? Recent advances in medical technology, surgical methods and other elements of ACL rehab have allowed athletes who suffer one of these injuries to have a higher return-to-play rate (RTP) than ever before. And although plenty of high-profile success stories illustrate this, including quarterbacks Robert Griffin III of the Washington Redskins and Brian Hoyer of the Cleveland Browns, the improvements in treatment have filtered down to college and high school programs, where athletes who suffer ACL injuries have a better (and often faster) recovery than in the past.
ACL rehab has come a long way since the 1980s, when a more conservative approach kept athletes immobilized longer and out of their sports for extended periods of time. The protocol done today is more aggressive, and according to recent studies, far more successful. Research presented at the American Orthopaedic Society found that with today’s methods, “overall, the return-to-play rate was 82 percent for all athletes,” and noted influential factors played a significant role in their RTP. Interestingly, collegiate athletes on scholarship had a significantly higher RTP rate (88%) than non-scholarship athletes (69%).
To see how much ACL rehab has changed in 30 years, one need only compare the protocols of the 1980s to those of the 2010s:
1980s: Conservative Rehabilitation Programs
Programs of the past included five phases: maximum protection, moderate protection, minimum protection, return to activity and activity & maintenance.
- During the first 12 weeks after surgery, no movement was allowed
- Preparation for walking (assisted with crutches) with full weight bearing began no sooner than the 16th week
- Between weeks 24 and 36 (approximately), the athlete could participate in “protected” activity, with restrictions on running and jumping, all done with the use of a brace full-time
- Roughly 9 to 12 months after the operation, during the “return to activity” phase, an athlete could begin running and neuromuscular endurance and coordination
- Following success in the return to activity, the athlete could enter the “activity and maintenance” phase and could return to his or her sport
Today: Aggressive Rehabilitation Programs
Today’s rehabilitation process begins immediately following an ACL injury and progresses from pre-surgical rehab to post-surgical rehab. It is crucial to model the rehabilitation program based on the graft the physician uses in surgery. This facilitates the most efficient recovery and helps reduce complications during the rehabilitative process.
- Immediately after surgery, full passive knee extension is emphasized
- Immediate motion following surgery
- Immediately after surgery, the athlete works on partial weight bearing
- The goal is to discontinue use of crutches by day 10
- Advanced activity phase, weeks 10-16: strengthening exercises, proprioception and neuromuscular control
- Weeks 16-22: full range of motion, 80+ percent full strength and muscular balance; continue strength, proprioception, plyometric drills and progress to agility and sport-specific training
As you can see, the ACL rehabilitation progression has changed dramatically over the past 30 years. Through research and hands-on application, improved techniques in orthopedic surgery, and a more aggressive approach to pre- and post-surgery rehab by certified athletic trainers and physical therapists, there has been a remarkable acceleration in the recovery process for an ACL surgical patient.
With these advancements, athletes are returning to their sports more quickly, with a neuromuscular and proprioceptive edge that athletes in the past did not have.