Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries ACL Rehabilitation Pathway Expediating Safe Return to Optimum Performance www.sportssurgeryclinic.com
Contents Introduction... 2 SSC ACL Rehabilitation Pathway... 3 Stage 1: Prehabilitation... 3 Stage 2: Post-operative Inpatient Rehabilitation... 4 Stage 3: Initial 2 Dimensional (2D) ACL Review... 4 Stage 4: 3 Dimensional (3D) Biomechanical ACL Review... 6 Stage 5: Final 3D Biomechanical Review... 7 ACL Research... 9
Introduction Sports Surgery Clinic (SSC) prides itself as a world class centre of excellence in the surgical reconstruction and rehabilitation of anterior cruciate ligament (ACL) injuries. Over 600 ACL reconstructions are carried out by our orthopaedic surgeons in the clinic each year. All of these patients will take part in an extensive rehabilitation programme under the guidance of their physiotherapist. This rehabilitation programme will focus on restoring normal knee joint function ensuring that your knee is capable of dealing with the physical demands of your chosen sport (See Fig 1). Inadequate completion of your ACL rehabilitation may compromise the stability of your knee, prolong time to return to sport, affect your performance upon returning and increase your risk of re-injury. At Sports Surgery Clinic we have developed the ACL Rehabilitation Pathway to compliment the rehabilitation being completed by you and your physiotherapist. This programme is designed to optimise your rehabilitation and provide you with clarity regarding your readiness to return to sport and direction on how to get there in a safe and timely manner. You will undergo a comprehensive objective assessment utilising the most innovative technology available clinically in Europe. The assessment results will then be explained in detail to you by a member of our rehabilitation team ensuring that you understand the areas of your rehabilitation that require further focus giving you the best possible chance of successful return to sport. We will provide your surgeon and physiotherapist with a detailed report of your testing to guide you towards the end goal of optimal biomechanics enabling you to return to the highest level of performance in your chosen sport. Full ROM Single Leg Neuromuscular Control Strength / Power Running Turning Training Graduated Return to Performance Fig 1. Components of a successful ACL rehabilitation programme 2 ACL REHABILITATION PATHWAY
SSC ACL Rehabilitation Pathway Participation in the SSC ACL Rehabilitation Pathway (See Fig. 2) will begin immediately after your initial consultation with your orthopaedic surgeon and guide your return to optimal performance. There are 5 key stages of the rehabilitation pathway which are described in detail below. STAGE 1 Prehabilitation STAGE 3 Initial 2 Dimensional ACL Review STAGE 2 STAGE 4 STAGE 5 9 Month 3 Dimensional ACL Review Post-Operative Inpatient Rehabilitation 6 Month 3 Dimensional ACL Review Stage 1: Prehabilitation When: After your initial consultation with your orthopaedic surgeon at SSC. Why: To educate you on the rehabilitation process and to commence restoration of optimal knee function prior to surgery ensuring best post-operative outcome. What s involved? To educate you on the rehabilitation process Assessment of gait Assessment of knee joint range of motion and strength Assessment of single leg control Provision of prehabilitation exercises and pre-operative advice Outline of what to expect during your in-patient stay and during the early stage of rehabilitation ACL REHABILITATION PATHWAY 3
Stage 2: Post-Operative Inpatient Rehabilitation Stage 3: Initial 2Dimensional (2D) ACL Review When: Morning after your ACL reconstructive surgery at SSC. Why: To empower you with the skills and knowledge to maximise function during the early stages of your rehabilitation. What s involved? Assessment of the Knee joint Completion of post-operative rehabilitation exercises Gait practice with crutches Completion of stairs assessment Discharge paperwork for your physiotherapist who you will see within 7-10 days of discharge Review the ACL rehabilitation pathway and outline early rehabilitation phase Answer any questions you may have about the surgery, rehabilitation and biomechanical reviews When: Approximately 3 months post ACL reconstruction at SSC. Why: To provide you with an accurate assessment of your progress to date, highlighting areas of your rehabilitation that require further development in order to optimise outcome and timely return to sport. What s involved? Feedback on your rehabilitation to date Assessment of knee joint range of motion 2D motion analysis of single leg control Isokinetic strength testing of the quadriceps and hamstring muscles Mid thigh pull to assess strength through the kinetic chain Single leg vertical jump height Progress report for you, your consultant and physiotherapist Overview of 6 month 3D testing protocol What do I need for testing? Runners Ankle socks Shorts T-shirt Sports bra for female athletes 4 ACL REHABILITATION PATHWAY
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Stage 4: 3 Dimensional (3D) Biomechanical ACL Review When: Approximately 6 months after your ACL reconstruction at SSC. Why: 3D motion analysis allows us to analyse your movement in an environment that closely replicates the demands of your sport with a high degree of accuracy in our astro turf motion capture laboratory. Your 3D motion analysis results will be used to accurately tailor your rehabilitation to enhance your knee s functional stability, reduce the risk of future injury and facilitate safe expediated return to performance. What s involved? Review of your rehabilitation progress to date Assessment of knee joint range of motion 3D motion analysis of single leg control and sports specific movement including indecision testing using Smartspeed speed gate system Isokinetic and mid thigh pull strength testing Single leg vertical and horizontal jump profiling Progress report for you, your consultant and physiotherapist 6 ACL REHABILITATION PATHWAY
Stage 5: Final 3D Biomechanical Review When: Approximately 9 months post ACL reconstruction at SSC. Why: Many athletes may have returned to play before the final review. Return to play however is a step towards full rehabilitation, not the end of rehabilitation. The final 3D assessment identifies any remaining strength, power or biomechanical deficits that may lead to pain or re-injury when your training load increases or limit your ability to return to optimum performance. What s involved? This testing process will mirror that of the 6 month protocol ideally placing you in the best position for a successful return to your chosen sport and completion of the rehabilitation process. You will be advised on how to resolve any remaining deficits and maintain healthy and high performing knees. ACL REHABILITATION PATHWAY 7
ACL Research At Sports Surgery Clinic we are continuously striving to improve the quality of care that we provide to all our patients. Currently we are carrying out on-going research to improve the outcome for patients post ACL reconstruction. We are investigating whether certain patient characteristics, interventions, rehabilitation programmes and biomechanical tests prior to return to play will lead to better outcome and less re-injury after ACL reconstructive surgery. In order to answer these questions participation from those who have undergone ACL reconstruction is required. After your initial consultation with your orthopaedic surgeon you will be introduced to our ACL Research Coordinator and invited to be a participant in our ACL study. Your participation in this study is voluntary. If you do not wish to participate in the study your decision will not in any way affect your medical care. If you do decide to participate in the study your identification will remain completely anonymous. You will be asked to give some additional information regarding your injury history and complete a number of questionnaires via email. There are no additional risks to your health and you are free to withdraw from the study at any point without needing to give a reason. Our ACL Research Coordinator will go through in more detail what is specifically required of you if you decide to participate in the study and will give you the opportunity to ask any questions that you may have. If you would like further information or have any questions relating to your ACL rehabilitation at SSC please feel free to contact the ACL Administrator and Research Co-ordinator: Sports Surgery Clinic, Santry Demesne, Dublin 9. E: aclpathway@sportssurgeryclinic.com T: 01 526 2247 ACL REHABILITATION PATHWAY 9
Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries Santry Demesne, Dublin 9 Telephone: 01 526 2247 E-mail: aclpathway@sportssurgeryclinic.com www.sportssurgeryclinic.com