Posts tagged ACL surgery
Quad Weakness After ACL Surgery Associated With Decreased Cartilage Health
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ACL injury is one of the most common traumatic sports medicine injuries seen in Boulder Physical Therapy practice. For patients who elect for surgical repair post operative Physical Therapy is key to facilitating a safe return to activity and sports. Common limitations for individuals returning to activity after ACL repair include: a loss of range of motion, balance and agility impairments, as well as, hip and quadricep weakness. The quadriceps are key muscles in maintaining strength and stability of the knee joint and when healthy improve weight bearing across the knee joint surfaces. Abnormal weight bearing in the knee joint leads to a decrease in joint space and increases the likelihood of knee osteoarthritis development. When undergoing surgical procedures of the knee, any effort to decrease progression of post-traumatic osteoarthritis should be taken.

Previous research has shown patients who sustain an ACL tear, treated either with PT or surgery, have an increased risk of knee arthritis. A recent study examined the cartilage and joint health of patients who had undergone ACL surgery (Pietrosimone et al. 2017). Consistent with prior research, authors found a decrease in quadricep strength in individuals 6 months after ACL repair. Concurrently, the authors found a greater T1p relaxation time within the joint which is a key marker of articular cartilage health. Thus, patients with quadricep weakness demonstrated decreased joint health compared to their stronger post operative peers. This emphasizes the importance of restoring quadricep strength after ACL surgery in order to optimize cartilage and joint health.

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Risk Factors for Second ACL Injury with Return to Sport
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We have written previously about the high rates of subsequent knee injuries after an athlete returns to sport and activity after ACL surgery.  Interestingly, the most common site of injury is on the opposite knee indicating athlete's are using a compensatory balance and coordination strategy during play.  Current research is working on developing physical therapy rehabilitation programs to reduce the risk of injury upon return to sport.  Some research has shown delaying a return to sport longer than 9 months can reduce re injury rates by as much as 84%.  A current study has identified other risk factors which may place an athlete at risk for future knee injury after returning to sport following ACL reconstruction surgery.

An article in the Orthopedic Journal of Sports Medicine followed 163 patients who underwent ACL reconstruction to determine risk factors for a second ACL injury (Paterno et al. 2017).  The authors reported 1 in 5 of the returning athletes sustained a second ACL injury.  These athletes were then examined to determine which factors correlated with their injury.  The authors placed these athletes in either a high or low risk pool based on established factors for ACL injury.  High risk athletes for a second tear included one of two groups

1.  < 19 years old, limited and asymmetrical triple hop distance

2. <19 years old, female sex, high knee confidence, limited and asymmetrical triple hop distance

Athletes in either high risk group were 5 times more likely to injure their ACL again compared to a lower risk athlete.

Athletes are encouraged to complete all of their prescribed physical therapy visits up to 9 months as well as successfully pass return to sport testing before considering a return to sport.