Return to Sport after ACL Surgery

Jan 11, 2024

ACL (anterior cruciate ligament) injuries are relatively common, particularly in sports that involve pivoting,
jumping, and sudden changes in direction. For this reason, it is seen very commonly in athletes in Ireland. The exact prevalence of ACL injuries can vary depending on factors such as age, gender, sport, and level of participation and represent approximately 2% of all sports injuries. In Ireland, studies would suggest that approximately 22% of all GAA injury claims are in respect of ACL injuries. Females and young athletes (under 16 years) are at a significantly higher risk of sustaining an ACL injury.

Returning to sport following an ACL injury is a complex process that depends on various factors, including the severity of the injury, damage to other structures such as ligaments and knee cartilage, individual healing and rehabilitation progress, and guidance from healthcare professionals. The timeline for returning to sport after an ACL injury can vary, but it typically takes 9 12 months of dedicated rehabilitation. It is important to follow a structured rehabilitation program supervised by a qualified healthcare professional, S&C coach and Professor Moran’s clinical specialist team.

The decision of when to return to play following ACL (anterior cruciate ligament) surgery is typically made collaboratively between the athlete, surgeon and rehabilitation team, based on several factors.

These factors may include the individual’s progress in rehabilitation, biomechanical testing analysis which we perform here at UPMC SSC Sports Lab, the specific surgical technique used, age of the athlete, psychological readiness, the sport or activity being considered, and the individual’s overall physical condition. Professor Moran and his clinical specialist team will work with closely with you on this.

To ensure a safe return to play, a graduated exposure approach is commonly used. This approach involves gradually increasing the athlete’s
exposure to the demands of their sport, starting with low-risk activities and progressing to higher risk activities. It allows the athlete’s body to adapt and build confidence while minimising the risk of re-injury. The progression typically includes a series of phases, starting with basic functional movements, then progressing to sport-specific drills, noncontact practice, and finally full-contact practice.

Fatigue has been shown to increase the risk of ACL injuries. When an individual is fatigued, their neuromuscular control and coordination may be compromised, leading to altered movement patterns and increased stress on the knee joint. Therefore,
managing fatigue during return to sport is crucial to minimise the risk of re-injury. This can be achieved through a graduated approach ensuring that match/competition play is built up gradually in intervals of 15-20 minutes over a period of a few
weeks.

Adopting a control to chaos continuum in the late stages of ACL rehabilitation is important to prepare athletes for a safe and successful return to sport. The control to chaos continuum refers to gradually progressing from controlled, predictable
movements to more dynamic and unpredictable movements that mimic the demands of the athlete’s sport.

Read more about rehabilitation following ACL surgery here.

References:

Culvenor AG, Girdwood MA, Juhl CB, et al. Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus British Journal of Sports Medicine 2022;56:1445-1453.

Kotsifaki, Roula, et al. “Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction.” British journal of sports medicine (2023).