Anterior Cruciate Ligament (ACL) injury is a common problem in the sporting population with upwards of 200,000 ACL injuries occurring each year. The average patient cost of ACL injury requiring surgical reconstruction and rehabilitation is reported to be over $11,000 per occurrence. The potential for a secondary injury, especially if returning to a sport requiring cutting and pivoting such as soccer and basketball, are reported to be as high as 38% (Grindem, 2016; Kyritsis, 2016; Losciale, 2019; Kaeding, 2015; Webster, 2014; Webster, 2016; Wiggins, 2016; Paterno, 2014). Re-injury not only poses an additional economic burden but also results in an increased rate of developing osteoarthritis in the knee later in life.
Although there are several clinical tests that can help predict an athlete’s ability to return to sport (RTS) with a reduced risk of re-injury, only 50% of athletes pass these tests at one year post-surgery and only 66% pass after two years. These tests focus on identifying asymmetry in lower extremity strength, hopping distance, and the athlete’s ability to control their lower extremity in certain positions during jumping and landing tasks. It’s been speculated that residual strength deficits, psychological factors (such as fear, which may change how the athlete plays the sport) and/or impaired neuromuscular control/proprioception may be responsible for this poor prediction of who can safely RTS.
Several novel rehabilitation techniques, such as Blood Flow Restriction (BFR) training, are now gaining popularity. BFR training is a technique in which a pneumatic cuff is applied to the upper leg during low intensity exercise. The resulting reduced blood flow to the limb has been shown to enhance utilization of oxygen in the muscle, stimulate the release of growth hormones and decrease the level of myostatin in the muscle, which at higher levels can inhibit muscle growth. This cascade of responses result in an increased cross sectional area of the muscle and subsequent gains in muscle strength near-equal to those achieved with high intensity strength training. Because athletes can engage in low intensity strength training with the use of BFR more days per week, it is anticipated they will be able to move through their rehabilitation process faster and, consequently, achieve greater strength gains by 9 months that will reduce their risk of re-injury. Several research studies, including research projects at Berkana, are exploring if this is the case and if this results better RTS pass rates with fewer resulting secondary injuries. Other factors found to reduce the risk of re-injury include plyometric and single leg landing mechanics as well as sport specific training. Equipment such as force plates and motion analysis equipment can aide in enhancing these aspects of recovery as well.
Obviously it’s critical for the athlete to complete their full rehabilitation program, but working with a physical therapist with an in-depth knowledge of ACL rehabilitation, access to biomechanical equipment needed to objectively measure limb strength and movement equality and specialized knowledge of how to implement RTS testing can make all the difference. For more information on how Berkana can make the difference in your recovery, give us a call at 970-797-2431.
Optimizing your recovery and performance!
Dr. Matt Girodanelli, PT, DPT, ATC, CSCS