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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 3/2017

01-09-2017 | ACL Rehab (T Sgroi and J Molony, section editors)

Non-operative Care of the Patient with an ACL-Deficient Knee

Author: Mark V. Paterno

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2017

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Abstract

Purpose of Review

The purpose of this review is to provide an update to the most objective, evidence-based path through a non-operative course of rehabilitation after anterior cruciate ligament injury for those hoping to return to pivoting and cutting sports.

Recent Findings

Anterior cruciate ligament (ACL) injuries are prevalent in pivoting and cutting athletes with many of these patients electing to pursue surgical reconstruction in hopes of returning to prior levels of function. Despite many athletes pursing ACL reconstruction, some may elect to pursue a non-operative course of care. Success with this treatment plan should be defined as the ability to return to sport without subsequent giving way episodes.

Summary

Identification of those most likely to successfully return to sport with a non-operative course begins with completion of an evidence-based screening tool. If the patient has no concomitant injury and successfully passes the screening, they may proceed to a systematic, evidence-based progression through rehabilitation. Finally, the patient must complete a return to sport program and meet appropriate objective criteria, prior to return to sport.
Literature
1.
Gottlob CA, Baker CL Jr. Anterior cruciate ligament reconstruction: socioeconomic issues and cost effectiveness. Am J Orthop (Belle Mead NJ). 2000;29:472–6.
2.
Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am. 2011;93:1159–65.CrossRefPubMedPubMedCentral
3.
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42:1567–73.CrossRefPubMedPubMedCentral
4.
Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–606.CrossRefPubMed
5.
Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50:3145–52.CrossRefPubMed
6.
•• Smith TO, Postle K, Penny F, McNamara I, Mann CJ. Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee. 2014;21:462–70. Systematic review and meta analysis comparing operative and non-operative management of ACL injury.
7.
Noyes FR, Butler DL, Paulos LE, Grood ES. Intra-articular cruciate reconstruction. I: Perspectives on graft strength, vascularization, and immediate motion after replacement. Clin Orthop Relat Res. 1983;71–7.
8.
Fitzgerald GK, Axe MJ, Snyder-Mackler L. A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc. 2000;8:76–82.CrossRefPubMed
9.
•• Hurd W, Axe M, Snyder-Mackler L. Management of the athlete with acute anterior cruciate ligament deficiency. Sports health. 2009;1:39–46. This is a review article highlighting evidence based management of the athlete with ACL deficiency.
10.
Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W. Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orthop. 1990;204–14.
11.
Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80:1132–45.CrossRefPubMed
12.
•• Hurd WJ, Axe MJ, Snyder-Mackler L. A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury: Part 1, outcomes. Am J Sports Med. 2008;36:40–7. This is a 10 year outcome study of patients who have pursued non-operative management of ACL injury.
13.
•• Bogunovic L, Matava MJ. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review. Phys Sportsmed. 2013;41:33–40. This is a clinical update of both operative and non-operative management of ACl injury in the athletic population.
14.
Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994;22:632–44.CrossRefPubMed
15.
Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med. 1982;10:329–35.CrossRefPubMed
16.
Snyder-Mackler L, Delitto A, Bailey SL, Stralka SW. Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation. J Bone Joint Surg Am. 1995;77:1166–73.CrossRefPubMed
17.
Snyder-Mackler L, Ladin Z, Schepsis AA, Young JC. Electrical stimulation of the thigh muscles after reconstruction of the anterior cruciate ligament. Effects of electrically elicited contraction of the quadriceps femoris and hamstring muscles on gait and on strength of the thigh muscles. J Bone Joint Surg Am. 1991;73:1025–36.CrossRefPubMed
18.
Tagesson S, Oberg B, Good L, Kvist J. A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain exercise in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function. Am J Sports Med. 2008;36:298–307.CrossRefPubMed
19.
Beynnon BD, Fleming BC, Johnson RJ, Nichols CE, Renstrom PA, Pope MH. Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med. 1995;23:24–34.CrossRefPubMed
20.
Hewett TE, Paterno MV, Myer GD. Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop Relat Res. 2002:76–94.
21.
Hewett TE, Torg JS, Boden BP. Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism. Br J Sports Med. 2009;43:417–22.CrossRefPubMedPubMedCentral
22.
Chmielewski TL, Hurd WJ, Rudolph KS, Axe MJ, Snyder-Mackler L. Perturbation training improves knee kinematics and reduces muscle co-contraction after complete unilateral anterior cruciate ligament rupture. Phys Ther. 2005;85:740–9. discussion 50-4PubMed
23.
Chmielewski TL, Rudolph KS, Snyder-Mackler L. Development of dynamic knee stability after acute ACL injury. J Electromyogr Kinesiol. 2002;12:267–74.CrossRefPubMed
24.
25.
Di Stasi SL, Snyder-Mackler L. The effects of neuromuscular training on the gait patterns of ACL-deficient men and women. Clin Biomech (Bristol, Avon). 2012;27:360–5.CrossRef
26.
Fitzgerald GK, Axe MJ, Snyder-Mackler L. The efficacy of perturbation training in nonoperative anterior cruciate ligament rehabilitation programs for physical active individuals. Phys Ther. 2000;80:128–40.PubMed
27.
Beynnon BD, Fleming BC, Churchill DL, Brown D. The effect of anterior cruciate ligament deficiency and functional bracing on translation of the tibia relative to the femur during nonweightbearing and weightbearing. Am J Sports Med. 2003;31:99–105.CrossRefPubMed
28.
Fitzgerald GK, Axe MJ, Snyder-Mackler L. Proposed practice guidelines for nonoperative anterior cruciate ligament rehabilitation of physically active individuals. J Orthop Sports Phys Ther. 2000;30:194–203.CrossRefPubMed
29.
Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. Br J Sports Med. 2016;50:471–5.CrossRefPubMed
30.
Schmitt LC, Paterno MV, Ford KR, Myer GD, Hewett TE. Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sports Exerc. 2015;47:1426–34.CrossRefPubMedPubMedCentral
31.
32.
Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine. 2008;9:9–15.CrossRef
Metadata
Title
Non-operative Care of the Patient with an ACL-Deficient Knee
Author
Mark V. Paterno
Publication date
01-09-2017
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 3/2017
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-017-9431-6

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