Issues in the management of ACL deficiency

I have offered to host a discussion on ACL rehabilitation, primarily because I am keen to learn from the resource that is my colleagues, who also work in this field, and because I am *not* “the expert”!

I have specialised in lower limb assessment and rehabilitation for 10 of my 15 years as a Physiotherapist, and continue to be challenged to understand why some ACLD patients cope without reconstructive surgery, and why others, despite going through surgery, and a lengthy rehabilitation process, still struggle to return to their pre-injury activity levels.

There are clear differences in loading patterns and kinematics between copers and non-copers, and some physical performance tasks have alluded to ACLD patients who may need ACLR in future. Also, self-reported outcomes have been shown to identify those who may fail to return to chosen activities. It is important therefore to assess whether we can establish ways to identify those who may cope without surgery (to save unnecessary risk to patients, and strain on resources), those who are likely to benefit from ACLR, and those who may not achieve their desired outcomes despite surgery and good quality rehabilitation, to allow us to counsel our patients in the best way.

I am keen to understand whether the approach used within the services in which I work, is representative of the approach of the wider community in this patient group, and therefore whether I can add to/change my practice for the better. To this end, I hope the questions I have set for the PhysioTalk will help us to discuss specific treatment approaches, and the most appropriate outcome measures to establish the levels of our success.

Participants may therefore wish to familiarise themselves with the work of Richard Frobell’s group (the KANON study), May Risberg and Lynn Snyder-Mackler’s group in the Delaware-Oslo cohort collaboration, and the work of Clare Ardern looking at the role of psychological responses in RTP/RTS.

ACL rupture

Useful Resources

Questions to consider before the chat

  • Is reconstructive surgery a key aspect in the rehabilitation of the ACL deficient patient?

  • Is rehabilitation alone a realistic treatment option?

  • What differentiates a coper from a non-coper?

  • Does delaying potential reconstructive surgery provide any specific advantages/disadvantages?

  • What are the key outcome measures to determine readiness for RTS/RTP?

About Chris

I have been qualified as a Physiotherapist since 2001. I have worked for Bradford Teaching Hospitals as Team Leader in the Orthopaedic Gymnasium, during which time I gained my MSc in Musculoskeletal Physiotherapy Practice from the University of Bradford (2009). I am still employed there part-time as an ESP (Lower Limb) working in Orthopaedic Triage and as a member of our soft tissue knee service, alongside my ESP colleague and our surgeons. I also work in private practice, running my own clinic, and in professional sport with Yorkshire County Cricket Club.

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