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In October 2016 Dr Clare Ardern presented the topic are ACL reconstructions appropriate for return to sport (RTS). She stated that the maturation of the ligament is a 9+month event with the ligment being weakest at 6-8months post surgery.
Current long term studies have resulted in 89% of ACL’s intact 15 years post reconstruction with a re-rupture rate of 1% per year. The biggest difference over the past 15 years is the increase in children requiring surgery with a 4x increase in this period. This has been with the noticeable difference of risk of re-rupture in the first 2 years and 20% increase in the contralateral rupture. Males, primarily adolescents, are 54% more likely to re-rupture.
“There are many many different reasons why an ACL reconstruction (surgery) is appropriate.”
Athletes commonly choose to have surgery following an ACL injury in an attempt to return to sport. “We need to be thinking a lot about whether that is appropriate” says Dr Ardern.
Dr Ardern published a review in the British Journal of Sports Medicine on return to sport following ACL reconstruction surgery. This review found just 45% of athletes returned to competitive sport following surgery.
“Having an ACL reconstruction does not mean you automatically go back to playing sport.”
Just as importantly, when we look at the evidence, some athletes can return to sport without surgery, says Dr Ardern. There are two main treatment options available to someone who has recently injured their ACL:
- Choosing to have surgery early combined with exercise rehabilitation
- Attempting exercise rehabilitation without surgery, with the option of delayed surgery if the person is not satisfied with the outcome
A study in Sweden reported that both treatment options can result in a successful return to sport. There does not appear to be any benefit for early surgery at either two or five year follow-up.
“The best quality evidence shows us that the patient reported outcomes are similar, and the return to sport outcomes are similar irrespective of (which of these two) treatments that you choose”
Dr Ardern says it is important to note that this research involves the typical young active population who most commonly injure their ACL and present to private practices and public hospitals for treatment. Factors to consider when making the decision on whether to have surgery for an elite athlete may be different.
“It is a different decision making process for that (elite) athlete than our non-professional athletes.”
Regardless of the athletes ability, it is clear talking to Dr Ardern that ACL injury and surgery do not go hand in hand as has commonly been believed.
Could success of the ACL surgery be guided by the 17% of individuals actually complete the full battery of RTS tests?
If you are suffering from an ACL injury and need advice on your next step, Pivotal Motion can help. Book an appointment with the physiotherapist Newmarket relies on by calling on 07 3352 5116 or you can book your exercise physiology appointment online now!
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