A C L
R E C O N S T R U C T I O N
E x p e c t a t i o n s r e g a r d i n g
r e t u r n t o s p o r t a n d
l o n g - t e r m o u t c o m e s
Dr Jason Beer | Orthopaedic Surgeon
A n t e r i o r
C r u c i a t e
L i g a m e n t
There are more scientific articles written
about the ACL than any other ligament in
the body. However, operative technique,
graft choice and rehabilitation guidelines for
reconstruction remain varied and numerous.
Generally speaking, depending on the pre-injury level of
activity, around 70-80 percent of patients who have undergone
ACL reconstruction will return to their pre-injury level of
activity, if so desired. The key attributes for a successful and safe return
to sport include a stable knee and a functional return to 85-90 percent of the
normal knee as measured on objective testing. These tests include, quadriceps
and hamstring strength, single leg hop, triple hop and agility. An early return
to sport can lead to an increased risk of graft re-rupture and therefore needs to be
carefully considered. Some recent studies have shown that a 50 percent reduction
in all knee injuries (not just ACL) can be achieved with every month a return to
sport is delayed past 6 months and up to 9 months following ACL reconstruction
(1, 2). An experienced physiotherapist, with an interest in these type of rehabilitation
protocols, working closely with the treating surgeon is an integral requirement for a
successful outcome in this setting.
Certain groups of patients are at an increased risk of recurrent injury despite a successful
surgery and rehabilitation. The attributes of these groups include: age is less than 20 years,
ligamentous laxity, contact/high impact sport and degree of rotational instability prior to
reconstruction (and subsequently there-after). It is these groups of patients who require careful
consideration and often an extra-articular reconstruction (“lateral tenodesis”) in combination with
a standard ACL reconstruction.
42 | Pindara Magazine ISSUE 13 | 2018