AANA Middle East Arthroscopy Master Course (International)-Rehabilitation and return to play after ACL surgery

Rehabilitation and return to play after ACL surgery

Pdf Summary

This document, authored by Dr. Pietro M. Tonino, outlines a comprehensive approach to rehabilitation and return to play following anterior cruciate ligament (ACL) surgery, emphasizing goals, rehabilitation phases, functional testing, and risk management.<br /><br />Post-ACL surgery rehabilitation aims to restore knee function, enable safe return to sports or work, and minimize re-injury risk. Although no consensus exists on a best post-op protocol, early rehab beginning before surgery addresses quadriceps weakness—a key factor influencing long-term outcomes and osteoarthritis risk. Dr. Tonino favors full weight-bearing in extension for four weeks, early initiation of quadriceps and hamstring isometrics, and tailored weight-bearing based on associated injuries like meniscus or MCL repair.<br /><br />Rehab is divided into four phases over up to a year: Phase 1 (weeks 1-6) focuses on regaining knee extension, controlling swelling, and beginning strengthening without certain movements; Phase 2 (weeks 6-12) advances range of motion and proprioception; Phase 3 (3-6 months) includes resistance training, plyometrics, and gradual running protocols; Phase 4 (6-12 months) maximizes strength, agility, and introduces sport-specific activities, ensuring objective criteria are met (e.g., >75% strength symmetry, hop tests).<br /><br />Return-to-play decisions balance medical evaluation and subjective factors like patient readiness and motivation, acknowledging a 4-fold re-injury risk after return. Functional testing—covering strength, agility, balance (using tests like Star Excursion and Y-balance), and neuromuscular control—is crucial, as 30% of patients face second ACL tears and many never reach pre-injury sport levels. Fear of re-injury affects half of patients’ return decisions, underlining psychological factors.<br /><br />The document stresses prevention, rigorous testing batteries, close post-return observation, and setting clear expectations among athletes, coaches, and families to optimize outcomes and reduce complications such as graft or contralateral ACL ruptures.

Keywords

ACL surgery rehabilitation

anterior cruciate ligament

post-operative rehab phases

quadriceps strengthening

weight-bearing protocols

functional testing

return to play criteria

re-injury risk

psychological factors in rehab

sport-specific training