Traditional rehabilitation following ACL reconstruction has always been an ever-evolving practice. We have gone from immobilization to accelerated rehab and everywhere in between as far as our rehab progressions. Traditional rehab protocols have often utilized a time based approach to treatment progression. This "cookbook" approach has often caused clinicians to push their patients more aggressively than appropriate. Although post-operative time often has a strong influence in progression, not all patients fall within the "norms" at a given point in time. Co-morbidities, age, complications with surgery and even differences between doctors surgical techniques and philosophies all come into play with rehab progression. It is the responsibility of the clinician to constantly assess and reassess the objective status of the patient to ensure patients progress with their rehabilitation appropriately.
One of the most controversial and challenging dilemma to the clinician is knowing when to safely progress a patient from standard rehab (ROM ,PRE, Proprioception training, Etc.) into impact and more sport specific training. The purpose of the following protocol is to take a research derived criterion-based approach to progressing a patient all the way back to their given sport. Soft tissue healing, graft selection and incorporation, dynamic stability, range of motion, and patient confidence all have be taken into account. Specific clinical "mile stones" have been outlined and must be met before progressing into the next phase of training. Following such guidelines allows us to safely monitor and control the many variables that go into progressing rehab as safely and quickly as possible. The patient should be carefully monitored throughout this progression with the clinician watching for any signs of abnormal joint stress, effusion or pain.
Over the last 10 years, a wealth of research has been focused on ACL injury prevention. Prevention programs have been shown to drastically decrease the incidence of catastrophic knee injuries as well as improve athletic performance. Physio Pro has taken this information into account and incorporated an "enhancement/return to impact" program consisting of progressive plyometrics beginning at about 12 weeks post-operatively extending to the 6-8 month mark. Once an athlete has completed the protocol they are put through a comprehensive return to sport test. This too is criterion based. If the clinician, athlete and surgeon all agree that the clinical goals are met, then medical release can be considered.