Thread by @czuppons

Finally getting to review a few of the @ACLStudyDay home sessions! First up: Managing ACL injuries and athlete RTS with @clare_ardern! Notes to follow in this thread....

@ACLStudyDay @clare_ardern #ACL rehab goals:
1) protect the meniscus
2) QUADS QUADS QUADS (strength)
3) injury free sport participation

@ACLStudyDay @clare_ardern #ACL Mythbusting:
1) Surgery isn't necessarily needed to get the knee back to "normal."

Rehab alone, early ACLR, delayed ACLR - all had same self-reported knee fctn at 2 yrs post-injury.

@ACLStudyDay @clare_ardern #ACL Mythbusting:
2) Surgery may not be necessary to return to sport

Whether no sx, immediate sx, or delayed sx:
- Return to sport at 2 yrs post-injury are similar
- 5 yrs post-injury, 20% in each groups still playing pre-injury sport

@ACLStudyDay @clare_ardern #ACL Mythbusting:
3) Individ that have immediate surgery don't necessarily have superior outcomes.

Prehab! Ideally min 3 mths can be very beneificial.

@ACLStudyDay @clare_ardern #ACL Mythbusting:
4) Surgery won't prevent OA.

OA prevalence is pretty equal after ACLR or non-surgical treatment (Lie 2019 BJSM)

@ACLStudyDay @clare_ardern Isolated ACL tear: low OA prevalence.

Combined injuries with ACL tear (bone marrow lesion, meniscus tear, articular cartilage lesion etc): higher OA

(Oiestad 2009 AJSM)

@ACLStudyDay @clare_ardern How do you get better quads?

HIGH QUALITY REHAB.
Ex: NMSK training, longer duration of rehab program, progressive loading.

(It's actually pretty sad how often this doesn't happen....)

@ACLStudyDay @clare_ardern ACL rehab keys:
- start ASAP
- realistic expectations
- criterion-based progressions (individualized/athlete specific)
- respect biology / tissue healing
- high quality rehab
- don't guess, assess!

@ACLStudyDay @clare_ardern Return to sport planning:
Good reminder of this paper if you've never read it - free to d/l:
bjsm.bmj.com/content/50/14/…

@ACLStudyDay @clare_ardern Return to sport planning:

It's part of the continuum - weaved in through your entire rehab program ... it's NOT just the end of rehab!!

Not just Y/N - Should be shared decision making

@ACLStudyDay @clare_ardern Post-ACLR:
Return to any sport = 80%
Return to pre-injury sport = 65%

Mental readiness (low fear of injury and better confidence) key!

@ACLStudyDay @clare_ardern Return to sport testing:

1) Multiple tests that mimic sport
2) Open tasks (eg, sport-specific situations)
3) Reactive decision-making when fatigued
4) Monitor workload
5) Check psych factors

@ACLStudyDay @clare_ardern Understand the demands of the sport!

RTS Tests:
- time (min 9 mths)
- hop symmetry (and agility)
- Quad strength/symmetry
- Psych readiness/confidence
- on-field testing

@ACLStudyDay @clare_ardern Some sport rehab progression papers to check out:

1) Taberner 2019 BJSM: bjsm.bmj.com/content/53/18/…
2) Buckthorpe 2019 BJSM: bjsm.bmj.com/content/53/5/2…

@ACLStudyDay @clare_ardern Re-injury rates:
65% within 6 months after RTS (Kyritsis 2016 BJSM)

@ACLStudyDay @clare_ardern "Return to sport planning is really about managing injury risk."

How much risk are you willing to tolerate? Your answer is going to vary based on the injury (severity), age, etc.

@ACLStudyDay @clare_ardern Risk assessment:
1) Health risk (age, strength, past history of injury, etc)
2) Sport risk (demands of sport)
3) Risk tolerance (coach, imptnce of game, etc)

@ACLStudyDay @clare_ardern Other references:
1) ACL rehab consensus guidelines BJSM 2016: bjsm.bmj.com/content/50/24/…
2) 2018 IOC consensus on pediatric ACL injuries BJSM: bjsm.bmj.com/content/52/7/4…
3) Evidence-based ACL injury prevention (incl videos&field-based progressions!) JOSPT 2018: jospt.org/doi/full/10.25…