Return to Play After ACL Reconstruction

This session included presentations on: The biology of ACL graft healing: what is known?; How accurate is imaging after ACL reconstruction; A good start with rehabilitation; The importance of strength and conditioning; Confidence: the psychology of RTP; General and sport-specific RTP criteria; Returning to sport after multi-ligament surgery.

This session covered the biology of the native ACL and graft healing, imaging, rehabilitation and return to play (RTP) after ACL reconstruction. Healing takes longer than originally thought, up to 12 months or more. This is particularly so with multi-ligament injuries, where the proprioceptive deficit should not be underestimated. MRI is not useful for defining RTP, but is good for identifying problems with the graft reconstruction. Quadriceps muscle strength is a key factor in the recovery process: good prehabilitation improves outcomes and building strength is key in rehabilitation. Activity progression should be logical and graduated, and beware of increasing strength demands with increased task complexity too soon. Coach good movement/manoeuvre patterns and train for reactive agility, not just planned agility. A stronger emphasis on psychological factors improves RTP and, if possible, involve the sports psychologist early as a normal part of the multidisciplinary team. The StARRT Framework is a good general model for RTP decisions, which should be individualised for the patient.