Paradigm shift in ACL rehabilitation – Things to think about.

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Please follow these steps to receive full CEU credit.

  1. Please read through the outline and course description presented below.
  2. Please watch the entire presentation – The presentation power point is available to print or view for you to follow along with.
  3. Once you complete the course course you may move on to the exit exam. A passing course of at least an 80% is needed to received credit for the quiz. A certificate will be automatically generated with a passing score.

Course Description: Rehabilitation for Anterior Cruciate Ligament reconstruction (ACLR) has for years followed the time based approach progressing athletes to the next step based solely on how far they are out from surgery.  Research has shown that criteria based protocols, where each athlete only progresses once they reach a specific goal improves outcomes in patients, specifically athletic populations. (cited research) In this course participants will learn and discuss different methodologies for athletic trainers to use determining rehabilitation advancement for patients returning from ACLR.

Outline

Why do we say that at 6 weeks every ACL should be able to do a partial squat and be at 90 degrees flexion?

Adrian Peterson only needed 6 months…he rehabbed 25 hours per week

  • Navarro Bowman had Failure To Thrive and was 12 months +
  • Normal rehabilitation is about 9 months but often they athlete still lacks full function at this point and they are not totally comfortable with their knee
  • Let’s look at it similar to school…you pass the test you move on…you fail the test you get held back.
  • 150,000-200,000 ACL surgeries per year.
  • How are we doing a disservice to our patients using a time-based rehab program?
  • NFL bases their timeline on RTP for week ONE readiness

What are the parameters for RTP?

Each phase should have criteria before advancing:

  • Physician approval,
  • Published research
  • Biological healing

Tissue healing – know the biological clock and tissue remodeling for each surgery

  • Graft type fixation
  • Other ligaments involved
  • Meniscal repair
  • Micro fracture probability
  • Published literature
  • Validates rehabilitation protocol
  • Widespread use by paraprofessional
  • Looking at specific criteria for return to play