Paradigm shift in ACL rehabilitation – Things to think about.

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  • Why do we say that at 6 weeks every ACL should be able to do a partial squat and be at 90 degrees flexion?
  • 6 months was only Adrian Peterson…he rehabbed 25 hours per week
  • Navarro Bowman had Failure To Thrive and was 12 months +
  • Normal rehabbers are about 9 months but often they athlete still sucks at this point and are not 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