Over the past two years, our Research Department has been conducting a study designed to determine if there are any specific factors that we can use to predict the chance of a patient having a successful outcome after anterior cruciate ligament (ACL) reconstruction surgery.
We chose to conduct a study on ACLs because injury to this ligament is common; around 1800 occur in the UK every year with around 1400 patients going on to have surgery. Injury to the ACL commonly occurs during sporting activities that require multi-directional movements such as football, skiing and netball. Following surgery, most patients aim to return to one or more of these sports. At present however, we estimate that around 40% of patients do not successfully return to sport after surgery and rehabilitation.
This got us thinking, what if we could predict who is likely to fall into this unsuccessful 40% group? Once we have the answer to this question, could we then identify this group, early in the post-operative period, and change their treatment so that they too could have a successful outcome?
To answer the first question we conducted a study, that was funded by the Private Physiotherapy Education Fund (http://ppef.org.uk), collecting a variety of data from 90 patients who had surgery and then came to see us, at Pure Sports Medicine, for rehabilitation.
The key findings were as follows:
- Only half of the patients in this study reported a successful outcome at 9 months after their surgery.
This is interesting, as most patients present expecting to be completely fit and well by this time point. Whilst recovery in 9 months may be possible, it is sensible to expect a slower recovery (say 12 months) and anything faster should probably be seen as a bonus.
- Patients with poorer muscle function in their non-surgical limb early on in their rehabilitation were more likely to have an unsuccessful return to sport.
Whilst there could be several causes for this, it does support the suggestion that the fitter you are before surgery, the better your chances of a successful outcome.
Many of the surgeons that we work with closely send patients to us before surgery for what is known as pre-habilitation. This finding suggests that ‘prehab’ is beneficial for patients’ recovery and being inactive before surgery is certainly to be avoided.
- Patients with poorer health-related quality of life scores mid-rehabilitation were also more likely to have an unsuccessful return to sport.
This shows that you need to be not only physically ready to return to sport, but also psychologically ready. A large part of middle to end stage rehab post-ACL reconstruction should be focused around this and restoring your confidence with respect to whatever sport you wish to play. We can determine this in part with a very simple questionnaire; which has now become standard practice at all of our clinics.
If you are unfortunate enough to rupture your ACL and do go on to have surgery, please do not despair. Many of our clinicians have great expertise in the rehabilitation of ACL injuries and the results of this study mean that we are now better equipped to guide your successful return to sport.
We recommend that you contact us soon after your injury to see one of our Physiotherapists before you have surgery. This way you will be better equipped to cope with your post-op rehabilitation and ready to get back in the gym and work hard towards your recovery.
