Journal Article

Infographic. ACL injury journey: an education aid

Gleadhill, Connor Patrick, Barton, Christian J

2021

Overview

Information to decide whether to have surgery (or not) Patients need a clear appraisal of the evidence, to make an informed decision about whether to have ACL reconstruction (ACLR) or not following ACL injury.2 There is only one published randomised trial comparing the two options; it reported no difference in pain, function or return to preinjury activity levels at 1-year, 2-year and 5-year follow-up.3 Current evidence suggests that the long-term prevalence of osteoarthritis is no difference between patients who receive ACLR compared with those who do not undergo surgery.4 Although factors like a patient’s age and plans to return to sports involving pivoting may predict success of surgery,2 there are individuals who can cope without ACLR after ACL injury.3 4 Part 2—your ACL journey guide: rehabilitation explained The need to ensure quality rehabilitation Regardless of treatment pathway, patients should focus on evidence-based rehabilitation immediately after their ACL injury as their firstline treatment.2 Rehabilitation is key to restoring normal knee function, preventing further knee injury and optimising long-term quality of life.2 Patients should progress through an individualised, criterion-based programme with through three distinct ‘phases’.5 Patients with better functional performance have better long-term outcomes, including lower rates of osteoarthritis.6 Intense rehabilitation is important to optimise outcomes as currently very few patients manage to reach the standard required to return to sport safely.7 8 When to return to play During the final stage of rehabiliation, patients face another complex decision—when are they ready to return to sport? Return to sport should include sport-specific training and underpinned by a battery of performance tests, for example, hop tests.1 5 It is also important that patients feel confident to return to sport before actually returning.1 How to reduce the likelihood of injury Exercise-based injury reduction programmes can reduce the incidence of ACL injuries, but implementation is inconsistent at community level.10 Part of the challenge is choosing between many options and optimising specificity for chosen sports.10 However, there are a few key components of effective programmes, including regular strengthening and neuromuscular challenges like landing and agility practice.10 Clinicians, coaches, patients and parents should understand and communicate the importance of adherence to injury reduction programmes. Evidence-Based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus.

• Publisher: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine,BMJ Publishing Group LTD
• Subject: anterior cruciate ligament / Arthritis / Clinical medicine / Decision making / education / exercise rehabilitation / Infographic / injury prevention / Knee / Ligaments / Osteoarthritis / Patients / Physical therapy / Rehabilitation / Sports injuries / Surgery / Systematic review