ACL Rehab – When Can I Run Again?

Knee 0
author

Dr Caleb Burgess

Physical Therapist United States

This blog is a shortened version of a review from the 14th issue of the Physio Network Research Reviews. It highlights a study titled “Criteria for Return to Running after Anterior Cruciate Ligament Reconstruction: A Scoping Review” by Rambaud A et al (2018). It was reviewed by ACL expert Mick Hughes.

Background/Objective:

  • There is a lack of high-quality information regarding when ACLR (Anterior Cruciate Ligament Reconstruction) patients can return to running (RTR)
  • The primary purpose was to find out what criteria are used in the clinical decision making for RTR following ACLR
  • They also aimed to provide information to help clinicians and patients make quality decisions regarding RTR

Methods:

Reviewed 201 studies which included participants ranging from skeletally mature adolescents to those aged 40 years, who had undergone a primary ACLR (autograft only, with or without meniscus surgery)

Results:

  • The median time from which RTR was permitted was 12 post-operative weeks
  • Apart from “time after surgery”, only 18% of the studies used additional criteria to allow patients to RTR
  • The most common clinical criteria were full knee AROM and pain <2/10 in the visual analog scale (VAS)
  • For strength, the most common objective criteria were isometric quadriceps limb symmetry index (LSI) >80% and isokinetic quadriceps and hamstrings LSI >70%
  • For performance-based criteria, the most common objective tests were: proprioception LSI of 100%, composite score on Y-Balance Test >90%, hop test LSI >85%, 10x consecutive single leg squats to 45 degrees knee flexion and 30 step up and holds

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Clinical Implications:

  • The decision to allow someone to start a running program should be made on passing clinical/strength/functional criteria, rather than being based on an arbitrary time-point
  • It should be individualized and for many patients it might be reasonable to commence running between weeks 8-16 post-op provided that there has been adequate progressively loaded rehab
  • The patient should have <2/10 pain, full to near full AROM, and little to no effusion
  • The clinician may also choose to use a battery of strength and performance-based tests

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About the Author

author

Dr Caleb Burgess

Physical Therapist United States

Dr. Burgess primarily works with the sports and orthopedic populations, with a focus on blending biomechanics, pain science, and foundational strength and conditioning principles to provide a truly eclectic approach to his patients. He is a board certified Orthopedic Clinical Specialist, Certified Strength and Conditioning Specialist, and has completed two separate year long orthopedic residency and sports/orthopedic fellowship programs. In addition to practicing in clinic, Caleb assists in mentoring orthopedic residents in Kaiser Permanente Southern California's Orthopedic Physical Therapy Residency program and students at Azusa Pacific University He posts on social media daily and can be found on his Instagram, Facebook or website links below.

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