This plan follows a complete tear of the anterior cruciate ligament (ACL) in a high school multisport athlete. The student elected to have surgery to repair the ACL. A graft was obtained from the patellar tendon from the affected knee and used to replace the torn ACL. The following rehabilitation plan was designed for this student with considerations to the sports that he plays and the location of the grafted tissue. ACLs are common sport injuries that often result from a twisting motion on the knee or when the knee gives out after planting the foot and cutting. The athlete injured tore his ACL while planting and cutting in basketball practice.
Physiological responses to trauma
While initial injury of the ACL sets off the body’s response to injury it is important to understand that surgery, which is essentially premeditated trauma, will also trigger the body’s recovery mechanisms as well. Understanding how these mechanics work and how a response to an injury can become compounded by the resulting corrective surgery is key to developing an effective rehab plan. Ligaments, like other soft tissues, heal in three phases. These phases are the “Inflammatory Phase”, the “Repair Phase”, and the “Remodeling Phase”. The inflammatory phase begins with the trauma. This phase can typically last 3-5 days depending on the severity of the injury.
During the inflammatory phase chemicals are produced and nociceptors are activated alerting the body to the injury. This results in the sensation of pain. Subdermal bleeding results in swelling and edema which can put pressure on the surrounding nerve endings causing more pain. Bruising can also occur due to ruptured blood vessels. The pain response alerts the body to th...
... middle of paper ...
...n to play. Several criteria must be met before this can happen however. Among these requirements are as follows.
• No functional complaints
• The athlete is confidence in the knee when running, cutting, jumping and all other movements at full speed
• Full ROM, strength, cardiovascular endurance, and proprioception.
• Is able to perform all sport specific activities at least as good as before the injury
• No pain present during any activity or motion
Of the return to play criteria, the most critical is that the athlete has full confidence in his or her knee’s ability to hold up to all the demand of the sport. Psychological readiness parallels physiological readiness when retuning an athlete to play. This is due to the threat of re-injury if the athlete does not have confidence in their knee and plays timid or underperforms as a result of psychological restrictions.
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