Anterior Cruciate Ligament (ACL) Rehabilitation and Testing Service
ACL injuries and reconstructions are on the rise in Australia, with a 43% increase in the number of reconstructions performed since 2000, with many of these occurring in our younger athletes (1,2). Unfortunately, the rate of revision surgery is also rising (3). At PROmotion, we are aiming to improve outcomes from ACL reconstructions by guiding rehabilitation and aiding return to play decision-making through evidence based periodical testing.
This service has been developed and will be led by our PRO Physiotherapist Paul Atkinson, who has considerable expertise in ACL rehabilitation from his time working in the prestigious ACL rehab and research department in Sports Surgery Clinic, Dublin. This service is unique in Perth and aims to be a standard bearer in this area, with all testing being performed by Physiotherapists with extensive knowledge in this area.
The protocol is broken into three levels; to match the systematic progressive approach to ACL rehabilitation. At each testing level, a battery of strength, biomechanics and movement control will be analysed and objectively measured. Higher-level activities of power development, running analysis, change of direction and agility will be analysed in level 2 and 3.
Psychological barriers to recovery and subjective reporting on knee outcomes will be measured at each testing point. Current evidence suggests that psychological readiness for return to play is one of the most important factors (4). Tackling this is central to our testing.
-Psychological readiness for return to play and subjective knee outcomes
-Review of surgical details, rehab to date, goals from rehabilitation
-Strength testing: maximal quadriceps, hamstring, as well as leg press strength scores
-Biomechanical Assessment: Utilising slow-motion video capture to objectively examine movement efficiency.
-Balance and Proprioception: Y-Balance testing captured
-Feedback and report on early stage rehab and important areas to improve before progressing to next stages
-Decision making on return to running, and higher level rehab activities given
-Psychological readiness for return to play and subjective knee outcomes
-Additional power and rate of force development measures added to maximal strength testing
-Running analysis using ViMove Software
-Agility and change of direction movement control added
-Feedback on testing and decision making on focus areas for sports specific rehabilitation and return to play decision-making.
As per level 2. This is usually the final test on returning to play, or is performed after returning to play to ensure that rehabilitation outcomes are maintained and that the risk of injury is minimized as much as possible. This is especially pertinent as the biggest risk of re-injury is seen in the first year of return to play (5).
Feedback and Reporting
Rehabilitation following an ACL injury is very much a team approach. Our ACL testing service aims to inform the whole team on rehabilitation outcomes to date, what is being done well, and what areas need to be focused on in the next stages to ensure a successful return to performance. Most important in this team is the person themselves, however, a full report is also developed for the referring Surgeon and Doctor, Physiotherapist and Rehab team, as well as coaches and parents.
This ensures that everyone is informed and a an environment of support is nurtured, as well as informed decision making on stages of rehab and return to play.
Why is this testing important?
The rate of ACL revision surgery is rising faster than primary ACL reconstructions in Australia (3). A number of risk factors for reinjury within our control have been identified across a number of studies; these include asymmetries from the unaffected side in strength and power development, insufficient recovery time from surgery, and psychological barriers (6).
A research study found that those who failed to achieve greater than 90% in strength testing and hop distance tests when returning to play had a 38% chance of re-injury; this is in contrast to less than 6% chance of reinjury than those who did achieve this marker (6).
It is difficult to notice some of these deficits yourself. Utilising industry leading video-capture software and strength testing protocols, as well as utilising real time movement analysis software (ViMove) we aim to objectively measure these impairments. This will give you, and your rehab team a objective data on your rehabilitation, ensuring that your dedication and commitment is rewarded with a specific and guided approach.
How long does testing take?
Level 1 testing takes a total of 1 hour to complete, with a full report and feedback given.
Level 2 & 3 testing incorporates higher level testing protocols such as running analysis, agility testing and analysis of power and rate of force development. This process takes up to 1.5 hours.
It is not essential to have performed level 1, to be do level 2 & 3 testing. If you are in a later stage of rehabilitation and are looking for guidance on return to play a level 2/3 testing protocol can be performed.
ACL & PCL Rehabilitation in PROmotion
In PROmotion movement is our medicine; with a fully kitted strength and conditioning gym, as well as Physio rehab studio we are perfectly situated to guide you on your rehabilitation journey.
With a team of Physiotherapists and Exercise Physiologists, we can develop your rehabilitation program that best suits your needs.
Surgical reconstruction is certainly not for everyone, with a conservative approach to rehabilitation being the preferred option for many who don’t see themselves returning to high level multi-directional sport. This approach can have great outcomes when rehabilitation is consistent and progressive in terms of restoring strength, power, and agility. Our testing protocol is still applicable in ensuring your rehabilitation is specific, and ensuring that you have the best outcomes possible.
Beck, N. A., Lawrence, J. T. R., Nordin, J. D., DeFor, T. A., & Tompkins, M. (2017). ACL Tears in School-Aged Children and Adolescents Over 20 Years. Pediatrics, 139(3). doi:10.1542/peds.2016-1877
Shaw, L., & Finch, C. F. (2017). Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005-2015. Int J Environ Res Public Health, 14(6). doi:10.3390/ijerph14060599
Zbrojkiewicz, D., Vertullo, C., & Grayson, J. E. (2018). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000-2015. Med J Aust, 208(8), 354-358.
Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., . . . Bizzini, M. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50(14), 853.
Crawford, S. N., Waterman, B. R., & Lubowitz, J. H. (2013). Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy, 29(9), 1566-1571. doi:10.1016/j.arthro.2013.04.014
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med, 50(13), 804-808. doi:10.1136/bjsports-2016-096031