A comparative video analysis of hamstring injuries mechanism and situational pattern in men's and women's football (soccer).

PURPOSE: To describe the injury mechanism and situational patterns of severe (absence >28 days) hamstring muscle injuries in professional male and female football (soccer) players. METHODS: The data for males were sourced from Serie A clubs participating in both national and international competitions from 2018 to 2021. For the female cohort, hamstring injuries were identified during matches of the top national/international competitions from 2017 to 2023. Video footage was obtained, and three raters categorised injury mechanisms and situational patterns. Injuries were also examined according to the month, minute and location. RESULTS: A total of 129 severe hamstring injuries were identified, with 64 occurring in females and 65 in males. Video analysis was possible for 29 (45%) female cases and 61 (94%) male cases. Female injuries had longer lay-off times (97.8 ± 77.1 days) than males (39.6 ± 20.9 days). Females had a higher proportion of indirect contact injuries (34%) than males (13%) and a lower proportion of non-contact injuries (66% vs. 87%). Four situational patterns were identified: running was the most common for both sexes, representing 59% of female injuries and 41% of male injuries. Over-stretching injuries were split across open and CKC scenarios but collectively explained nearly half (48%) of male injuries but only one in five (21%) female injuries. Kicking injuries had a higher proportion in females (17%) than males (10%). Injuries were more common in the second half for females and the first half for males. CONCLUSION: Females had a higher proportion of indirect contact, running and kicking injuries and a lower proportion of non-contact and stretch-type injuries than males. Understanding injury patterns can inform tailored prevention programs, considering sex-specific differences. LEVEL OF EVIDENCE: Level IV.

Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACL study on 6008 trials.

PURPOSE: To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACL study and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system. METHODS: One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05). RESULTS: A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95th percentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MS and total score (p < 0.01). CONCLUSION: Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols. LEVEL OF EVIDENCE: Level IV.

Injury mechanisms and situational patterns of severe lower limb muscle injuries in male professional football (soccer) players: a systematic video analysis study on 103 cases.

OBJECTIVE: The objective of this study is to describe the mechanism of injury and situational patterns (based on ball possession and playing action leading to injury) of severe (lay-off time >28 days) lower limb muscle injuries in professional male football (soccer) players during match play. METHODS: Players experiencing a severe muscle injury of the lower limb during Italian first (Serie A) division male football matches over three consecutive seasons (2018-2021) were identified. Video footage was obtained and three raters independently categorised injury mechanism and situational patterns using a standardised checklist. Injury epidemiology (month), timing of injuries within the match and location of injuries on the pitch were also examined. RESULTS: We identified 121 lower limb severe muscle injuries. Videos of sufficient quality were available for 103 (85%) cases, including 61 (60%) hamstring, 17 (16%) calf, 16 (15%) adductor and 9 (9%) quadricep muscle injuries. Nearly two-thirds of injuries involved the dominant/kicking leg (n=65, 63%). Eighty-five (83%) injuries were non-contact and 18 (17%) indirect contact. Four main situational patterns were identified and accounted for 88% of injuries: (1) running/acceleration (n=35, 34%); (2) closed kinetic chain stretching (n=21, 20%); (3) open kinetic chain stretching (n=19, 18%) and (4) kicking (n=16, 16%), with differences between muscle groups. 71% of injuries occurred in the first half of the match (p<0.01), with a gradual increase through the first half. CONCLUSION: Most severe muscle injuries during football matches were non-contact and occurred in the first half during running/acceleration, open and closed kinetic chain stretching, or kicking.

Football-specific extension of the IOC consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020.

Several sports have published consensus statements on methods and reporting of epidemiological studies concerning injuries and illnesses with football (soccer) producing one of the first guidelines. This football-specific consensus statement was published in 2006 and required an update to align with scientific developments in the field. The International Olympic Committee (IOC) recently released a sports-generic consensus statement outlining methods for recording and reporting epidemiological data on injury and illness in sport and encouraged the development of sport-specific extensions.The Fédération Internationale de Football Association Medical Scientific Advisory Board established a panel of 16 football medicine and/or science experts, two players and one coach. With a foundation in the IOC consensus statement, the panel performed literature reviews on each included subtopic and performed two rounds of voting prior to and during a 2-day consensus meeting. The panel agreed on 40 of 75 pre-meeting and 21 of 44 meeting voting statements, respectively. The methodology and definitions presented in this comprehensive football-specific extension should ensure more consistent study designs, data collection procedures and use of nomenclature in future epidemiological studies of football injuries and illnesses regardless of setting. It should facilitate comparisons across studies and pooling of data.

Epidemiology of Achilles Tendon Rupture in Italian First Division Football (Soccer) Players and Their Performance After Return to Play.

OBJECTIVE: To evaluate the epidemiology, incidence rate, incidence proportion, and prevalence of Achilles tendon ruptures (ATRs) in professional footballers and their performance after the injury. DATA SOURCES: Professional male footballers participating in Serie A in 11 consecutive seasons (2008/2009-2018/2019) were screened to identify ATRs through the online football archive transfermarkt.com. Exposure in matches and training was calculated. The number of matches played in the 5 seasons before and after ATRs was obtained, when possible, together with transfers to a different team or participation in lower Divisions. MAIN RESULTS: Eleven ATRs were found in 11 footballers with a mean age of 29.8 ± 4.4 years; 72% of ATR involved the nondominant leg; 58% occurred during matches and 42% during training, with no peculiar distribution along the playing season. The overall incidence proportion was 0.17% (0.11% during matches and 0.06% during training). The overall incidence rate was 0.007 injuries per 1000 hours of play (0.051 during matches and 0.003during training; P < 0.0001). All players returned to play soccer after a mean of 170 ± 35 days after ATRs and participated in an official match after a mean of 274 ± 98 days. However, 2 seasons after ATRs, 3 footballers were playing in a lower Division; 1 played less than 10 matches (compared with >25 matches in the 5 seasons before an ATR) and 1 had retired. CONCLUSIONS: An overall ATR rate of 0.007 per 1000 hours of soccer play and an incidence proportion of 0.17% were reported. All footballers return to play; however, up to 40% players decreased the level of play by reducing the number of games or participating in a lower Division 2 seasons after an ATR.

The three-dimensional reconstruction of an Achilles tendon rupture in a professional football player reveals a multiplanar injury mechanism.

Achilles tendon rupture (ATR) is a rare although very serious injury for football players; currently, studies on ATR in football are scant. This case report intends to firstly describe the situational pattern and three-dimensional mechanism of the ATR injury occurred to a professional football player during the last UEFA 2020 Championship. To reconstruct the full 3D joint kinematics throughout the injury action, the model-based image-matching technique was used. The key findings were: (i) ATR injury combined a sudden ankle dorsiflexion action with an internal plantarflexion moment while performing a crossover cut at high speed; (ii) a multi-planar loading occurred during the push-off phase.Level of evidence V.

A 2D video-analysis scoring system of 90° change of direction technique identifies football players with high knee abduction moment.

PURPOSE: Abnormal joint biomechanics and poor neuromuscular control are modifiable risk factors for Anterior Cruciate Ligament (ACL) injury. Although 3D motion capture is the gold standard for the biomechanical evaluation of high-speed multidirectional movements, 2D video analysis is a growing-interest alternative because of its higher cost-effectiveness and interpretability. The aim of the present study was to explore the possible association between a 2D evaluation of a 90° change of direction (COD) and the KAM measured with gold standard 3D motion analysis. METHODS: Thirty-four competitive football (soccer) players (age 22.8 ± 4.1, 18 male and 16 females) were enrolled. Each athlete performed a series of pre-planned 90° COD at the maximum speed possible in a laboratory equipped with artificial turf. 3D motion analysis was recorded using 10 stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D evaluation was performed through a scoring system based on the video analysis of frontal and sagittal plane joint kinematics. Five scoring criteria were adopted: limb stability (LS), pelvis stability (PS), trunk stability (TS), shock absorption (SA), and movement strategy (MS). For each criterion, a sub-score of 0/2 (non-adequate), 1/2 (partially adequate), or 2/2 (adequate) was attributed to the movement, based on objective measurements. The intra-rater and inter-rater reliability were calculated for each criterion and the total score. The Knee Abduction Moment (KAM) was extracted from the 3D motion analysis and grouped according to the results of the 2D evaluation. RESULTS: Excellent intra-rater reliability (ICC > 0.88) and good-to-excellent inter-rater reliability (ICC 0.68-0.92) were found. Significantly higher KAM was found for athletes obtaining a 0/2 score compared to those obtaining a 2/2 score in all the sub-criteria and the total score (20-47% higher, p < 0.05). The total score and the LS score showed the best discriminative power between the three groups. CONCLUSION: The 2D video-analysis scoring system here described was a simple and effective tool to discriminate athletes with high and low KAM in the assessment of a 90° COD and could be a potential method to identify athletes at high risk of non-contact ACL injury. LEVEL OF EVIDENCE: IV.

Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation.

Clinical evaluation and management of anterior cruciate ligament (ACL) injury is one of the most widely researched topics in orthopedic sports medicine, giving providers ample data on which to base their practices. The ACL is also the most commonly treated knee ligament. This study reports on current topics and research in clinical management of ACL injury, starting with evaluation, operative versus nonoperative management, and considerations in unique populations. Discussion of graft selection and associated procedures follows. Areas of uncertainty, rehabilitation, and prevention are the final topics before a reflection on the current state of ACL research and clinical management of ACL injury. Level of evidence V.

High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study.

BACKGROUND: Studies on subsequent anterior cruciate ligament (ACL) ruptures and career length in male professional football players after ACL reconstruction (ACLR) are scarce. AIM: To investigate the second ACL injury rate, potential predictors of second ACL injury and the career length after ACLR. STUDY DESIGN: Prospective cohort study. SETTING: Men's professional football. METHODS: 118 players with index ACL injury were tracked longitudinally for subsequent ACL injury and career length over 16.9 years. Multivariable Cox regression analysis with HR was carried out to study potential predictors for subsequent ACL injury. RESULTS: Median follow-up was 4.3 (IQR 4.6) years after ACLR. The second ACL injury rate after return to training (RTT) was 17.8% (n=21), with 9.3% (n=11) to the ipsilateral and 8.5% (n=10) to the contralateral knee. Significant predictors for second ACL injury were a non-contact index ACL injury (HR 7.16, 95% CI 1.63 to 31.22) and an isolated index ACL injury (HR 2.73, 95% CI 1.06 to 7.07). In total, 11 of 26 players (42%) with a non-contact isolated index ACL injury suffered a second ACL injury. RTT time was not an independent predictor of second ACL injury, even though there was a tendency for a risk reduction with longer time to RTT. Median career length after ACLR was 4.1 (IQR 4.0) years and 60% of players were still playing at preinjury level 5 years after ACLR. CONCLUSIONS: Almost one out of five top-level professional male football players sustained a second ACL injury following ACLR and return to football, with a considerably increased risk for players with a non-contact or isolated index injury.

A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading.

PURPOSE: The deceleration (pressing) is a common situational pattern leading to anterior cruciate ligament (ACL) injury in football. Although mainly assessed for performance purposes, a stronger focus on movement quality might support the screening of at-risk athletes. The aim of the present study was to describe a 2D scoring system for the assessment of the deceleration task and to associate it with the knee joint loading (knee abduction moment) evaluated through the gold standard 3D motion capture. The hypothesis was that lower 2D scores would be associated with higher knee joint loading. METHODS: Thirty-four competitive football (soccer) players (age 22.8 ± 4.1, 16 females) performed a series of deceleration tasks. 3D motion analysis was recorded using ten stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D qualitative assessment was performed via a scoring system based on the video analysis of frontal and lateral planes joint kinematics for five scoring criteria. The intra- and inter-rater reliabilities were calculated for each 2D scoring criteria. The peak knee abduction moment was extracted and grouped according to the results of the 2D evaluation. RESULTS: An ICC > 0.94 was found for all the 2D scoring criteria, both for intra-rater and inter-rater reliability. The players with low 2D frontal plane scores and low total scores (0-4) showed significantly higher peak knee abduction moment values (p < 0.001). A significant negative rank correlation was found between the total score and the peak knee abduction moment (ρ = - 0.25, p < 0.001). CONCLUSIONS: The qualitative 2D scoring system described successfully discerned between athletes with high and low knee joint loading during a deceleration task. The application of this qualitative movement assessment based on a detailed and accurate scoring system is suitable to identify players and patients with high knee joint loading (high knee abduction moments) and target additional training in the scenario of the primary and secondary ACL injury risk reduction. LEVEL OF EVIDENCE: Level IV.

Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors.

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson's correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55-0.96, CMC 0.63-0.96) and transverse (r 0.45-0.84, CMC 0.59-0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.

Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases.

BACKGROUND: A few small studies have reported on the mechanisms of ACL injury in professional male football. AIM: To describe the mechanisms, situational patterns and biomechanics (kinematics) of ACL injuries in professional male football matches. METHODS: We identified 148 consecutive ACL injuries across 10 seasons of professional Italian football. 134 (90%) injury videos were analysed for mechanism and situational pattern, while biomechanical analysis was possible in 107 cases. Three independent reviewers evaluated each video. ACL injury epidemiology (month), timing within the match and pitch location at the time of injury were also reported. RESULTS: 59 (44%) injuries were non-contact, 59 (44%) were indirect contact and 16 (12%) were direct contact. Players were frequently perturbed immediately prior to injury. We identified four main situational patterns for players who suffered a non-contact or an indirect contact injury: (1) pressing and tackling (n=55); (2) tackled (n=24); (3) regaining balance after kicking (n=19); and (4) landing from a jump (n=8). Knee valgus loading (n=83, 81%) was the dominant injury pattern across all four of these situational patterns (86%, 86%, 67% and 50%, respectively). 62% of the injuries occurred in the first half of the matches (p<0.01). Injuries peaked at the beginning of the season (September-October) and were also higher at the end of the season (March-May). CONCLUSIONS: 88% of ACL injuries occurred without direct knee contact, but indirect contact injuries were as frequent as non-contact injuries, underlying the importance of mechanical perturbation. The most common situational patterns were pressing, being tackled and kicking.

Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction.

PURPOSE: To assess the rate of return to sport (RTS) following revision Anterior Cruciate Ligament Reconstruction (ACLR) in a rehabilitation-based cohort of patients. A secondary goal of the study was to evaluate the association between compliance in post-operative rehabilitation and RTS rate. METHODS: The study cohort included 79 sport-active patients (62 males, 17 females, 30.0 ± 10.2 years old) who underwent revision ACLR surgery and followed the same functional-oriented rehabilitation protocol. Patients were evaluated using a RTS survey: return to any kind of sport participation, return to the same pre-injury sport, return to the same sport at the same pre-injury level. With regards to compliance in post-operative rehabilitation, patients were then grouped in (1) Fully Compliant (FC), (2) Moderately Compliant (MC), (3) Scarcely Compliant (SC), and (4) Non-Compliant (NC). RESULTS: At an average follow-up of 29 ± 12 months, 86% of the patients returned to some kind of sport activity, 62% returned to the same pre-injury sport activity and 59% returned to the same pre-injury level of sport activity. While no surgical aspects were correlated with RTS, higher BMI was found to have a negative influence (p = 0.033). Regardless of the type of sport, compliance significantly affected RTS at the same pre-injury level (p = 0.006): 86% in FC, 67% in MC, 50% in SC, and 45% in NC. For each compliance goal achieved, the probability of RTS increased by 68% (OR = 1.68; p = 0.027). CONCLUSION: RTS at the same pre-injury level after revision ACLR is challenging. A higher compliance in rehabilitation significantly increases the chances of RTS. LEVEL OF EVIDENCE: IV.

Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport.

PURPOSE: An increasing number of patients undergo revision anterior cruciate ligament (ACL) reconstruction, with the intention of returning to sport being a major indication. The aim of this study is to assess the available evidence for clinical improvement and return to sport, to understand the real potential of this procedure in regaining functional activity, and to facilitate improved counselling of patients regarding the expected outcome after revision ACL reconstruction. METHODS: The search was conducted on the PubMed database. Articles reporting clinical results for revision ACL reconstruction were included. A meta-analysis was performed on return to sport, and results were compared to the literature on primary ACL reconstruction. Other specific clinical outcomes (Lysholm, Tegner, IKDC Objective scores) were also included in the meta-analysis. RESULTS: Of the 503 identified records, a total of 59 studies involving 5365 patients were included in the qualitative data synthesis. Only 31 articles reported the rate of return to sport. Whereas 73 % of good objective results and satisfactory subjective results were documented, 57 % of patients did not return to the same level of sport activity, significantly inferior to that of a primary procedure. CONCLUSION: The real potential of revision ACL reconstruction should not be overestimated due to the low number of patients able to return to their previous activity level, significantly inferior with respect to that reported for primary ACL reconstruction. This finding will help physicians in the clinical practice providing realistic expectations to the patients. Future studies should focus on participation-based outcome measures such as return to sport and in strategies to improve the results in terms of return to previous activities after revision ACL reconstruction. LEVEL OF EVIDENCE: Systematic review and meta-analysis including Level IV studies, Level IV.

Neurocognitive Errors and Noncontact Anterior Cruciate Ligament Injuries in Professional Male Soccer Players.

CONTEXT: Evidence is emerging that core neurocognitive functions such as working memory and inhibitory control (ie, motor-response and attentional inhibition) are linked to the anterior cruciate ligament (ACL) injury risk. Research has been conducted in laboratory settings, but the contribution of neurocognition to actual ACL injuries under real-world conditions is unknown. OBJECTIVE: To describe the possible neurocognitive errors involved in noncontact ACL injury mechanisms. DESIGN: Case series. SETTING: Soccer matches. PATIENTS OR OTHER PARTICIPANTS: A total of 47 professional male soccer players. MAIN OUTCOME MEASURE(S): Three independent reviewers evaluated 47 videos of players sustaining noncontact ACL injuries. Neurocognitive errors in inhibitory control were operationalized as follows: (1) motor-response inhibition was scored when a player demonstrated poor decision-making and approached the opponent with high speed that reduced the ability to stop or change the intended action and (2) an attentional error was scored when a player shifted his selective attention away from the relevant task to irrelevant stimuli. RESULTS: Of 47 noncontact ACL injuries, 26 (55%) were related to a pressing-type injury, 19 (73%) of which involved a deceiving action made by the opponent, suggesting poor inhibitory control of the defender. Of the remaining 21 noncontact ACL injuries (45%), 16 (76%) could be attributed to attentional errors. Agreement among the 3 raters was very good for all items except poor decision-making, which showed fair to good agreement (Fleiss κ = 0.71). Interrater reliability was excellent (intraclass correlation coefficient = 0.99-1.00). CONCLUSIONS: Errors in motor-response inhibitory control and attentional inhibition were common during noncontact ACL injury events in professional male soccer players. The interrater agreement in detecting neurocognitive errors in general was very good.

3-Dimensional Biomechanics of Noncontact Anterior Cruciate Ligament Injuries in Male Professional Soccer Players.

BACKGROUND: The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise serious concerns. PURPOSE: To advance our understanding of the causal pathways leading to ACL injury with a large-scale reconstruction of 3-dimensional (3D) whole-body joint kinematics of injuries that occurred to male elite soccer players, as well as to compare the joint angle time course among situational patterns. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 33 consecutive noncontact and indirect contact ACL injuries that occurred in 6 national and 2 international professional leagues (seasons 2020-2021 to 2022-2023 until December 2022) were analyzed: (1) multiview noncoaxial television images were inspected; (2) multiple camera views were taken from 400 ms before the initial ground contact to 200 ms after the injury frame; (3) a size-matched pitch was modeled and used to calibrate cameras; (4) a 3D skeletal model was adjusted to fit the player's pose in each frame/view; and (5) poses were interpolated, and Euler joint angles were extracted. RESULTS: The authors reconstructed the 3D lower limb joint kinematic curves preceding and during ACL injuries in 33 cases; notably, a sudden external (up to 5°) and then internal knee rotation was observed after the initial contact and before the injury frame. The overall kinematics at injury were knee moderately flexed (45.9°± 21.7°), abducted (4.3°± 5.1°), and externally rotated (3.0°± 6.4°); trunk shallowly flexed (17.4°± 12.5°) and rotated and tilted toward the injured side; and hip flexed (32.0°± 18.7°), abducted (31.1°± 12.0°), and slightly internally rotated (6.6°± 12.2°). Variable behaviors were observed at the ankle level. CONCLUSION: Via reconstruction of the sequence of whole-body joint motion leading to injury, we confirmed the accepted gross biomechanics (dynamic valgus trend). This study significantly enriches the current knowledge on multiplanar kinematic features (transverse and coronal plane rotations). Furthermore, it was shown that ACL injuries in male professional soccer players manifest through distinct biomechanical footprints related to the concurrent game situation. CLINICAL RELEVANCE: Interventions aimed at reducing ACL injuries in soccer should consider that environmental features (ie, situational patterns) affect injury mechanics.

Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction.

Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).