The effects of neuromuscular training on the ability to return-to-activity for the ACL reconstructed athlete

White, Kathleen
Journal Title
Journal ISSN
Volume Title
University of Delaware
Each year 175,000 anterior cruciate ligament reconstructions (ACLR) are completed in the United States. Outcomes are poorer than previously reported with high rates of second knee injury and low rates of return to pre-injury activities. Abnormal movement patterns, low self-reported knee function and poor functional performance are suspected reasons for poor outcomes after surgery. Intervening after surgery, and before athletes return to activities, may benefit patients in the short-term. The ACL- Specialized Post-Operative Return to Sports (ACL-SPORTS) Training program was developed from current ACL injury prevention techniques and evidence-based rehabilitation to improve outcomes after surgery. The goal of this work was to better prepare patients to return to activities after surgery. Gait biomechanics were used to evaluate movement patterns before and after completing ACL-SPORTS Training. Self-reported knee function measures were analyzed after training and one year after surgery to determine normal knee function. Readiness to return to activities was determined using return-to-activity criteria after training and one year after surgery. These results suggest that symmetrical movement patterns may be more related to functional performance rather than specific treatment intervention. Knee function measures were not different between the treatment groups however, all subjects in the current study demonstrated higher scores than those reported by large ACL ligament registries. Subjects who failed strict return-to-activity criteria after training had larger quadriceps femoris muscle strength deficits, however these individuals had a larger decrease in fear of movement/re-injury one year after surgery. These findings suggest the addition of a measure of fear of movement/re-injury after surgery to the return-to-activity criteria may identify subjects who are safe to return to activities. Overall benefits of this work has allowed us to characterize athletes after surgery by comparing biomechanical, functional and clinical measures of two different return-to-activity training protocols to establish best-practice guidelines for this high-risk population. Characterizing patients with established outcome measures of perceived knee function, based on their readiness to return-to-activities, will allow clinicians to target areas of weakness for those who do not meet strict return-to-activity criteria. Evaluating common variables of interest utilized by researchers will allow for an easy comparison to other research groups.