ACL

Surgical time: Acute/ Early/ Delayed

ACute: <48 hours

Early: 48 hours-8 days

• better outcomes

Delayed: >3-10S

Surgical Timing: Late

worsening and development of concomitant soft tissue knee injuries

BPTB

overall good outcomes graft of choice for majority of US elite

BPTB potential problems

patellar fractures, patellar tendonitis/rupture, anterior knee pain

Hamstring grafts: semitendinosus and gracilis

good option for certain populations

better stability with LET

great cross sectional area and no extensor mechanism involvement

Hamstring grafts: semitendinosus and gracilis potential problems

Higher failure of BPTB, healing time, unpredictable size, knee flexion weakness, infection

Quadriceps autograft

longer wider higher tensile strength than BPTB

similar pt outcomes to BPTB

less risk of infections, less anterior knee pain, less donor site morbidity, low rate of quad defects

Quadriceps autograph potential problems

donor sit pain, RF retraction, bleeding, patellar fracture

Allografts: HS, quad, patellar achilles, ant/post tib

not usually recommended for those under 35

decreased return to sport rate

shorter operative time, no harvest site morbidity,

Allografts: HS, quad, patellar achilles, ant/post tib

higher rupture rate

when is return to participation

3-5 months

what components of RTP need to be implemented

foundation for sport specific movement

performed in a controlled environment

physical demands of sport need to be reversed engineered day one

progression of strength training

initial of sub-maximal plyometrics

initiation of return to running progression

what is the return to running progression criteria

3-5 months post op

full knee ROM

Quad strength >= 80% LSI

quad peak torque to BM ratio > 1.45-2.0

No effusion following strength training

Return to running consideration

can start on antigravity treadmill

running days should occur on strength training days

recommend running no more than 3x/wk

ned to monitor soreness rules and swelling

start linear→ angular and frontal plane change of direction

During to participation what is the hallmark of this phase

neuromuscular system to control deceleration w/ running and plyometric activities

what is the main focus of RTS phase?

skill development

progression to higher impact plyos

transitioning from strength training program to emphasizing power

during RTS physical therapist should continue to

complete regular isometric and or isokinetic testing

work toward quad strength >= 90% LSI

quad peak to BM ration >2.5-3.0

monitor movement quality

is there a gold standard for RTS clearance?

no

what are the general recommendations for RTS?

complete full rehab 9+ months

LE isometric/isokinecti testing >=90% LSI

hop testing >=90%

100% EPIC for DL countermovement jump

<10% asymmetry w/ SL CMJ

SEBT >94%

what is the most common psychological barrier to return to sport/competition

kinesiophobia

what is periodization

Periodization is a structured training approach that involves manipulating training variables, such as volume and intensity, over specific periods to optimize athletic performance and adaptation while minimizing the risk of injury.

what is linear periodization

Linear periodization is a training model that involves gradually increasing the intensity while decreasing the volume over time, typically focusing on long-term performance goals in a systematic manner.

what is vermeils hierarchy

Vermeil's hierarchy is a model used in sports rehabilitation and training that prioritizes elements such as mobility, stability, strength, and power to facilitate effective athlete recovery and performance progression.