160. ACL Reconstruction: Expectations vs Reality w/ Nicole Surdyka and Chris Hughen
Aug 6, 2024
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Nicole Surdyka, an ACL rehabilitation expert, and Chris Hughen, a professional focused on surgical outcomes, delve into the realities of ACL recovery. They tackle common myths about recovery timelines and rates of return to sports. The discussion reveals the risks of re-injury and emphasizes the necessity of personalized rehabilitation plans. They also compare allograft and autograft options in surgery and highlight the importance of selecting the right surgeon for optimal outcomes. Continuous learning in clinical practice is encouraged for better patient care.
Many athletes have unrealistic timelines for returning to sport post-ACL surgery, often expecting recovery in less than 12 months.
Eighty percent of ACL reconstruction patients return to some sport; however, only 65% reach their pre-injury performance level.
Robust rehabilitation, sports-specific training, and mental preparedness are crucial in reducing the risk of re-injury post-ACL reconstruction.
Deep dives
Understanding Expectations of ACL Surgery
Many athletes have unrealistic expectations regarding recovery from ACL surgery, often believing they will return to their previous level of performance more quickly than is typically feasible. Research indicates that a significant number of athletes expect to return to pre-injury levels shortly after surgery, with studies showing that two-thirds anticipate returning without any restrictions. However, evidence suggests that the average recovery timeline for a safe return to sport after ACL reconstruction is actually between 9 to 12 months, which is much longer than many athletes expect. This disconnect between expectation and reality highlights the need for better preoperative education to align realities with athletes' beliefs regarding their recovery.
Return to Sport Rates Post-ACL Injury
Statistics indicate that around 80% of individuals who undergo ACL reconstruction return to some level of sport, but only approximately 65% manage to reach their pre-injury performance level. This discrepancy emphasizes a significant gap between athletes' expectations and actual return rates, leading to disappointment and confusion. Factors such as the level of sport played before the injury and individual recovery progress significantly influence these rates. Higher-performance athletes, especially those competing at a professional level, are reported to have better odds of returning to their original capacity compared to recreational players.
Risk Factors for Second ACL Injury
The chances of sustaining a second ACL injury, either to the reconstructed knee or the opposite one, can be significant, with previous studies indicating that approximately 20% of athletes may experience re-injury. The primary risk factor identified is returning to high-risk sports that involve pivoting, cutting, or rapid changes in direction. Young athletes under the age of 25 who participate in these sports are particularly susceptible, as their high activity levels often lead them back to these challenging environments. Understanding the implications of returning to high-risk sports is crucial for both athletes and clinicians to mitigate the chance of re-injury.
The Importance of Comprehensive Rehabilitation
A robust rehabilitation program that addresses the complexities of recovery post-ACL reconstruction is fundamental in reducing the risk of re-injury. Athletes should ideally engage in sports-specific training that escalates in intensity over time, and a structured gradual return to competition is critical. Additionally, physical therapists should frequently reassess the athlete’s progress through standardized testing to ensure that they are not only meeting benchmarks but genuinely prepared for the demands of their respective sports. Mental preparedness and confidence are equally vital; athletes must feel psychologically ready to return to high-performance activities, as doubt can increase the risk of injury.
Evaluating Graft Types and Their Impact on Recovery
The choice of graft—either autograft from the patient or allograft from a donor—can influence postoperative outcomes and the risk of re-injury. Autografts generally offer lower rates of re-rupture compared to allografts, making them a more common choice for surgeons. Among autograft options, there isn't a definitive winner, as studies suggest similar outcomes across bone-patellar tendon-bone, hamstring, and quadriceps tendon grafts. The decision on graft type should primarily align with the preferences and expertise of the surgeon, as they will have the best understanding of which method is most effective for their patient cohort.
Chris Hughen sat down with Marc and Nicole Surdyka to discuss all things ACL Rehab. We dive into commonly held beliefs related to ACL surgery, average rates of return to sport, potential risk factors associated with a second injury, strategies to reduce the likelihood of a second tear, and much more.