Summary
Novel evidence-based strategies will be presented to assist in the development of efficacious interventions targeted to these impairments to optimize safe return to high-risk activity.
Abstract
Surgical Reconstruction is the standard of care for athletes who suffer anterior cruciate ligament (ACL) rupture. Most ACL Reconstruction (ACLR) surgery restores mechanical stability of the knee, at least in the sagittal plane, but post-surgical outcomes vary. Less than 50% of ACLR athletes return to sport (RTS) within the first year after ACLR, and about 30% of young, active ACLR athletes will go on to a second ACL injury. A third of these young active athletes will go on to radiographic osteoarthritis within a decade of the initial injury. The outcomes after a second ACL injury and surgery are significantly worse than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques improve to restore passive joint stability to the pre-injury level, successful RTS after ACLR is predicated on numerous post-surgical factors. Second ACL injury is strongly correlated to modifiable post-surgical risk factors. Biomechanical abnormalities and neuromuscular asymmetries are prevalent in this cohort, can persist despite high function levels, and represent control deficits and imbalances that are associated with another subsequent ACL injury. Decreased neuromuscular control and high-risk movement biomechanics, which are heavily influenced by abnormal trunk and lower extremity movement, predict both first and second ACL injury risk. These findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to and exacerbated by the initial injury. Evidence-based strategies will be presented to assist in the development of efficacious interventions targeted to these impairments to optimize safe and effective return to high-risk sports activity.