Why Discharge After ACLR Doesn't Mean You're Done
Apr 25, 2024
A successful and confident discharge from PT after ACLR is always priority number one. But what exactly does it mean to be discharged? Ideally, it means you have passed a battery of objective testing, regained confidence in your knee’s athletic ability, and you’re ready to perform!
But is there more to it? I think so.
Discharge day is the greatest feeling from both the athlete's and the provider's perspectives. All of the hard work has paid off. We met our shared goals and the athlete is ready to compete! Despite meeting numerous objective testing batteries and subjective questionnaires, truly being 100% after ACLR is a feat that not many can accomplish. I don’t think it’s a guaranteed prognosis simply based on the type of surgery performed, but more so due to other factors often less considered.
- Graft maturation is an ongoing process and it has been suggested that this process can take up to 2+ years.
- The reconstructed graft doesn’t hold the same tensile capacity as the native ACL.
- There may be lingering deficits in the rate of force development, differences in single-leg power, differences in single-leg vertical and horizontal jump heights, and so on.
- Quad peak torque: BW may not have been considered.
- You likely haven’t restored prior acceleration and max velocity capacities.
You get the idea. You may now be wondering, how were they discharged in the first place if all of these factors remain present? The answer to that is a tricky one because while there are many suggested metrics offered in the literature to guide return to sport clearance, the literature is continuously evolving so there isn’t a universally agreed upon cluster of tests to reference as the gold standard. Rehab professionals must make return to sport (RTS) decisions based on the most readily available and valid research.
This is a good time to draw a line between RTS and return to peak performance. The restoration of full capacity is a process that will extend past your time in traditional/formal physical therapy. A common misconception is that traditional “physical therapy” is only relevant during a state of injury. In reality, physical therapy and performance training lie on the same continuum and should be progressed from one end to the other if high-level performance is really what we are after. Physical therapists are now much more prepared to extend care beyond “rehab” and continue to be a resource to the athletes as they transition back into performing. I believe this is often the missing piece to the big picture as so often, athletes are cleared to RTS and neglect a majority of what was focused on over the past 9-12 months. Once cleared to RTS, this is the perfect time to be “nit-picky” and identify exactly what is holding you back from your peak performance.
If you or someone you know is seeking guidance after ACLR, call us at 470-355-2106 or fill out the contact form in the link below.
Thanks for reading,
Dr. Mike, PT, DPT, CSCS, PES
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