Safe Return to Play Following ACL Reconstruction in Young Athletes

Abstract

In order to reduce the risk of a second ACL injury following primary ACL reconstruction in young athletes, return to play (RTP) strategies are implemented that utilize temporal, psychological, and functional benchmarks. This strategy should be discussed with patients and their social support group prior to surgery in order to set proper expectations. Physiologically, time is needed for both graft maturation and incorporation as well as neuromuscular recovery. To monitor readiness for return to sport, validated measurement tools should be utilized along with functional assessments to address neuromuscular deficiencies. Patient reported outcome measures and psychological readiness should also be taken into account when assessing athletes' readiness to return to play. As athletes transition back to sport, ACL injury prevention training programs should be implemented on an ongoing basis. There remains insufficient evidence to support the routine use of functional ACL bracing to prevent ACL reinjury. Key Concepts: • Young athletes are at a high risk for a second ACL injury following a primary ACL reconstruction, with graft rupture or contralateral ACL tear occurring in up to one third of patients within 2 years after index ACL reconstruction. • A return to play strategy should utilize not only temporal but also functional and psychological benchmarks. • ACL injury prevention programs that incorporate neuromuscular training have been shown to reduce the rate of ACL tears and should be utilized to address functional deficiencies and for ongoing injury prevention. • Functional assessments should be repeated at multiple time intervals to track progress and identify areas for improvement early on in the rehabilitation process.