Sometimes there are other influencing factors when it comes to returning to play following an ACL injury. Everyone is different and rather than implementing specific timeframes, this injury requires a criteria-based rehabilitation approach. Sometimes even when the knee is stronger than before the injury, these people never end up back on the sporting field or in the environment that led to their initial ACL injury.
It is important to note that fear of re-injury and lack of confidence play a major role in ones return to play following an ACL injury. One study by Toele et al 2021, examined the number of participants who either returned to play or did not return to play. Of the 1363 participants included, 138 participants did not return, with fear of re-injury, lack of confidence and pain accounting for around 56% of the reasons.
The clinical implications of these findings, whilst very generalisable, highlights the necessity to not neglect the psychological parameters of each patient. We need to instil confidence by working collaboratively with them, implementing shared decision making, building social support groups and ensure that their goals are at the forefront and that their rehabilitation process is unique to them. Everyone heals at different rates, so next time when your patient is feeling anxious, reassure them that it is simply part of the process and they have an amazing support network to lean on!
Toale, J.P., Hurley, E.T., Hughes, A.J. et al. The majority of athletes fail to return to play following anterior cruciate ligament reconstruction due to reasons other than the operated knee. Knee Surg Sports Traumatol Arthrosc 29, 3877–3882 (2021). https://doi.org/10.1007/s00167-020-06407-5
