Return to Sport, or technically return to your previous pre-injury activity level, is usually the goal for ACL folks. It's the reason why we keep doing rehab, to check off the required steps and make it back to the life we once knew. It's a whole rehab continuum. If I had not had such a pre-injury active lifestyle, then maybe the bar wouldn't be set so high. Maybe it wouldn't be such a mental battle. A 2014 paper from Arden et al. summarized over 7,000 male and female ACL patients (BPTB or HT) return to sport statistics. The graphic below is just a visual summary of Arden et al. findings created by Mark Roe, PhD of Ireland. Here are the stats for my case (3 years, female, recreational) and the likelihood of returning to my previous activity level:
Those aren't great odds! But I am so determined to be part of the numbers in the orange column! It may take several years! Desire just has to outlast the length of rehab! There are a variety of reasons people don't make it back to where they were. I think surgeons aren't very up front with these facts either. I like to break those that don't make it back into two different categories:
With the first group, rehab is simply insufficient. Of course you cannot make it back; you're not done with rehab or ready for RTS testing. Things that can cause rehab to be insufficient are pain, loss of motivation, social pressures (people telling you to give it up, family obligations, etc), fear of reinjury, poor rehab quality, poor guidance, etc. The second, RTS tests declare your knee is physically capable of handling your sport demands, so you can remove the "rehab is insufficient" factor from the first category. Still, you can make it that far and not actually return to your previous level for several reasons. They kind of look like the list above, but rehab is actually sufficient now. Fear of reinjury seems to be the biggest factor people don't get back to sport (Nwachukwu et al 2019). If you are still afraid of a retear after having a fully rehabbed knee, then perhaps some counseling, visualization, going back to sports drills in a controlled environment, gradual exposure to your sport, more time are all ways to get over that kinesiophobia with a fully rehabbed knee. So whenever I hear someone didn't make it back, I always think to myself, "Did they finish rehab and pass the tests?" But it's also OK to not go back your previous level if you don't want to. Go do something else with your knew bad-ass strong knee. That is OK too. I have been told that you can pass those full RTS sports testing criteria with a SORE KNEE. The idea is that we just get it so adapted that it can handle the demands but the soreness hasn't actually gone away yet. Kind of like how I got adapted to biking and hiking. Took many months, it's still sore, but I can do it. That is good news, because I thought my sore knee would actually hold me back, aka prevent me from getting to the fancy part of rehab (jumps, agility, etc). We can get things strong and adapted enough, but there can still be pain. At least hope to get to that level. Will it still be fun to ski with pain? Well I'll have to find out. Too soon to tell. On the flip side I am part of the black column! 79% make it back to some kind of sport after 3 years; 80% of sub-elite make it back to some kind of sport; and 75% of women make it back to some kind of sport after ACLR. So even with my delayed, drawn out case I am still in the black column.
1 Comment
Jamie
2/27/2020 07:31:58 am
I, too, am soooo determined to be in that orange column! Let's do this!
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AuthorA 45 year old active female who tore her ACL in January 2017 (at the age of 40). Reconstructive surgery in February 2017 with bone-patellar tendon-bone autograft. Archives
November 2022
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