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  1. Matthias Keller,
  2. Oliver Schmidtlein,
  3. Eduard Kurz
  1. OSINSTITUT, Munich, Germany


Background The most current follow-up treatments after ACL injuries are time-oriented. The decision-making procedures for return-to-sport are not uniform. The ACL rehabilitation approaches comply mostly with empirical values in time-dependent schemes. However, specific questionnaires and functional assessments become more important during the control of rehabilitation. Therefore this presentation aimed to present a function-oriented return-to-activity algorithm.

Methods The 29-year-old male professional soccer athlete with traumatic ACL rupture of the left knee and a bodyweight of 74 kg participated in an active rehabilitation program for a period of five months. The rehabilitation protocol started five days after surgical ACL repair through hamstring tendon. Anamnesis revealed no previous knee injuries and the absence of any further physical complaints. The athlete was free of psycho-social risk factors and showed a very good compliance.

The return-to-activity algorithm applied consisted of different tests within four levels. Starting with quasi-static single leg stability measures, the algorithm proceeds with three dynamic hop tests with progressing impact. After ensuring sagittal (single leg hop) and frontal (side hop) planes stability, a multi-planar (square hop) test is performed. The protocol estimates limb symmetry indices (LSI) within each of the four levels. By using this approach, the unaffected side serves as the control. Only athletes who pass the test with a minimum LSI of 90% are allowed to move on to the next level and thus stress the structures with level-specific activities (e.g. cutting movements within the third level).

Results The first level (Y-balance test) was completed two months after operative treatment with an average LSI of 95%, whilst the LSI of the single leg hop for distance (second level) revealed only 50%. After a further period of four weeks, the LSI of the single leg hop test improved considerably to 81%. The athlete reached the predefined boundary of 90% four months after surgery. After that time, initial moderate jogging activities and dynamic exercises were allowed. Five months after the operation, the third (side hop test) and fourth (square hop test) levels revealed an LSI of 99% and 94% respectively. The rehab protocol was now completed and integration into team training could begin.

Conclusion In this case report, an athlete returned to his previous sport level within a period of twenty weeks. The proposed return-to-activity algorithm was easy applicable and helpful to control the different rehabilitation phases. On the basis of such a procedure, individual recommendations are decoupled from time-oriented approaches. Thus musculo-skeletal function becomes a central component in judging progressions during rehabilitation.

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