Returning to running after ACL reconstruction.

Background/Objective:
🔘There is a lack of high-quality information regarding when ACLR (Anterior Cruciate Ligament Reconstruction) patients can return to running (RTR)
🔘The primary purpose was to find out what criteria are used in the clinical decision making for RTR following ACLR
🔘They also aimed to provide information to help clinicians and patients make quality decisions regarding RTR
-
Methods:
🔘Reviewed 201 studies which included participants ranging from skeletally mature adolescents to those aged 40 years, who had undergone a primary ACLR (autograft only, with or without meniscus surgery)
-
Results:
🔘The median time from which RTR was permitted was 12 post-operative weeks
🔘Apart from "time after surgery", only 18% of the studies used additional criteria to allow patients to RTR
🔘The most common clinical criteria were full knee AROM and pain <2/10 in the visual analog scale (VAS)
🔘For strength, the most common objective criteria were isometric quadriceps limb symmetry index (LSI) >80% and isokinetic quadriceps and hamstrings LSI >70%
🔘For performance-based criteria, the most common objective tests were: proprioception LSI of 100%, composite score on Y-Balance Test >90%, hop test LSI >85%, 10x consecutive single leg squats to 45 degrees knee flexion and 30 step up and holds
-
Clinical Implications:
🔘The decision to allow someone to start a running program should be made on passing clinical/strength/functional criteria, rather than being based on an arbitrary time-point
🔘It should be individualized and for many patients it might be reasonable to commence running between weeks 8-16 post-op provided that there has been adequate progressively loaded rehab
🔘The patient should have <2/10 pain, full to near full AROM, and little to no effusion
🔘The clinician may also choose to use a battery of strength and performance-based tests