ACL REHABILITATION - TRACK AND FIELD

Abstract

HISTORY: A 27 year old decathelete sustained a ruptured anterior cruciate ligament while pole vaulting. He underwent successful anterior cruciate ligament reconstruction using a bone-patellar ligament-bone autograft. Rehabilitation included traditional multiple-joint (e.g. squatting) and single-joing (e.g. leg extension) muscle strengthening activities, functional plyometrics, and agility training. During track and field practice and competition the following year he experienced occasional pain, swelling, and weakness upon repeated curve running, throwing, and jumping. PHYSICAL EXAMINATION: Except for occasional pain at the harvest site and joint swelling, results of physical examination were normal. Manual muscle tests of lower extremity musculature and isokinetic tests of lower extremity muscle strength were inconclusive; no significant side-to-side deficits were detected. An isokinetic evaluation was used by the physician to clear the patient for full return to normal athletic activity. Knee extension range of motion was symmetrical but knee flexion range of motion was slightly less on the involved side. DIFFERENTIAL DIAGNOSIS: Loss of explosive strength of the involved knee extensor musculature Muscle strength imbalance between hip, knee, and possibly ankle musculature in the involved leg (IL) TEST AND RESULTS: Functional lower extremity testing: - Single leg hop test: Slight increase in knee instability in the IL - Multiple maximal single leg hops: Significant loss of explosive knee extension strength and stability in the IL Kinetic and Kinematic Analysis of Squat Exercise: - Increased involved-limb hip and ankle moments and a decrease in involved-limb knee moment with no change in joint kinematics - Preferential loading of the IL (increased Vertical Ground Reaction Force IL) FINAL/WORKING DIAGNOSIS: Lack of quadriceps strength and excessive hip extensor strength in IL TREATMENT AND OUTCOMES: Alter methods of performing all closed kinetic chain exercise to emphasize hip moment in uninvolved leg and knee moment in the IL Add single leg open kinetic chain quadriceps exercise for involved leg Side to side differences in function no longer evident at 6 weeks No report of pain, weakness, or swelling with training after treatment Supported by California Physical Therapy Fund #99–14