Abstract
Current return to sport (RTS) timelines after anterior cruciate ligament reconstruction (ACLR) suggest a minimum of 9 months before returning to competitive sports. Time, quadriceps limb symmetry index (qLSI) deficits and movement mechanics are recognized as indicators of RTS surgical limb performance and re-injury risk reduction. Current isolated therapy models may not provide appropriate skilled rehabilitation leaving individuals with impairments near the end of their care. PURPOSETo examine the effects of combined therapy and group-based strength training on known RTS strength criteria following ACLR surgery. METHODSTwenty-two individuals (17 +/- 2 years) having undergone ACLR (CON) were age, sex and graft harvest matched with individuals who participated in a group-based strength and conditioning program between 3 and 9 months post-surgery (ACLRSC). 900 flexion isometric dynamometer strength testing was administered at 3, 6 & 9 months post-surgery. Individuals maximally kicked out for five seconds and was repeated 3 times. Dependent strength variables were average peak torque (Nm), relative torque (Nm/kg) and qLSI (%). ACLRSC completed strength sessions between 3 and 9 month testing (40 +/- 1 visits). The primary quadriceps specific stimulus was closed kinetic chain, semi supported, single leg squat exercises beginning with an asymmetrical loading ratio of 3:1 of exercise sets and progressed to 2:1 and 3:2 for the surgical limb compared to nonsurgical. Independent samples t-tests were used to determine differences in strength variables per group. RESULTSNo significant differences between groups at all time points in surgical limb average peak torque or relative torque (p > .05) was. No difference was found in qLSI at 3 or 6 (p > .05) months. However, at 9 months post-surgery qLSI was significantly higher in the ACLRSC group compared to CON (p = 0.03). CONCLUSIONIndividuals who completed combined therapy and training during rehabilitation reach RTS qLSI criteria at 9 months post-surgery compared to those who do not complete additional training. This model of combined therapy and group-based strength training proves to increase positive functional outcomes after ACLR. It further justifies the importance of a team based, patient centered, objective measure driven rehabilitation model.
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