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Improving Management of ACL Injuries in Active Athletes

In part one of this two-part study, researchers from the University of Delaware devised a screening exam and classification algorithm (steps in the decision process). These tools were used to help guide the management of anterior cruciate ligament (ACL) injuries. Active athletes were their target group.

In this study, the same screening exam was tested on a large number (345) of athletes with an ACL injury. It was used to identify factors that separated athletes who needed surgery from those who didn't. The screening exam includes joint motion, knee laxity, and quadriceps strength. Several tests involving hopping skills were also included. The patient gave a self-report on knee function as well.

Up until now, it has been assumed that knee laxity in the anterior (forward) direction was a good indicator of rehab-versus-surgical candidates. Activity level before the injury was also used to gauge function after surgery. The higher the activity level, the more likely surgery would be needed.

The results of this study bring those guidelines into question. The results showed that simple hop tests and patient surveys about knee function were better predictors of outcome.

Preinjury level of activity was not a reliable way to predict knee stability. In other words, athletes with the highest level of activity were not the ones who needed the surgery. And there was no difference in joint laxity between those who could rehab without surgery and those who needed ACL reconstruction.

This information will help guide the patient and surgeon's decision about treatment of ACL injuries in the weeks after the trauma occurs. Using the University of Delaware's screening exam and algorithm makes it easier to identify patients with good potential for recovery without surgery.

References: Wendy J. Hurd, PT, PhD, et al. A 10-Year Prosective Trial of a Patient Management Algorithm and Screening Examination for Highly Active Individuals with Anterior Cruciate Ligament Injury. Part 2. Determinants of Dynamic Knee Stability. In The American Journal of Sports Medicine. January 2008. Vol. 36. No. 1. Pp. 48-56.

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