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Questions and Answers
What is the primary focus of ACL prevention programs?
What is the range of injury rate reduction mentioned in the text due to ACL prevention programs?
Who benefits more from ACL prevention programs according to recent studies?
When is the recommended time to start ACL prevention programs for patients?
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What is the significance of ACL prevention warm-up for young female athletes?
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How does ACL prevention relate to early onset OA, according to the text?
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What is the main purpose of patient education mentioned in the text?
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How does manual therapy contribute to recovery after surgery according to the text?
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What do the general suggestions for rehabilitation include in the text?
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Which category of protocols is specifically mentioned for comorbid pathologies?
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What is a key difference between hamstring graft protocols and other rehab protocols mentioned in the text?
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How many stages do most ACL rehab protocols typically span according to the text?
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Why does the text suggest that all 12-25 year old athletes in ACL-risky sports should undertake ACL prevention protocols?
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What percentage of patients might experience a second ACL rupture within a few years?
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What percentage of patients might require meniscus surgery within 5 years after an ACL tear?
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What is a recommended strategy for those who have already experienced ACL tears regarding daily activity and BMI?
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What do studies by LaBella, Olson, and Petersen suggest regarding ACL prevention protocols?
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What type of training is suggested as best practice for ACL injury prevention according to the text?
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What is suggested as a key factor for better injury prevention outcomes in prevention programs?
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What percentage of patients expect a full recovery after ACL surgery?
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What is one of the unrealistic expectations patients have regarding ACL procedures?
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What is the purpose of informing patients about return to function thresholds?
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What are some benchmarks that indicate readiness to start prehabilitation for ACL surgery?
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Why are females more likely than males to suffer ACL tears?
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What is a common symptom experienced by patients when the ACL tears?
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What percentage lower re-tear rate do patients have if they pass return to sport batteries?
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Which factor is NOT identified as a risk factor for ACL tears?
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What is the significance of informing patients about return to function thresholds?
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Study Notes
ACL Prevention and Rehabilitation
- Primary prevention for ACL injury can reduce injury rates by 52-88% (literature reviews suggest).
- Prevention programs seem to work better for males than females, but are still effective for both.
- ACL injury severity may also be reduced with these programs.
- Prevention programs should start in the off-season and progress into the regular season, with a warm-up before practice and games.
ACL Rehabilitation
- Patient education should temper patient expectations, set thresholds for a successful recovery, and teach the patient about activity modulation, weight-bearing status, RoM precautions, crutch use, icing, and brace use.
- Manual therapy can increase mobility of the patella and address myofascial dysfunction after surgery.
- Clinical practice guidelines suggest advocating for prehabilitation, encouraging early mobility, weight-bearing, ice, and bracing, and promoting strength and motor control.
- Guidelines argue against rehab lasting longer than 16 weeks.
Protocols for ACL Rehabilitation
- Protocols usually fall into four categories: accelerated, regular, hamstring graft, and concomitant surgery for comorbid pathologies.
- Differences between protocols involve specific precautions, like not challenging the hamstrings after a hamstring graft, and progression through stages.
- Most rehab protocols flow through six stages, from preoperative visits to return to activity.
Importance of ACL Prevention and Rehabilitation
- All 12-25 year old athletes in ACL-risky sports should undertake ACL prevention protocols, regardless of gender or dynamic valgus and weakness.
- Up to 30% of patients have a second ACL rupture within a few years, and 50% go on to have meniscus surgery within 5 years.
- OA rates climb close to 50% for those with a comorbid condition.
Secondary Prevention and Return to Sport
- Patients who have already experienced ACL tears should participate in daily activity and maintain a healthy BMI to reduce the risk of re-tear.
- Patient education should include information on re-tear rates, especially for athletes returning to pivot sports.
- The re-tear rate drops for every month you wait to return to sport, up to 9 months.
Effective ACL Prevention Programs
- Effective programs work on core, hip, and knee control, and include strength and plyometric training.
- Knee-only programs don't work, and programs that focus on balance have been shown to increase injury risk.
- The longer the exercise session, the higher the frequency, and the more compliant the athlete, the better the injury prevention.
Pre-Surgical Rehabilitation (Prehabilitation)
- Prehabilitation has mixed but positive evidence, with increases in quad strength, single-leg hop testing, return to sport ability, and self-reported measure scores at 3-months and 2 years.
- Patient education should include discussing expectations, return to sport, and functional events.
- Informing patients about return to function thresholds increases compliance, and those who pass return to sport batteries have a 32% lower re-tear rate.
Patient Characteristics and Risk Factors
- ACL tears typically present with deep, diffuse pain surrounding the knee.
- Patients are typically athletes between 15-40 who participate in a pivot sport, and are 2-8 times more likely to be female than male.
- Risk factors for ACL tears include fatigue, generalized laxity, decreased ACL size, hormonally influenced changes in laxity and motor control, and lower peak force production.
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Description
Explore the profound piece of advice from AOPT practice guidelines suggesting ACL prevention protocols for all athletes in ACL-risky sports, regardless of gender or risk factors. Delve into the hesitancy of researchers in making broad recommendations for all athletes.
