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When to Run When You Have Anterior Cruciate Ligament (ACL)?

April 8, 2020

“Criteria for Return to Running after Anterior Cruciate Ligament Reconstruction: A Scoping Review”, reviewed by Mick Hughes (@mickhughes.physio)

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

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