Anterior cruciate ligament surgery and rehabilitation: does anybody really know what time it is?
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EDITORIAL
Anterior cruciate ligament surgery and rehabilitation: does anybody really know what time it is? John Nyland1,2 · Mahmut Nedim Doral2 · David N. M. Caborn3 Received: 27 October 2020 / Accepted: 2 November 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
An index anterior cruciate ligament (ACL) injury occurs at the instant of tissue failure as the athlete suddenly feels a pop, shift, buckle, or giving-way event. This defining moment occurs in the lives of many primary, secondary, and college athletes every year [13]. At onset and thereafter, the memory of this life-changing event may influence future career, education, vocation, and life sporting activity choices. Memory of this event often becomes a recurring discussion topic for the remainder of a person’s life. When the index ACL injury involves a contact or collision mechanism, the athlete’s knee is more likely to * John Nyland [email protected] 1
Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
2
Department of Orthopaedics and Traumatology, Dr. Rıdvan EGE Hospital, T.C. Ufuk University, Ankara, Turkey
3
Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
immediately transition from a purely pre-morbid to a suddenly morbid condition. During a non-contact knee injury event, however, additional factors should be considered. Might the sudden tissue failure have been related to an unrelenting series of high-intensity sports maneuvers and practice sessions often combined with supplemental strength and conditioning training with limited or no dedicated time for active recovery, remodeling, regeneration, or healing? Or, given the restrictions associated with the COVID-19 pandemic, might it have been related to severe under-training? While it is unlikely that a single event in this context was the sole causative factor that prompted sudden tissue failure, somewhere in the milieu of aggregate life activities lies the answer to this puzzle. How best should the ratio of active recovery and training be managed or “periodized” [10]? Knee surgeons place considerable value on “time zero” or time of surgery information such as the selected surgical approach (repair, reconstruction, or a combination of both), lesion characteristics, graft and fixation type, tunnel or socket locations and dimensions, etc. Information gleaned from pre-operative clinical evaluation and imaging studies [1], and the index surgery often helps guide patient
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care decisions over the ensuing weeks and months post-surgery. We know from in vitro biomechanical studies, however, that this information has little or no bearing on tissue healing, neuromuscular function recovery, patient perceptions of function, fear, and pain, return to sports readiness, or many other essential outcome factors [6, 7]. Return to sports timing is another widely discussed key recovery topic. What does thi
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