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The Hockey Doc ACL reconstructions
QUESTION: I have had several people contact me about anterior cruciate ligament reconstructions and their implication on
ice hockey. I will try to answer several of these questions in this column.
ANSWER: One of the
most frequent questions that I have about
Thus, it is not unreasonable for someone
with minimal instability and at the end of the year to try to rehabilitate
their knee in an attempt to get back to skating for the rest of the season.
However, for those athletes at the beginning of a season or who have
significant instability on their exam, it is probably best to look at having
the
In terms of the choice of grafts, for
athletes younger then 25, it is almost universally recommended that they have
their own tissues used rather than that of a cadaver (allograft). This is
because studies have shown that the risk of re-tear is much higher at this age
group when using an allograft.
While using an allograft does allow one
to have less pain and theoretically get back to competition sooner, the results
of revision
The issue of whether to use a patellar
tendon autograft or hamstring autograft
can be depended upon one’s natural laxity, whether one plays other contact
sports and what the surgeon does best in his or her own hands. In general,
using one’s patellar tendon autograft is still
considered the gold standard for an
In terms of rehabilitation issues after
an anterior cruciate ligament reconstruction, for the
first few weeks we stress patients to try to get their range of motion back and
also work on reactivation of their quadriceps mechanism. We have found that
those patients that get their knee out straight after surgery tend to have a
much quicker return to function.
For the first couple of weeks after
surgery, we stress patients staying on crutches until they can walk without a
limp. We also request that they stay in their knee immobilizer until they can
do a straight leg raise without an extension sag. Once
they can do this, they can usually progress off of crutches.
It is important for the first six weeks
after surgery not to do any extensive lifting, twisting, turning or pivoting as
it takes a minimum of six weeks for the bone plug from the
Between weeks 6 and 12, athletes are
allowed to progressively increase their activities on the use of a stationary
bike, an elliptical machine and leg presses as tolerated. Towards the end of
this time frame, they may work on more involved exercises and work on the
balancing program.
At three months postoperatively, most
athletes are strong enough that they could start a jogging and running program.
They may also work on more sports specific activities. It is usually about this
time that we allow athletes to return back to skating but they should not have
any contact. We also recommend that they avoid any significant twists, turns or
pivoting and usually avoid crossovers for the first 1-2 weeks after they get
back to skating.
When an athlete has full return of their
strength and function, which is usually right around five months after surgery,
we will test them to make sure that they have good agility, balance and overall
strength. If they pass these tests, we then allow them to get back to full
on-ice activities.
We have found out that athletes that return
back to competition sooner then this have a higher risk of re-injury of their
anterior cruciate ligament and we generally recommend
against returning to competition sooner then 4 1/2 to 5 months postoperatively.
The issue of when to return to play after
an
Dr. Rob LaPrade,
MD, PhD, is the team physician for the