Readiness for return to sports activity after ACL surgery depends on many factors. We like to see evidence from our physical exam that the graft is properly healed, motion is back to normal, and strength is nearly normal. My partners at Stanford and I also place a lot of emphasis on normalized landing mechanics and other movement-based measurements. And another area we like to consider is whether the athlete herself/himself feels ready to return to sports. It turns out the psychological readiness is a bigger factor than we’ve realized.
Athletes after ACL surgery often get fixed on a return to play timeline. Sometimes this is media driven, as some professional athletes return to their sport at about 6 months after surgery. And sometimes the timeline is highly influenced by an upcoming season. In these cases it’s easy to let the timeline become the dominant thought in the athlete’s mind about return to play.
Most orthopedic surgeons defer to the opinion of the athlete, the athlete’s family, physical therapists, or athletic trainers when determining an athlete’s readiness for return to play. Those individuals are closer to the athlete on a day-to-day basis and are better tuned in to the athlete’s psychology.
A recently published study attempted to identify whether psychological readiness to return to sports after a first ACL injury and reconstruction surgery was associated with a second ACL injury. They found that lower psychological readiness (as measured by a psychological readiness scoring test) was in fact a risk factor for a second ACL injury in the under-20 age group.
This is important because the under 20 athlete has a much higher rate of ACL re-tear compared to older athletes.
The study was designed to examine the correlation between the psychological readiness score and a subsequent ACL re-injury, but the central question of “why” remains. These are young athletes who passed all the other stringent criteria for return to play, and still their risk of a second ACL tear was higher than the comparison group with high psychological readiness.
Does the lower psychological readiness somehow lead to “fear” during return to play? And does that somehow lead to changes in function during sports? Right now we’d have to say that’s pure speculation.
What we can definitely say is that psychological readiness is an important component of the overall return to play criteria. I ask my patients to “listen to the voice in the back of their head” when thinking about readiness for sports. If the voice tells you “hey, maybe we need a little more time” then you’d be wise to listen and give it some additional time.
Make sure that voice says you’re good to go before you get back in the game.
√ Many criteria are used to advise an athlete on return to play after ACL surgery.
√ Psychological readiness (whether an athlete feels confident to return to play) is an important component.
√ Young athletes with low psychological readiness may be at increased risk of a re-tear of the ACL surgery.Responding to a knee injury: When to immediately see a doctor or go to ER
(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury management course and the Good to Go injury assessment App for coaches, managers, parents and players. Mishra writes about injury recognition and management at SidelineSportsDoc.com blog, where this article first appeared.)