Physical Therapy Continuing Education: Rehab Post Acl Surgery

Many of the Physical Therapy continuing education courses I have attended are taught by other Physical Therapists. Since many of the patients we see on a regular basis are post surgical, I'm surprised more courses don't have input from orthopedic surgeons.

We recently interviewed a prominent orthopedic surgeon to get his input on rehabilitation following an Anterior Cruciate Ligament (ACL) reconstruction surgery.

Here are some excerpts from the interview.

PhysicalTherapyContinuingEducation.Org: What are some of the key outcomes you are looking for when a patient comes back to see you after the surgery?

ACL Surgeon: So, I think important things are early on, again, gaining that extension, decreasing the swelling, getting that motion going, and then getting them on a bike and really working with them. And then the other thing is not trying to do things too fast. Ive seen some patients that have come back from therapists and said, Well, they tried to have me do this jumping or running or hopping or things like that before they were ready, and again, that was not necessarily in my protocol. Sometimes the patients doing so well that the therapist thinks that they may be able to do advanced things sooner, and that may not be the case.

So, communication I think is important, and both with the issues that are going on that are not good, or issues that are good that they may want to communicate and say, Johnny looks great and is doing real well. What do you think about doing this? And I really appreciate that kind of feedback and I appreciate the time that is taken that somebody like you will take with the athlete, and the expertise that you take in really getting this patient back.

If I do a good surgery and everything goes great but we dont have good rehabilitation then its all for not. At the same time I give a huge amount of credit to the physical therapists and the athletic trainers that work with these athletes because theyre really helping the athletes along, and getting them to where they need to be, and if we didnt have them then they wouldnt be able to get back. So, I think its really a joint effort and a combined effort that we can all take pride in when the athlete does get back on the field.

PhysicalTherapyContinuingEducation.Org: Excellent. Any exciting work on the horizon that youre aware of in regards to ACL reconstruction?

ACL Surgeon: It continues to advance. Theres some work with some of my colleagues that I used to work with at Vanderbilt in Tennessee that theyve been looking at growth factors and ways to potentially help to optimize healing of the ACL and looking at different scalpels that we may be using. Some off the shelf ACL type tissue that may be grown in the lab. That may be a ways off, but I think thats very interesting.

Additionally, I think the rehabilitation continues to evolve and advance, so I think thats exciting as well. We continue to gain a better understanding of what were doing and how to get people back and been very happy with the results.

Some of the work too, and Ive done some of the double bundle type procedures, I think theres a role for those, maybe not as a primary ACL type of surgery, but using two tunnels for the ACL and revision surgery may be very helpful and Ill be very pleased with that. So, theres some work done there that weve all got a great understanding of the anatomy of the ACL and again, I think understanding where to place the ACL is really important and that has come under great understanding with the concept of the two tunnel or double bundle techniques as well.

So, I think its all evolving and we are getting better at fixing these. Were getting better at doing the rehabilitation and providing better outcomes for our patients, and thats really what its about.