ACL re-tear rates are approximately 20-25%. That means one in every four to five athletes are suffering a second ACL tear. The question is, why are ACL re-tear rates so high? This is very much a loaded question but I’m going to contribute it to four major reasons:
- Orthopedic surgeons clearing athletes too early
- Physical therapists & athletic trainers not having a comprehensive understanding of ACL rehabilitation
- Standard physical therapy clinics are not properly equipped to handle all phases of ACL rehabilitation
- Insurance companies
Orthopedic surgeons are experts at surgery but NOT the rehabilitation process. In my experience, many orthopedic surgeons clear athletes way too early. Let me ask you, does the athlete spend more time with the surgeon or the physical therapist? Physical therapy following ACL reconstructions is lengthy and patients spend 2-3 times a week for months with the therapist. Orthopedists don’t have the time to assess how an athlete moves, how strong they are or discuss how confident they are to return to play. I’ve heard of many orthopedists (and PTs/ATs) who clear athletes at six months and that is way too early as supported by research.
Many physical therapists and athletic trainers DO NOT have a comprehensive understanding of ACL rehabilitation. Recovering from ACL reconstruction is an extremely lengthy process and is one of the most challenging injuries to overcome. It takes a significant amount of time to regain symmetrical muscle strength and confidence to restore an athlete’s ability to return to sport. Most physical therapy clinics generalize in rehabilitation and simply don’t have the capability of fully restoring an athlete back to play after ACL surgery. ACL physical therapy should be done with a physical therapist that is up to date with research and understands all phases of rehab. This could also mean referring to a strength coach who understands high level movements and strengthening. I believe some people view referring out as an indication of not being good enough. In reality it’s recognizing your limitations to do what’s right for the patient. The physical therapist and athletic trainer should be able to confidently determine when an athlete is safe to return to play through a battery of return to sport testing.
Standard physical therapy clinics are improperly equipped to handle all phases of ACL rehabilitation. Most physical therapy clinics are small, crowded and lack the necessary equipment to challenge athletes. They are capable of getting athletes back to jogging but lack the ability to address the middle to late stages of rehab. In the later phases of recovery, an athlete needs to gradually restore the ability to sprint, decelerate, jump, react and change direction. Additionally, having open field space allows the athlete to gradually improve their confidence with sport specific tasks. In standard facilities, the physical therapist is only able to see patients for 20-30 minutes before handing them off to a PT tech/aide. This is far from ideal as a physical therapist should be the one spending all of the time working with the recovering athlete.
Lastly, insurance companies are highly at fault for high re-tear rates as well. Insurances often cut off ACL patients at around 3-4 months because they deem the patients as “functional,” meaning they can get around in daily life with no issues. This is a huge issue as patients get released from physical therapy too early and have minimal direction for the rest of rehabilitation.
Physical therapy for ACL reconstructions should be done with a specialist who understands all facets of recovery. ACL tears is one of the most challenging injuries to overcome and having the right physical therapist can make all the difference. We seek out specialists for surgeons/orthopedists, dentists, mechanics, home repairs, etc. When it comes to ACL physical therapy, we call the most convenient facility and get randomly placed with a physical therapist.
I personally specialize in treating ACL reconstructions as approximately 75% of my patients are recovering from ACL surgery. I have a comprehensive understanding of the rehabilitation process from start to finish. My primary objective is to completely restore an athletes ability both mentally and physically to return to the sports they love. Our facility has a 40-yard turf field with ample equipment and weights to properly challenge athletes throughout the entire rehabilitation process. I DO refer out and work with strength coaches for the late phases of recovery. Understanding all phases and being able to execute them are two different things. I communicate with the strength coaches and let them know what I believe they should work on. This is a collaborative effort.
If you are seeking ACL physical therapy in the Rockville, MD area, please don’t hesitate to e-mail me at WesleyWang.DPT@HealthyBaller.com. You can also go to https://wesleywangdpt.com/acl-reconstruction-physical-therapy/ for more information. If you are not in the Rockville, MD area and are looking for quality care, please refer to the Clinical Athlete directory at www.ClinicalAthlete.com.