Friday, January 16, 2009

Thought Provoking

Kudos to Dr.'s Hurd, Axe, & Mackler from U. Delaware for their article, "Management of the Athlete with Acute ACL-D. in this month's Sports Health.

The authors challenged the notion that ALL ACL deficient knees need to be reconstructed. They designed an algorithm to better predict copers & non-copers.

I work in an inner city environment. Many of my athletes lack sufficient health insurance, and often are referred to charity care when they require surgery. A long waiting period is often involved. I can't tell you how many times an athlete has gone through "prehab" during this period and said to me, "P", you know, my knee feels great! Do I really need this surgery?"

The authors point out recent research into long term outcomes for ACL reconstruction indicating it does not automatically prevent future symptom complaints or degenerative knee arthritis. They got the idea for this study when some of their student-athletes refused to follow proper protocol after "prehab", which was surgical intervention. And most of them did quite well! This prompted a shift in their clinical practice guidelines.

The authors go on to stress the importance of "perturbation training" during rehab. That is, trying to keep still on a tiltboard. I guess you already know my opinion on that. I emailed the authors and asked them what they thought of my alternative- the body moving dynamically over a fixed foot. Dr. Mackler's response was, "The systems challenged are very different physiologically". I'm not sure if that's true, and if it is, if that is a good thing or a bad thing.


Brian said...

Good question to that researcher...! Am I mistaken that the mechanism for non-contact ACL injury is movement proximal up the chain on a fixed foot..? Thus rehab should mimick the mechanism of injury...? I would think so.....

Kev said...

There is probably room enough for both ideas in the rehab of an ACL reconstructed or deficient knee .... no?

Joe Przytula said...

True Kev, and tilt boards are cheap enough, and might add some variety & fun to a rehab program. It's just the idea of the floor moving beneath the foot & the "stillness" thing that just doesn't feel right to me. I go as far as buying some cheap carpet runners at Walmart,cut it into squares, toss them on the gym floor, have the athlete jog or sprint to them, hop on with one foot & slide.

Kev said...


Really like your carpet square idea. I had to reflect on it for a few minutes but the more I think on it the more it seems to me to be a great idea.