INCORPORATING WORKLOAD MEASURES INTO REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE REPORT

and purpose: Second anterior cruciate ligament (ACL) injury rates continue to be high, with a majority of injuries occurring soon after return-to-play, potentially because athletes may not be ready for the external load demands of the sport. Load metrics, tracked through wearable technology, may provide complementary information to standard limb symmetry indices in the return-to-play decision making process. The purpose of this case report was to quantify and monitor load using innovative technology during physical therapy rehabilitation after ACL reconstruction (ACLr) and compare to normative sport participation data.Case Description: The subject was a 12-year-old female soccer player that suffered an ACL injury followed by surgical reconstruction with a hamstring autograft and standard rehabilitation. Single-leg hop performance, isokinetic strength, and external loads (using wearable technology) were measured longitudinally during rehabilitation and analyzed at the time of return-to-play.Outcomes: The subject successfully achieved >90% LSI for isometric quadriceps strength (week 14), single leg hop battery (week 23), and isokinetic hamstrings (week 26) and quadriceps (week 31) strength by the time of return-to-play (week 39). At the time of return to play, external load metrics indicated that the subject's most intense rehabilitation session consisted of 36% less frequent movements, 38% lower total distances, and activity durations that were 29% lower than the expected demands of a match.

Standard rehabilitation may underload patients relative to required sport demands. Measuring external load during the rehabilitation period may help clinicians adequately progress workload to the necessary demands of the patient's sport. With the current emphasis on restoring limb symmetry, clinicians may need to shift focus towards load preparation when returning a patient to their sport.Level of Evidence: 4Keywords: anterior cruciate ligament, load, rehabilitation, return to play, step count, movement system.