Journal Club: Orthopedic Sport Edition

I spun the wheel of Journal Club topics and it landed back in the orthopedic/sport rehab world.  Today, we will be dealing with the infamous ACL reconstruction!  Now, if you have been in the orthopedic/sport rehab field for any duration of time, you will recognize that this is a common surgical procedure and you have most likely treated several patients who have had ACL reconstructions.
  
There are so many types and ways to repair the ACL from using hamstring grafts to patella tendon grafts to even cadaver grafts.  Each surgeon you work with will have his or her “go to” surgical technique and rehab protocol to guide the recovery process.  Generally, though it’s a rather lengthy process with certain milestones across the months ultimately ending with a functional return to sport test.

I’m sure you administer functional return to sport testing when the time comes just as I do.  We want to make certain that our patients are strong, stable, and ready to return to their respective activity objectively.  But what about mentally?  What about psychologically?  Are we assessing the psychological readiness of the patient to return to sport alongside the objective data?

We don’t want to miss this aspect of recovery and this was the discussion of our recent journal club meeting.  We discussed a psychological tool to administer to our patients who are recovering from ACL reconstruction.  That tool is the ACL Return to Sport after Injury Scale (ACL-RSI).  Below you will find the actual questionnaire along with 2 articles that provide more information about the tool and factors affecting psychological readiness.

ACL-RSI Tool         Factors Associated with Psychological Readiness        Progression of Psychological ACL-RSI Score
      
I think the main takeaway from these articles is being able to identify overconfidence or under-confidence in a patient. That will enable us, as the clinicians, to spend time educating the patient appropriately.  If a patient tests really well objectively but displays anxiety or timidity with full return to sport or activity, we can talk to the patient and coach them to see they are, indeed, ready.  Likewise, if a patient tests poorly during the objective measures but has a really high confidence index and thinks they can do more than what their knee can actually handle, we can educate on the importance of continued strengthening and activity caution.

I hope you begin to utilize ACL-RSI in your practice.  I think it will only improve your outcomes as you consider both the objective and subjective aspects of ACL reconstruction rehabilitation. Let’s go change the rehab world! 

​Jason

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