Returning To Football After Anterior Cruciate Ligament Surgery

Young football players work hard every season at every competitive level, from little league to NCAA, in hopes of making it to the National Football League (NFL). However, football is inherently dangerous and risky due to the nature of the sport. Football involves power, speed, agility, and brutal collisions. Injuries and setbacks are inevitable.

 

How Common Are Knee Injuries In Sport?

Injuries to the knee are widespread in football. One study showed that knee injuries incurred during football accounted for roughly 15% of all high school injuries.1 As youth athletes continue to grow in their sport, so does the risk of injury. The literature shows that knee sprains, for example, increase the rate of occurrence as the competition level increases.1 However, a knee sprain is mild trauma and will recover rapidly compared to a fully torn ligament of the knee. Another study revealed that “knee injuries are the most common serious injuries, accounting for 60% of high school sport related surgeries”.2 These injuries can happen in training, competition, during a collision, or even non-contact with poor footing when cutting on the field.

american football knee injury

 

How Common Are ACL Injuries?

Of the several ligaments that keep your knee intact, the anterior cruciate ligament (ACL) is of particular interest, given that ACL injuries make up for 50% or more of all knee injuries.2 A torn ACL is costly on the most valuable resources, time, and money. The athlete would require surgical repair and a lengthy bout of physical therapy if they want to return to their sport safely.2 Otherwise, the athlete risks re-rupture of the ACL and starting the process over again. Moreover, suppose the injury is not managed well. In that case, the athlete also has a higher predisposition to early-onset arthritis and long-term chronic pain, affecting their health and function in future years.2,3,5

illustrtion of torn acl

What Is The Relationship With Physical Therapy And ACL Rehab?

On their first visit during evaluation, the number one question (physical therapists) PTs receive from all patients, especially athletes, is “When can I return to my normal activity?” or “When can I play again?”. It’s a tough question to answer, given the wide variety of variables that can dictate the course of outcomes. The answer warrants a healthy dose of education to ensure the patient understands and will follow through with the rehabilitation plan for maximum positive results. For some patients, the first day of PT is actually before surgery in the “prehab” phase to minimize swelling and maximize knee mobility and quadriceps strength.3 It’s well documented in the literature on the benefits of pre-surgical rehabilitation and its effect on long-term outcomes after ACL reconstruction.3 If the athlete does (and should) start PT before surgery, the PT can educate the patient on the pros and cons of possible graft choices to repair their ACL and what to expect in progressive rehab phases after surgery from the first week to several months later. Thankfully, extensive research was conducted for ACL reconstruction about the factors, criteria, and timing for a safe return to sport.

ACL-injury-bandage

How To Safely Determine Return To Football After ACL Surgery?

Safety is of utmost importance for the young athlete through their journey of athletics, including training, competition, physical therapy process for returning to sport, and their long-term health. However, the rates of a repaired ACL reinjury and re-rupture are high with young athletes due to return to level one sports, including movements such as pivots, cutting, and jumping needed in football, basketball, and soccer.4 Athletes who return to level one sports after repairing their torn ACL are four times more likely to retear the same knee and five times more likely to tear the ACL in their other knee.3

The timing of their return to sport is critical, considering half of reconstructed ACL graft ruptures occur during the first year after their surgery.4In fact, the rate of reinjury was decreased by 51% for every month the athlete was restricted on return to sport until they reached nine months after the surgical reconstruction.5 Aside from time-based guidelines corresponding with biological processes of healing, it’s also important for the athlete to follow criterion-based milestones for performance for the athlete’s ability to participate in progressions of running, sprinting, plyometrics (jumping), agility, cutting, pivoting, and progressive return to competitive sport.3,5 For a specific example, if there is a >90% symmetry of quadriceps strength between the athlete’s knees, this significantly decreases their risk of reinjury in conjunction with a delayed timeframe for return to sport.3,5 The last component to minimize reinjury risk for a safe return to football includes a primary and secondary prevention program to ensure the athlete maintains the progress gained in physical therapy, including proper dynamic warm-up, strength, agility, and plyometric training.3

 

How Can Physical Therapy Help?

Overall, a torn ACL is devastating to football, soccer, or basketball athletes. However, recovery is possible with the help of a Physical Therapist. Your PT can help you manage the injury in the preoperative phase of rehabilitation by minimizing pain and swelling and maximizing strength, mobility, and functional activities of daily living. Furthermore, your PT can help educate you on the pros and cons of various graft options for surgical reconstruction and what progressions to expect postoperatively from the first week to the ninth month. Most importantly, your PT will develop and execute a personalized, comprehensive plan of care to optimize your outcomes for a safe return to the gridiron.

 


For a thorough evaluation and individualized treatment, contact our Sherwood clinic or our Bethany clinic today, and be seen in less than 48 hours.

Check out what injuries we commonly treat and what to expect during an appointment.  


 

Josh “JP” Pate is originally from Lafayette, Louisiana. He studied Kinesiology at Louisiana State University, where he earned his Bachelor’s degree. JP graduated with a Doctorate in Physical Therapy from the University of St. Augustine for Health Sciences in San Diego, CA, at the top of his class with an award for orthopedics and manual therapy. Following PT school, JP moved to Portland, OR, where he practices in outpatient orthopedic and sports. JP’s patient care emphasizes functional movements, strength training, manual therapy, proactive symptom management, patient education, and empowerment.

 References 

  1. Clifton DR, Onate JA, Schussler E, Djoko A, Dompier TP, Kerr ZY. Epidemiology of Knee Sprains in Youth, High School, and Collegiate American Football Players. J Athl Train. 2017;52(5):464-473. doi:10.4085/1062-6050-52.3.09 
  2. Joseph AM, Collins CL, Henke NM, Yard EE, Fields SK, Comstock RD. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train. 2013;48(6):810-817. doi:10.4085/1062-6050-48.6.03 
  3. Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports Health. 2021 Dec 13:19417381211056873. doi: 10.1177/19417381211056873. Epub ahead of print. PMID: 34903114
  4. Webster KE, Feller JA. Return to Level I Sports After Anterior Cruciate Ligament Reconstruction: Evaluation of Age, Sex, and Readiness to Return Criteria. Orthop J Sports Med. 2018;6(8):2325967118788045. Published 2018 Aug 2. doi:10.1177/2325967118788045
  5. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016 Jul;50(13):804-8. doi: 10.1136/bjsports-2016-096031. Epub 2016 May 9. PMID: 27162233; PMCID: PMC4912389.