ACLR – ACL Reconstruction in the Professional Or Elite Athlete

There are several important factors to consider prior to ACLR. An individualised ACLR has proven to improve outcomes, but larger studies are needed to determine the true efficacy of these procedures. Graft selection and return to sport are also critical issues to consider. In addition, there are psychological factors to consider when planning a sports-specific surgical procedure. This article will provide helpful information about ACLR in the professional or elite athlete.
Analyzing ACLR – ACL reconstruction in the professional or elite athlete

The current ACL guidance for athletes has been inconsistent. It is unclear how to manage ACL injuries, and a conflict of interest may arise when studying the care of athletes. Fortunately, there are some strategies that can help prevent ACL injury and improve athlete outcomes. In this article, we will discuss three of these strategies. In addition to determining the optimal surgical procedure, you should also determine the athlete's level of activity.

One effective strategy for determining limb asymmetry is to use alternate directions of travel (ADT). In this test, athletes with ACLr may have symmetrical performance in the VGRF upon landing. This could be attributed to decreased acceleration and protective deceleration, and could improve athletic performance. However, this technique requires advanced training and specialized testing. Those who perform the procedure should be atop a team.
Graft choice

The graft choice for ACL reconstruction in the professional and elite athlete may be influenced by the time required for return to play and the desired postoperative outcome. The use of allografts and HT autografts may facilitate a quicker return to play, while there is some evidence that allografts may pose an increased risk of second injury. Further, there is a significant risk of graft rejection and second injury.

An autograft is almost always the better choice for young competitive or recreational athletes. Hamstring or cadaver grafts are preferred by most orthopedic surgeons. However, autografts may be ineffective for older patients, and they may require ACL revision surgery if the graft fails to heal properly. A study by the MOON Knee Group evaluated the incidence of contralateral ACL graft revisions, and the authors concluded that an autograft was still better than no graft at all.
Return to sport

Whether an athlete should return to sport after ACLR reconstruction is a controversial topic. The literature is largely unclear, and the return-to-play criterion for professional and elite athletes is still under debate. Return to sport after ACLR reconstruction is typically defined as the athlete's ability to perform at a pre-injury level, with performance statistics decreasing after surgery. While return to performance is an important goal for many athletes, there is currently little empirical research supporting it.

While there is no set timeframe for an athlete to return to sports after ACLR reconstruction, athletes who have recently undergone ACLR reconstruction have higher risks of reinjury and graft rupture than those who did not receive the procedure. The risk for contralateral ACL injury is greatest in the first two postoperative years. However, as the recovery period increases, so does the risk of contralateral ACL injury. There have been numerous studies conducted to investigate this topic, but the majority of studies report that age and sex are major risk factors for graft rupture after ACLR reconstruction.
Psychological factors

The current literature shows that psychological factors play an important role in determining the successful recovery and return to sport after an ACL injury. The participants in the present study reported several psychological barriers to returning to sports. These barriers include the perception of pain and stiffness, perceived barriers to physical activity, and the athlete's level of motivation and self-efficacy. The psychological factors of ACLR recovery in the elite and professional athlete may differ in men and women.

Young athletes often demonstrate an unrealistic sports passion and lack the maturity to evaluate their readiness to return to sport. Because of these characteristics, it is difficult to understand their decision-making processes regarding return to play. In order to better understand this patient population, clinicians must consider the impact of psychological factors on sports participation, including adolescent athletes' self-identity and concepts. The aim of this article is to synthesize the current research and provide recommendations for treating this patient population.