Current practice: postoperative and return to play trends after ACL reconstruction by fellowship-trained sports surgeons

PURPOSE

Advances in anterior cruciate ligament (ACL) reconstruction have allowed for many progressions in postoperative management. However, there is no standardized protocol for immediate postoperative management or return to play. Our objective was to evaluate current trends in immediate postoperative and return to sport practices after ACL reconstruction.

LEVEL OF EVIDENCE

Cross sectional study, Level IV.

METHODS

Surveys were obtained from four large sports fellowship alumni networks. Demographics included years of practice and ACLs performed per year. Postoperative questions included weight bearing status, brace use and continuous passive motion (CPM) use. Return to play included time for return, brace use and metrics used for clearance to sport.

RESULTS

A total of 143 surveys were completed (32% response rate). Average years in practice were 15.1 years. Average ACL reconstructions performed per year was 20-50 in 44% and 50-100 in 29%. 26% used CPM in all patients, 8% if concomitant meniscal repair and 66% never. Bracing after surgery was used in 84% and 48% after return to play. Return to play was allowed at 6-9 months in 67% and overall 94% from 6 to 12 months. No consensus on return to play metrics was used, with the hop test being most important followed by specific time point after surgery.

CONCLUSION

Immediate weight bearing after surgery is commonplace with intermittent CPM use. Bracing is common postoperatively and half the time with return to play. Return to play is typically allowed after at least 6 months with no consensus on return to sport metrics. Years after fellowship and ACLs performed yearly had no correlation with postoperative practices.

The surgical approach to lateral meniscal repair

Peripheral lateral meniscal tears are amenable to meniscal repair. Rasp abrasion and fibrin clot deposition along with vascular access channels are advances that, one hopes will increase healing rates of meniscal repairs. A basic principle that is not emphasized in the literature is how to perform the surgical approach to the lateral meniscus for safe placement of a meniscal repair retractor. This article reviews the anatomical planes of which the surgeon must be cognizant to facilitate retractor placement.