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Return to play preparation following ACL reconstruction: Implications for the hockey player

Joe Eischen PT, SCS, ATC, CSCS Mayo Clinic Sports Medicine Center

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Necessary Milestones:

• Full range of motion.

• Minimal to absent effusion.

• Normal gait.

• Progression of neuromuscular lower extremity control exercises.

• Progression in core training.

• Tolerating aerobic progression.

• Tolerating low level agility drills.

• Proper loading and unloading mechanics.

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Return to play programs following ACL reconstruction:

• What does the literature say about returning the hockey player following ACL Reconstruction?

• Not much…

• Tyler, McHugh. Neuromuscular Rehabilitation of a Female Olympic Ice Hockey Player Following Anterior cruciate ligament Reconstruction. JOSPT 2001; 31 (10): 577-587.

• Pierce, Laprade, Wahoff, O’Brien, Philippon. Ice Hockey Goaltender Rehabilitation, Including On-Ice Progression, After Arthroscopic Hip Surgery for Femoral acetabular impingement. JOSPT March 2013, Vol. 43, Number 3.

Many articles on soccer and basketball:

• Bizzini, Hancock, Impellizzeri. Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer. JOSPT April 2012, Vol. 4, Number 4.

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How do we safely and effectively return a hockey player to the game?

• Skating treadmill:

• Safe.

• Improve mechanics.

• Build endurance and power.

• Build player confidence.

• Build medical staff confidence.

• Individual skating progression.

• Partner skating progression.

• Non-contact team drill progression.

• Re-introduction to contact.

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Dartfish and the skating treadmill

• Team approach:

• Interaction of skating coach, PT and patient.

• Assess fundamentals of skating.

• Progressive reintroduction of joint to skating.

• Patient excitement.

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See it, feel it, do it………..

• Through the analysis of the patient’s skating with the skating coach and Physical Therapist patient is made aware of potential flaws.

• Baggage prior to injury.

• Flaws related to current MSK status.

• Leads to:

• Education of patient on rationale of various training exercises.

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Skating video

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Dartfish Analysis:

Trunk Tilt:

10 degree difference while on right side.

Concerning for:

Ligament dominance movement fault with valgus stress to right knee.

Trunk dominance movement fault.

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Dartfish Analysis

Hand rotation:

Will this lead to more valgus stress at the knee?

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Dartfish Analysis

Side view

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Now Let’s Train It!

• Refocus rehab/training based on what we are seeing in our skating analysis.

• Better patient buy-in.

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Bibliography • Bizzini, Hancock, Impellizzeri. Suggestions From the

Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer. JOSPT April 2012, Vol. 4, Number 4.

• Tyler, McHugh. Neuromuscular Rehabilitation of a Female Olympic Ice Hockey Player Following Anterior cruciate ligament Reconstruction. JOSPT 2001; 31 (10): 577-587.

• Pierce, Laprade, Wahoff, O’Brien, Philippon. Ice Hockey Goaltender Rehabilitation, Including On-Ice Progression, After Arthroscopic Hip Surgery for Femoral acetabular impingement. JOSPT March 2013, Vol. 43, Number 3.

• Hewett, Ford, Hoogenboom, Myer. Understanding and Preventing ACL Injuries: Current Biomechanical and Epidemiologic Considerations-Update 2010. NASPT Vol. 5, No. 4, December 2010

• Adams, Logerstedt, Hunter-Giordano, Ax, Snyder-Mackler. Current Concepts for anterior cruciate ligament Reconstruction: A Criterion-Based Rehabilitation Progression. JOSPT, July 2012, Vol. 42, No. 7.

• Reid, Birmingham, Stratford, Alcock, Giffen. Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction. Physical Therapy. Vol. 87, No. 3, March 2007.

• Crieghton, Shrier, Shultz, Meeuwisse, Matheson. Return-To-Play in Sport: A Decision-based Model. Clin J Sport Med, Vol. 20, No. 5, September 2010.

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Thank You