Page 202 - Demo

Chapter 10200Chapter 8 describes a feasibility study on our newly developed rehabilitation protocol for patients after ACL reconstruction. In the search to offer patients a patient-centred alternative to rehabilitate after ACL reconstruction, we developed the Knee Rehabilitation on Skates (KROS) protocol. The skating position requires a high amount of trunk balance and prolonged squatting, enhancing the posterior kinetic chain. Despite the influence of COVID on this study, we have shown that further exploration of the KROS protocol is feasible and that, despite the small sample size, functional and strength limb symmetry is not different than that of subjects who followed the routine rehabilitation protocol. Athletes who prefer to be challenged and are looking for a fun aspect to rehabilitation may be interested in this alternative rehabilitation protocol. Chapter 9 highlights the results of the studies and presents implications for individualisation of ACL reconstruction. Special attention is turned towards biological, mechanical, neurogenic and psychological aspects that influence return to sports. To understand why patients do not return to sports, it is essential to evaluate patients in sport-specific circumstances, and hop test batteries are very useful in this respect. It is advised to emphasise in the preoperative consultations that even one year after ACL reconstruction altered knee kinematics still show, which indicates that rehabilitation requires more than one year. During ACL reconstruction it is important to recognise and respect the individual ACL anatomy. In current practice preoperative MRI images and remnant preservation can be useful, but patient-specific instrumentation could be the way to go for the future. Individualising the care for ACL-injured patients is not limited to the surgical procedure: individualising ACL rehabilitation can be a way to enhance participation and compliance. It is therefore important to address the topic of rehabilitation and discuss patient expectations and goals in the preoperative consultations. All in all, ACL reconstruction is only one item in the toolbox when treating a patient with ACL injury aiming to return to sports. It should be recognised that a one-size-fits-all approach is no longer appropriate in the treatment of ACL-injured patients, but rather a patient-centred approach is needed along all five R’s of the ACL: from rupture, rotation, reconstruction and rehabilitation towards return to sports. Mark Zee.indd 200 03-01-2024 08:56