Call for a Paradigm Shift in ACL Rehab


ACL Injury and Return to Play

For athletes whose lives revolve around their sport, having an injury that takes them off the playing field can be to play (RTP), we may be setting them up for failure by putting them back on the field prematurely.

ACL rupture is a common sports injury that can range in degree of damage from mild tocols should be considered on a case-by-case basis.

The Trouble with Time-Based Protocols

To date, established proto your destination, depending on where you are coming from.

Given the many factor play within a given period of time, when they may not yet be ready. Premature RTP sets the athlete up for impaired performance and further injury.

Proposal for Criteria-Based Protocols

With years of experience working with injured athletes, Wilson knows that recovery time varies from one athlete protocol identifies phases of recovery, and specifically outlines performance and readiness standards for each phase.

Phases of Recovery for RTP

Wilson identifies four phases of recovery for RTP, each with its own punchlist of performance and readiness standards:

● Phase I: Acute phase from injury to full ambulation without supportive devises.
● Phase II: Jogging.
● Phase III: Return to sport with agility training.
● Phase IV: Return to play with a pain scale score of ≲ 2.

Each phase uses multiple assessments to establish the degree of recovery, including balance tests, joint range of motion, landing pattern assessment, pain scale, functional performance tests and more.

“You’re Ready When You’re Ready”

The time it takes an individual athlete tor.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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