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Emory Faculty Members Collaborate to Change Standard of Care for Rehab After ACL Surgery

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(from L to R) Emory DPT Assistant Professors Mark Lyle and Peter Sprague and Emory Sports Medicine’s Jenny Hunnicutt.

Two Emory DPT faculty members, in collaboration with a team of caregivers from the Emory Sports Medicine Center, are leading a series of research projects that have the potential to change the standard of care in the treatment of patients who have had ACL reconstructions.

In one project, Mark Lyle, DPT, PhD, and Peter Sprague, PT, DPT, who both joined the Emory faculty within the past two years, hope to prove that a series of open kinetic exercises performed after ACL reconstruction surgery can actually strengthen the quadriceps and decease the chances of reinjury or osteoarthritis. Currently, the standard of care within the orthopedic community discourages the exercises for fear of weakening the quadriceps tendon graft used during surgery.

Last summer, at the request of Emory Chief of Sports Medicine John “X” Xerogeanes, M.D., Lyle and Sprague began compiling a database comparing patients who have done the quadriceps-strengthening exercises to those who haven’t. Typically, quadriceps strength after ACL surgery suffers. Early returns on the study have been eye opening.

“So far, evidence suggests that including these knee extension exercises immediately after surgery contributes to a quicker return of strength,” Lyle says. “Not only do patients who do these knee extension exercises have more strength after six months, there are no adverse effects on the knee joint ligament. It’s an exciting finding that is still very preliminary.”

According to Sprague, the research will continue to track patients through various stages of post-op measuring strength and movement 30 days after surgery, six months and one, two and three years. If they are successful in proving that the quadricep exercises are safe and effective, a revised standard of care, which Sprague calls “a career’s worth of work,” could contribute to stronger quadriceps after surgery which could go a long way in preventing future ACL injuries. Currently, 25 percent of athletes who get ACL reconstruction retear the same ligament or damage the other one.

“There are so many factors that involve the ability for human function, but we’re hopeful that we can change practice a little bit, improve quadricep function and help a lot of people out,” Sprague says.

While data collection and analysis continue, Lyle says the next key steps in the process will be sharing the findings within the rehabilitation community, writing a support paper and pursuing grants that allow them to more closely examine muscle contraction during the open kinetic chain exercises versus traditional ones.

The second project that Lyle and Sprague are collaborating on is one that closely tracks the movement ability and strength of high-performing athletes after ACL surgery to better determine when these athletes are able to return to competition or their previous activity levels.

According to Lyle, there is little criteria that suggests when an athlete can safely return to play. Motion capture data should provide quantitative-based evidence that will assist teams in making those important decisions. Sprague says they are tracking 60 athletes all at different stages of post-op recovery.

“We actually had them walk on a special mat that can identify whether they are walking symmetrically on each leg before Dr. X performed the surgery,” he explains. “We’re doing some data collection at the four-week mark on the gait map and will continue that through the six- and nine-month mark. We’re looking at weight-bearing restrictions. Are they able to walk normally? We look at how their feet hit the ground. We’ll also analyze movements like jumping and landing, cutting, lateral movement, forward/backward movement, deceleration – just higher functioning athletic-type activities. We’ll see if there’s anything in their movement that correlates with an increase in injury risk.We can’t predict injury, but we can probably identify risk.”

Jenny Hunnicutt, a post-doctoral research fellow at the Emory Sports Medicine Center who helps coordinate the projects and serves as the liaison between the two researchers and Dr. X, is impressed at how the entire team of researchers and caregivers work together to make these projects a reality.

“It’s been so great working with an interdisciplinary team that recognizes that we can’t tackle these questions on our own,” Hunnicutt, who is an athletic trainer, says. “Everyone here at Emory is very open to a team approach and everyone respects each other’s roles. The orthopedic surgeon is listening to the physical therapist and the physical therapist is listening to the athletic trainer who may be out on the field with the athlete. It really is such a team approach where everyone is respectful and willing to get input from these individual entities and fields.”

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