Neuromuscular rehabilitation of a female Olympic ice hockey player following anterior cruciate ligament reconstruction.
METHODS
Case study.


OBJECTIVE
To demonstrate the unique aspects of rehabilitating a female athlete participating in ice hockey following anterior cruciate ligament (ACL) reconstruction.


BACKGROUND
The patient was a 28-year-old female who sustained a traumatic injury to her left knee while playing ice hockey. After 6 weeks of rehabilitation (15 visits), the athlete elected to undergo ACL reconstruction following buckling episodes that she experienced during both skating and walking.


METHODS
Following ACL reconstruction using a patellar tendon autograft, the patient was treated for 6 months in 44 visits. Initial treatments consisted of effusion management, neuromuscular control of lower extremity muscles, and regaining passive range of motion, especially extension. Although instability testing revealed a negative pivot shift and a 2-millimeter side-to-side difference on KT-1000 examination, the patient reported a sensation of buckling when she attempted skating at 4 months (27 visits) following ACL reconstruction. Off-ice strength and functional testing of the lower extremity did not demonstrate deficits. At that time, a specific neuromuscular program for returning a patient to ice hockey was implemented.


RESULTS
Following 17 physical therapy visits, which combined sport-specific and sex-specific neuromuscular rehabilitation, the patient was able to return to competitive ice hockey. Six months following ACL reconstruction, the patient reported no feeling of instability during skating. The patient reported a Lysholm score of 100 and Tegner activity score of 9. An on-ice functional test revealed the athlete's score was 80% of her pre-injury score.


CONCLUSIONS
Failure of static knee stabilizers can be a cause of instability. Following ACL reconstruction, a neuromuscular rehabilitation program may prevent residual knee instability once the static stabilizers have been restored. A sport-specific neuromuscular rehabilitation program for the athlete participating in ice hockey should be considered.
Tyler
T F
TF
Nicholas Institute of Sports Medicine and Athletic Trauma, Department of Orthopaedics, Lenox Hill Hospital, New York, 10021, USA. tyler@nismat.org
McHugh
M P
MP
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D005260:Female; D006688:Hockey / Q000293:injuries*; D006801:Humans; D007593:Joint Instability / Q000534:rehabilitation*; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000503:physiopathology; D012421:Rupture