Integrating the Evidence and Clinical Expertise in the Shared Decision and Graduated Return to Sport Process: A Time Series Case Study after Anterior Cruciate Ligament Rupture and Reconstruction

INTRODUCTION: Rehabilitation following anterior cruciate ligament (ACL) rupture is often characterized by a large discrepancy between the available scientific evidence and its implementation into practice. PURPOSE: We aimed to research, selectively rate, and transfer the available evidence to the returntosport (RTS) process after ACL rupture adopting an athlete time series case study design. CASE REPORT AND METHODS: The participant is a male athlete aged 33 who was diagnosed with an isolated right-sided total ACL rupture. Knee arthroscopy using semitendinosus tendon plastic (×4) was performed. For rehabilitation, a graded and shared decision RTS algorithm was derived from the existing evidence and all relevant decision-makers expertise. Starting with basic functional abilities and range of motion, the functional ability at each stage had to be achieved before the next stage was aimed. The corresponding therapeutic focus (in addition to standard therapy) was adopted to reach this goal. Functions to be tested were as follows: Knee function confidence, dynamic balance, isometric and isokinetic strength/torque testing, as well as jumping ability (single-leg hop and triple crossover hop for distance). RESULTS: RTS was reached (Level 3) 5 months and (Level 2) 10 months post-surgery. CONCLUSION: Integrating the available evidence and the clinical expertise of all relevant stakeholders into a shared decision and graduated RTS process after ACL rupture and reconstruction was feasible and successful. Particularly, multiple functional measurements in a time series approach to determine the actual rehabilitation focus seem promising.