Fatores contribuintes para o sucesso da reabilitação de atletas amadores e recreacionais submetidos à reconstrução do ligamento cruzado anterior

Abstract

The purposes of the two studies that compose this thesis were to describe the current clinical practice of Brazilian physical therapists that treat patients who underwent anterior cruciate ligament reconstruction (ACLR) and to investigate the contributing factors to a successful postoperative rehabilitation of amateur and recreational athletes. The first study investigated the measures/criteria used by physical therapists to define the clinical rehabilitation discharge and return to sport clearance of patients who had undergone ACLR, and analyzed the factors associated with the proper use of the most recommended measures/criteria. A sample of 439 physical therapists answered an electronic survey questionnaire created in Google Forms. The results showed that less than 10% of physical therapists use all five recommended measures/criteria for return to sport after ACLR (quadriceps and hamstring strength, performance during functional tests, patient-reported functional outcome and psychological readiness). Professional certification in Sports Physical Therapy was the only factor associated with the use of these recommended measures/criteria. The measures most used for clinical rehabilitation discharge and return to sport clearance were related to physical factors, such as muscle strength and range of motion. A small number of professionals applies questionnaires to assess functional and psychological aspects of their patients for clinical decision-making. The second study was divided into two parts. In the first part, physical impairments of the hip, knee and ankle joints, assessed after physical therapy discharge and return to sport clearance, were compared among individuals who, when released for sports practice, attended or not most of the functional and psychological criteria for return to sport. In the second part, changes in the psychological readiness, patient-reported knee function, functional capacity and physical impairments of the hip, knee and ankle joints, during the rehabilitation process were investigated. The aim was to establish if these changes were able to differentiate individuals who return to sport from those who do not return to sport with the same preinjury level of participation. Twenty-seven non-professional athletes who had undergone ACLR with knee flexor tendon autograft were evaluated at physical therapy discharge, at return to sport clearance and six months after return to sport clearance (at least one year after surgery). The variables analyzed at physical therapy discharge that had an impact on the attendance of the return to sport criteria were torque of hip lateral rotators and abductors, and knee extensors. The variables that had an impact on the return to preinjury level of sports participation were the improvements achieved during rehabilitation for hopping capacity and for knee flexors torque. The results of the present thesis indicate that physical and functional factors contribute to a successful rehabilitation of non-professional athletes after ACLR. Knowledge about these factors may assist physical therapists in planning interventions during the postoperative rehabilitation of these athletes.