James T. Cavanaugh
© 2021 The Authors
Study Design: Case Report. Background: The patient was a 51-year-old female who tore her left anterior cruciate ligament (ACL) playing pickleball and opted for non-operative treatment. The clinicians involved treated the patient using the three pillars of practice: relevant scientific evidence, clinician experience, and patient perspective.
Treatment: The patient’s treatment consisted of therapeutic exercises, neuromuscular re-education, soft tissue massage, and motivational interviewing. Therapeutic exercises were designed to strengthen the muscles surrounding her hip and knee. Neuromuscular re-education helped to improve the patient’s knee stability and balance, while soft tissue massage was used to decrease swelling. Motivational interviewing helped her better align her attitude toward her restrictions with the goals of the rehabilitation process.
Outcome: The patient made progress and increased satisfaction throughout rehabilitation which was illustrated by objective tests and subjective reports. Improvements were noted with a 24% positive change in lower extremity functional scale (LEFS) score between initial and follow-up testing. Single leg hop tests by discharge revealed a 90% or higher right-to-left compatibility score.
Discussion: This case highlighted the plausibility of a conservative treatment approach in a patient with an ACL tear. It introduced a clinical decision-making model that emphasized the importance of including relevant research in the form of Clinical Practice Guidelines (CPG’s), addressing the patient's perspective on the impact of her injury, and incorporating clinician expertise in observing movement impairments. During treatment, the patient demonstrated appropriate lower extremity strength and stability according to the clinician’s expertise and outcome measures, but she did not feel confident enough to return to previous lifestyle activities. Patient perspective played a large role in determining progressions and accomplishments.
Norman, Eric; Madore, Michael; Magee, Kathryn; Calimer, Tyler; and Nally, Parker, "Utilizing An Evidence-Based Practice Framework In Non-Operative ACL Rehabilitation - A Case Report" (2021). Case Report Papers. 129.