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Data Collection

For the topic of physical therapy and the speed of ACL recovery time, a mixed method of

data collection was chosen. Information from meta-analysis and interviews provided the best

source of information to help further understand current issues in the specific field, and modeled

what people were thinking in two different ways. The researcher was able to understand how

conclusions and decisions regarding new surgeries were made and became the standard by

looking at two matching academic journals and professional phone interviews. This helped to

elaborate on current ideals. Talking to professionals first hand broadened the understanding of

information obtained in the academic journals and allowed the researcher to ask more specific

questions that cannot necessarily be answered by the information presented in academic journals.

Other data collection methods with a tool, like a poll or survey, wouldn't have worked as well for

this topic. This topic is most successfully researched by talking to professionals first hand and

researching specific academic journals with meta-analysis. These methods proved to provide

more information than a survey or poll. Also, considering the 6 questions asked in the phone

interviews and their responses, took approximately 5-8 minutes each, it was not feasible to get

answers from a survey or poll.

Data

Sources Conclusions

“Reconstruction of the anterior cruciate
ligament: Timing of Surgery and the
Incidence of Meniscal Tears and
Degenerative Change” by S. Church and J.
F. Keating, in The Journal of Bone and
Joint Surgery
This study concluded that waiting longer than
4 weeks to have an ACL reconstruction
surgery has the possibility to create certain
meniscal and knee deterioration problems
later in the recovery process.

“Results of Anterior Cruciate Ligament This study concluded that patients who have
Reconstruction Based on Meniscus and meniscal and knee deterioration problems pre-
Articular Cartilage Status at the Time of op were due to waiting too long to have the
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Surgery” by Donald K. Shelbourne and reconstruction surgery, causing them to have a

Tinker Gray, in The American Journal of much harder recovery.
Sports Medicine

Questions Megan Bish John Tis

What do you think has ● Increase in hard ● Yes increase but also
caused such a large increase hitting contact more knowledge
in ACL tears and other ● Training in one ○ Able to
knee and ankle injuries over dimension identify sooner
the past few years? ○ Training to be ● Intense sports
pro in one ○ Women being
sport more involved
● Youth sports ○ Youth
○ Pushing kids ○ Pushing kids
beyond limits past their point
all year long ■ injury
● Shoe type
○ Not tailored to
the kids needs

Many different studies show ● ACL tears from N/A

many different results about contact are pretty
injury prevention. Do you inevitable
● Non contact can be
think that injury prevention
prevented
truly does help to prevent ○ Train off
things like ACL tears? season
○ All planes of
motion

What are the main target ● Range of motion is as N/A

areas for physical therapy perfect
do you usually look at for ○ Post op
patients with ACL tears outcome better
before they go into surgery? ● Full extension
● Quad strength, glute
strength, hip/girdle
strength
○ More muscle
tone

How soon after the initial ● Not too long or too ● Wait to get back to
ACL injury would you short full range of motion
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recommend doing ACL ○ Decrease ○ 4 weeks

reconstruction? abnormalities ● Not too long
before surgery ○ Gets damaged
Meniscus

Over the past few years, ● Minimally invasive ● Less invasive

many new methods of
treatment, like easier
surgery and new methods of
physical therapy, have been
created. Do you think that
these new forms of
treatment have sped up
recovery time?
surgeries speed up surgeries
recovery time because ○ Less damage
the rehabilitation ○ Quicker to get
process in much easier back
with less scar tissue. ● New technology
● New types of PT to ○ arthroscopic
increase range of ○ Operate on
motion kids with open
growth plates
● Accelerated Physical
therapy
○ Start 1-2 days
after surgery
○ weight bearing
○ Running
● Electrostimulation

What are the main target ● Patient education N/A

areas for physical therapy ○ Not pushing
do you usually look at for themselves
● Full ability in their
patients after an ACL
sport
surgery? ○ Push harder in
clinic to make
sure they can
take it
○ Full range of
motion and
strength
● Getting muscle
strength back
● Knowledge of abilities
before surgery as well

Analysis
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By speaking to professionals and consulting academic journals, research has shown that

many things go into the ACL recovery process. Before an injury happens, injury prevention is

proven to be helpful in not only stopping an injury from happening, but during the recovery

process as well because the subjects would already have a body sense, or an understanding of

what their body can take, that helped them understand how to get back faster. The type of shoes

worn are also a contributing factor, according to Megan Bish, physical therapist, who said clients

need to pick shoes that are tailored to their body type, which can help prevent an injury, allow for

a faster recovery, and provide support to lower extremities, ankles and feet. Dr. John Tis,

orthopedic surgeon, did not agree with this thinking, which was surprising because all other

consulted resources said otherwise. However, it is a theory that has not been 100% proven to be

correct, so some disagreement was expected. Information researched from both interviews and

academic journals seemed to be unanimous and suggest that youth sports are the underlying

cause for ACL tears. Pushing kids to do one sport all year long created fatigue and worn out

muscles, thus making athletic participants not well rounded athletes and potentiated more

injuries. After the injury, knee health must be assessed first and taken in to account by the

physical therapist and surgeon. Range of motion and meniscal health seemed to be the number

one thing that is assessed before a surgery. The academic journal, “Results of Anterior Cruciate

Ligament Reconstruction Based on Meniscus and Articular Cartilage Status at the Time of

Surgery,” by Donald K. Shelbourne and Tinker Gray, in The American Journal of Sports

Medicine, showed that patients with healthy menisci and low knee deterioration before the ACL

reconstruction surgery was completed have a much higher success rate and recovery time.

Physical therapist Megan Bish said she always makes sure that patients have the best range of

motion they can have going into the operating room to ensure the best results. Also, Dr. John Tis
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and the academic journal, “Reconstruction of the anterior cruciate ligament: Timing of Surgery

and the Incidence of Meniscal Tears and Degenerative Change,” by S. Church and J. F. Keating,

in The Journal of Bone and Joint Surgery, both said that it was very important to not only have

knee health before the surgery, but to not wait longer or shorter than a month. Doing the surgery

too early can cause arthritis and knee stiffness, while waiting too long can cause many problems

as well, such as deterioration of muscles in the knee. Both cause postoperative recovery to be

slower and success to be lower. During surgery, many things have changed to speed up recovery

time. The creation of arthroscopic and less invasive surgery has helped enormously, according to

Dr. John Tis and Megan Bish. Less invasive surgeries have decreased scar tissue which has

optimized recovery speed and success. These new arthroscopic surgeries have also enabled

surgeries to be performed on young kids with open growth plates, according to Dr. John Tis,

which allows the kids to have healthier knees overall. These results were not surprising, however

the theories behind the research and what the results showed was better understood and

explained by doing this research. This research provided a deeper understanding and furthered

the researcher’s knowledge; thus, aiding in a conclusion to the research question of how to speed

up recovery time with ACL tears.

Conclusions

If something were to be changed in the data collection, more interviews would be done

rather than meta-analysis. Interviews allowed the researcher to ask extremely specific questions

tweaked specifically to answer the research question, how to speed up ACL tear recovery time.

Interviews also allowed for more detailed answers that proved more helpful than academic

journals. However, meta-analysis allowed the researcher to learn new things that provided

questions for the interviews, questions that may not have been asked before. The results and
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answers from the interviews and academic journals allowed many new conclusions to be made.

The researcher learned that there are many parts to ACL recovery, and that many things go into

getting an athlete back into their sport. This complicated the research question even more

because pre-injury, post-injury preoperative, perioperative, and postoperative, all need to be

considered in the ACL recovery process. Pre-injury, athletes need to have good shoes, know

limitations, not over train, and have complete knowledge of successful injury prevention skills

and training to hopefully prevent an injury. Pre-injury and post-op, patients need to have the best

range of motion possible during the 4 weeks after the injury so that they can be ensured the best

results. During operations, surgeons should avoid creating meniscal problems and scar tissue by

using arthroscopic/minimally invasive surgery. Finally, post-op patients need to have a plan for

physical therapy and train in all planes of motion tailored to their sport. The researcher is

specifically focusing on the perioperative and postoperative part of recovery, and how different

forms of physical therapy and surgery can speed up time of the recovery process, which began to

be answered in these interviews and academic journals.

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Works Cited

Church, S., & Keating, J. F., (2005). Reconstruction of the anterior cruciate ligament:

Timing of Surgery and the Incidence of Meniscal Tears and Degenerative Change. The

Journal of Bone and Joint Surgery, (Br), 1639-1642. Retrieved from:

https://pdfs.semanticscholar.org/8951/6f2dbc66c680979b6f4dc09f7abec4cc87c6.pdf

Shelbourne, Donald K., & Gray, Tinker., (2000). Results of Anterior Cruciate Ligament

Reconstruction Based on Meniscus and Articular Cartilage Status at the Time of Surgery.

The American Journal of Sports Medicine , 28(4), 446-452. Retrieved from:

citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.975.5027&rep=rep1&type=pdf

Tis, John. Personal Interview. 22 February 2018.

Bish, Megan. Personal Interview, 22 February 2018.