Is it all About the Quads? Implications of the Calf Musculature Post-ACL Injury in Return to Sport Rehab

Abstract

Anterior cruciate ligament (ACL) injuries are a significant injury for athletes participating in cutting and pivoting sports requiring lengthy rehabilitation. Athletes undergoing anterior cruciate ligament reconstruction (ACLR) continue to be limited in the ability to return to their sport and to their prior level of performance despite undergoing postoperative rehabilitation. For those that do return to sport, re-injury rates remain high (~20%). Current rehabilitation guidelines address knee joint impairments and neurocognitive/sensorimotor factors, but do not address how the triceps surae muscles are also affected following ACL injury. This clinical commentary aims to examine the potential mechanisms surrounding the contributions of the gastrocnemius and soleus musculature on tibial kinematics, the effects ACL injury has on the calf musculature, and the potential clinical implications for prevention of subsequent injuries in the post ACLR rehabilitation framework. Sex differences and rehab considerations across the pre- and post-surgical ACLR timeline are also addressed.