Achilles ruptures typically happen in sports where pivoting and twisting occur like in soccer or basketball.

The athlete may describe the injury as if they felt a pop or like they were kicked and then when asked to flex the ankle (plantar flexion), pushing the ankle down they cannot do so.

There are two basic treatments available for ruptured Achilles Tendon: surgical and non-surgical. The decision is between the athlete and the physician, either way physical therapy and post-physical therapy will play a major role in the recovery process.

The main goals in physical therapy will be to restore range of motion as well as rebuild strength.

Post-physical therapy can begin between 3-4 months post-op. Functional activities such as figure 8 running, zig-zags, as well as single leg calf raises and single leg strength exercises begin to progress into full activity, agility drills, and plyometrics.

Pivoting sports such golf, tennis, or racquet sports can begin at six months but advise that recovery can take up to a full year.

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Successful return to play remains a challenge for a soccer player after ACL reconstruction. In addition to a successful surgical intervention, a soccer-specific functional rehabilitation program is essential to achieve this goal. Soccer-like elements should be incorporated in the early stages of rehabilitation to provide neuromuscular training specific to the needs of the player. Gym-based and, later, field-based drills are gradually intensified and progressed until the player demonstrates the ability to return to team practice. In addition to the recovery of basic attributes such as mobility, flexibility, strength, and agility, the surgically repaired knee must also regain soccer-specific neuromuscular control and conditioning for an effective return to sports.

When straight line running is good, then proprioceptive training is introduced. This includes running in circles, figure ‘8’s, zig-zags, etc. This is the most important phase because this type of activity not only helps return to sport, but is has been shown to decrease subsequent ACL rupture or re-rupture.

Athletes can lower their risk of torn ACL by participating in performance drills that focus on improving lower extremity strength, agility, flexibility, and power. My #ACLInjury Reduction Program developed and designed for female soccer players can be applicable for all athletes both male and female.

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Studies show that within one year of ACL reconstruction surgery:
* Only one-third of athletes return to their previous level of competition.
* Less than 50 percent return to the same level of play within two to seven years.
* Only 81 percent will return to any level of athletic participation.

Functional training is a key element in regaining the soccer-specific neuromuscular control necessary to perform skills ranging from basic to soccer- specific drills. Particular attention should be given to the quality of the movement patterns and stabilization strategies.

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Patellofemoral Instability other wise known as Dislocated or Subluaxtion of the Patella. The injury can come from a direct blow or a noncontact twisting of the knee.

The most common mechanism for a patellar dislocation is a forceful inward rotation of the body on a planted foot. Athletes may describe the feeling as the knee giving out.

In an acute patellar dislocation, when a tear of the MPFL is identified, surgical repair (fixing the original ligament) of the MPFL may be a good treatment option. In the young athletic population, recurrence rates for patients treated conservatively are high with some studies reporting 40%. 

Proper stabilization of the patella is also affected by the soft tissue structures (ligaments and muscles) surrounding the knee. The medial patellofemoral ligament (MPFL) is a continuation of the deep retinaculum and vastus medialis oblique (VMO) muscle fibers (inner portion of the quadriceps muscle) on the inside of the knee. 

Return time varies depending on the degree of soft-tissue damage. A return to sport might require almost three months. A post-op recovery requires a period of bracing followed by physical therapy and post-PT training, delaying return time for up to six months.

In recurrent or chronic patellar dislocations, it may be necessary to perform reconstruction of the MPFL. Reconstruction differs from repair in that graft tissue (such as a hamstring tendon) is used to replace or reinforce the MPFL.

Surgery tends to have excellent results in preventing further dislocations, however athletes may have residual pain. 

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