We do have some questions. Fortunately there are no questions on concussion. So since we just had the ACL talk, one question is, what can, should a community ACL surgeon ask of our PTs to clear an athlete for return? »» That's a great question. So if we look historically at the measures which have been used, those big sex are the ones that are most frequently used. So strength test for sure, objective strength test, hop testing, it's what's historically been used in some type of patient reported outcomes. So there's been some data which has been published that does suggest in adults that folks who at least pass those tend to have better outcomes than those that fail those. When we looked at our young athletic population, we didn't see the same thing. So again, it speaks to just differences in the young population versus the more heterogeneous population. So to answer that question, at minimum, your patient should be passing strength, hop testing, and patient reported outcome measures. I think moving a step beyond though, we do need to start thinking about how we can objectively assess motion. And even if that is looking at, you know, using your phone to take a video of them and looking at are they going into some high-risk positions? Do their knees go into valgus? Are there too much motion in their trunk? That's a strong place to start. But I do think some emerging literature hopefully in the last five years and moving forward will get us to a point where we can say, hey, the top six are probably still good, but we need to add one or two more to get us to that point. And I mean, I'm biased to say that movement, I think an assessment of movement is important, but there's probably others too. And one especially being is, you know, there's been a lot of data recently about fear, you know, assessing physical readiness to return to sport. Is there fear of re-injury? And you know, there's some data to suggest that, you know, how folks measure or how folks perform on some of those patient reported outcome measures, especially like the ACLRSI or the TAMPA scale. Those are ones that I think are, there's emerging evidence that there's some relationship between those and future injury. So I just threw a lot of things at you. I think the bottom line is the top six for sure being strength, hop testing, and patient reported outcomes. But I also think movement is right there. We need to look at movement and fear and confidence is right behind it. Yeah, and movement patterns, it seems like we tried to objectify 30 years ago. And if you have like an AT, PT, ATC that can look and know or even a coach. And so I think sometime having coaches watching some of these functional assessments, and the kids know. I mean, if you have a, whatever functional assessment you come up with, they're tentative and they know. And so if you could get parents and coaches to watch them do it, they know they're not ready to go back. And you kind of use that maybe more as a mental, are you ready? And could be kinesiophobia as well. We do have the video on the concussion, but there's one other PT question. And that's, how can we get these options out to ATCs and underfunded schools or PT at small town practice? Yeah, that's another good question. Because again, it's an equity in healthcare, right? I mean, the ones that have the greatest resources and have the most, you know, therapists and athletic trainers are the ones that get the most services. So how do we get that out? And it's good. I mean, we work in Cincinnati. Obviously, we work with the Cincinnati Public Schools. So we work with some of those areas that are more challenged from a resource perspective. So us trying to get our staff into the school system as much as we can to try to limit the barriers of getting kids to our clinics, making sure we have clinics that are, you know, easy for our patients to get to, making sure that we have times that are easy for our patients to come at those times. I think some of those are keys, but I think ultimately getting out to the community is going to be key. And we can't sit in our clinics and think everyone's going to be able to get to our clinics easily. We need to get out to them. And I think a big key is trying to get children, boys and girls, active early. Because if they know how to land and maybe jump out of a tree and movement and things like that, then they move better in later life. Absolutely. I mean, the physical literacy movement is huge. I mean, we need to get kids active early.

ACL injuries

return to play

young athletes

functional assessments

physical literacy