AimThe Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction.DesignClinical practice guideline underpinned by systematic review and expert consensus.Data sourcesA multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015.Eligibility criteria for selecting studiesIncluded literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury.SummaryNinety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9–12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.

Patients with IC demonstrate an altered gait pattern compared with healthy controls. The most prominent differences were a prolonged relative and absolute duration of the flat foot position during the stance phase. This adaptation may be intuitive as an augmented arterial blood flow into skeletal muscles is allowed during a prolonged relaxation phase. Therefore, not only the lack of propulsion but also a gain of relaxation may explain these gait alterations.

Patients with IC show significant kinematic changes during walking. These alterations did not affect EMG activity duration of MG and TA muscles. However, EMG amplitude of both muscles did significantly increase during painful walking in IC patients.