ACL Rehabilitation Progression: Where Are We Now?

Abstract

Purpose of Review With the increase of publications available to the rehabilitation specialist, there is a need to identify a progression to safely progress the patient through their postoperative ACL reconstruction rehabilitation program. Rehabilitation after ACL reconstruction should follow an evidence-based functional progression with graded increase in difficulty in activities. Recent Findings Clinicians should be discouraged not to use strict time frames and protocols when treating patients following ACL reconstruction. Rather, guidelines should be followed that allow the rehabilitation specialists to progress the patient as improvements in strength, edema, proprioception, pain, and range of motion are demonstrated. Prior to returning to sport, specific objective quantitative and qualitative criteria should be met. The time from surgery should not be the only consideration. Summary The rehabilitation specialist needs to take into account tissue healing, any concomitant procedures, patellofemoral joint forces, and the goals of the patient in crafting a structured rehabilitation program. Achieving symmetrical full knee extension, decreasing knee joint effusion, and quadriceps activation early in the rehabilitation process set the stage for a safe progression. Weight bearing is begun immediately following surgery to promote knee extension and hinder quadriceps inhibition. As the patient progresses through their rehabilitative course, the rehabilitation specialist should continually challenge the patient as is appropriate based upon their goals, their levels of strength, amount of healing, and the performance of the given task.

Design Evaluation of a Novel Multicompartment Unloader Knee Brace

“…A brace that is capable of unloading the knee joint may allow for improved soft-tissue repair [56], or be used as a rehabilitation tool to help improve strength and range of motion while weight-bearing. Rehabilitation protocols highlight the need for progressive weight bearing, passive extension, quadriceps control and neuromuscular training following knee procedures including meniscal repair [57], anterior cruciate ligament reconstruction [58], and articular cartilage repair [59][60][61][62][63][64], all of which may be aided by the TCU's powerful and adjustable knee extension assist mechanism.…”

Real‐time biofeedback integrated into neuromuscular training reduces high‐risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation

“…Many musculoskeletal prevention and rehabilitation efforts focus on motor progression using strength training, proprioceptive exercises, range of motion activities, etc. (Ardern et al, ; Cavanaugh & Powers, ). Motor progression success is often assessed through biomechanical assessment (Hopper, Haff, Joyce, Lloyd, & Haff, ; Myer et al, ), and while current NMT practices are often beneficial in reducing risk of ACL injury (Petushek, Sugimoto, Stoolmiller, Smith, & Myer, ), our data support that neural progression should also be considered as part of current standards of care (Gokeler, Neuhaus, Benjaminse, Grooms, & Baumeister, ).…”

Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration

“…Even though some authors claim that home-based rehabilitation following ACL reconstruction is deleterious when prescribed to motivated patients [39], the question arises whether even the most motivated patient has the knowledge to handle with his own training without being supervised by a specialist. It is also worth adding that postoperative physiotherapeutic procedures have changed over the past couple of decades, and generally, the protocols based strictly on the time elapsed from ACLR have been replaced by criteria-based guidelines [40]. Our ACL-reconstructed patients were regularly monitored, and they were going through consecutive stages of the procedure based on objective criteria [33].…”