Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

Abstract

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.

Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review

“…Only one in every 10 studies reported clinical criteria—the most frequently reported were knee RoM, effusion and pain. Current evidence-based rehabilitation guidelines for ACL reconstruction37 recommend patients have no effusion, active knee extension RoM of at least 0° and normalised gait pattern to progress from early impairment-based rehabilitation to the second phase (heavy strength training, neuromuscular training and sport-specific training). It is possible that abnormal clinical examination was considered a contraindication to commence running (and simply not reported in the published article), and this might explain why there was a low proportion of studies citing clinical criteria for RTR.…”

Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making

“…Studies focusing on other musculoskeletal injuries previously emphasised the importance of psychological readiness assessment as a part of the RTP decision 55–57. For example, the Knee Self-Efficacy Scale is recommended for the RTP evaluation of patients rehabilitating from an anterior cruciate ligament injury 58. However, there are no valid tools to quantify psychological readiness after hamstring injury rehabilitation.…”

Report of the Primary Outcomes for Gait Mechanics in Men of the ACL-SPORTS Trial: Secondary Prevention With and Without Perturbation Training Does Not Restore Gait Symmetry in Men 1 or 2 Years After ACL Reconstruction

“…Therefore, although neither of the rehabilitation paradigms tested in the present study (SAP or SAP+PERT) restored gait symmetry or altered gait mechanics 1 or 2 years after ACLR, there may be other benefits to these programs. Previous work suggests neuromuscular training programs may be efficacious in improving functional performance and patient-reported outcomes [7,31,33,35,39] and facilitating return to sport while lowering second injury risk [11,23,44]. Future work should not only further investigate the functional, clinical, and biomechanical outcomes of SAP versus SAP+PERT training and compare them with outcomes of other programs and no additional training, but also explore new interventions to improve gait mechanics and ameliorate gait asymmetry in athletes after ACLR.…”