Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture

Abstract

Anterior cruciate ligament (ACL) rupture occurs most commonly in young and active individuals and can have negative long-term physical and psychological impacts. The diagnosis is made with a combination of patient's history, clinical examination, and, if appropriate, magnetic resonance imaging. The objectives of management are to restore knee function, address psychological barriers to activity participation, prevent further injury and osteoarthritis, and optimize long-term quality of life. The three main treatment options for ACL rupture are (1) rehabilitation as first-line treatment (followed by ACL reconstruction (ACLR) in patients, who develop functional instability), (2) ACLR and post-operative rehabilitation as the first-line treatment, and (3) pre-operative rehabilitation followed by ACLR and post-operative rehabilitation. We provide practical recommendations for informing and discussing management options with patients, and describe patient-related factors associated with a worse ACL-rupture outcome. Finally, we define evidence-based rehabilitation and present phase-specific rehabilitation recommendations and criteria to inform return to sport decisions.

Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study

“…Psychological factors such as motivation and satisfaction are important for return to sport following knee injury, 3 and stress reduction interventions 4 aid in injury prevention. This has led to recommendations that psychological factors be addressed in knee-injury treatment, 2 with evidence also suggesting their importance in injury prevention program planning. 5 However, structured psychological training intervenhttps://doi.org/10.1016/j.jsams.2020.09.004 1440-2440/© 2020 Sports Medicine Australia.…”

Physiotherapy treatment and rehabilitation following anterior cruciate ligament injury in New Zealand: Are we doing enough?

“…While many factors potentially influence outcomes after ACL injury and surgery, rehabilitation remains an important variable (Ebert, Webster, Edwards, Joss, D'Allesandro, et al, 2018) and is almost universally recommended (Adams et al, 2012;Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018;Lobb, Tumilty, & Claydon, 2012;van Melick et al, 2016). Over 80% of Australian physiotherapists believe six to 12 treatments are required in the first six weeks after ACL surgery (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018), with a physiotherapist review recommended every two weeks (Filbay & Grindem, 2019). Therefore, rehabilitation lasting from nine to 12 months would equate to between 21 and 35 physiotherapy visits within 12 months following ACL surgery.…”

“…Rehabilitation following ACL injury or ACLR should encompass a biopsychosocial approach (Scott, Perry, & Sole, 2018), which addresses patient education, physical rehabilitation and psychological barriers (Filbay & Grindem, 2019;Risberg, Grindem, & Oiestad, 2016;Zadro & Pappas, 2018). The physical component of rehabilitation involves restoration of knee range of movement, lower limb strengthening, neuromuscular and proprioceptive retraining, and activity specific exercises (Adams, Logerstedt, Hunter-Giordano, Axe, & Snyder-Mackler, 2012;Myer, Paterno, Ford, Quatman, & Hewett, 2006).…”

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“…While many factors potentially influence outcomes after ACL injury and surgery, rehabilitation remains an important variable (Ebert, Webster, Edwards, Joss, D'Allesandro, et al, 2018) and is almost universally recommended (Adams et al, 2012;Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018;Lobb, Tumilty, & Claydon, 2012;van Melick et al, 2016). Over 80% of Australian physiotherapists believe six to 12 treatments are required in the first six weeks after ACL surgery (Ebert, Webster, Edwards, Joss, D'Alessandro, et al, 2018), with a physiotherapist review recommended every two weeks (Filbay & Grindem, 2019). Therefore, rehabilitation lasting from nine to 12 months would equate to between 21 and 35 physiotherapy visits within 12 months following ACL surgery.…”

“…Rehabilitation following ACL injury or ACLR should encompass a biopsychosocial approach (Scott, Perry, & Sole, 2018), which addresses patient education, physical rehabilitation and psychological barriers (Filbay & Grindem, 2019;Risberg, Grindem, & Oiestad, 2016;Zadro & Pappas, 2018). The physical component of rehabilitation involves restoration of knee range of movement, lower limb strengthening, neuromuscular and proprioceptive retraining, and activity specific exercises (Adams, Logerstedt, Hunter-Giordano, Axe, & Snyder-Mackler, 2012;Myer, Paterno, Ford, Quatman, & Hewett, 2006).…”