Exercises Following Anterior Cruciate Ligament Reconstructive Surgery: Biomechanical Considerations and Efficacy of Current Approaches

Abstract

To enable a safe, effective return to daily functional activities and to prevent premature knee joint osteoarthritis, adults undergoing anterior cruciate ligament (ACL) surgery require carefully designed and appropriate rehabilitation strategies. In this article we critically examine the contemporary body of literature concerning the application and outcomes of various knee exercise rehabilitation protocols described in the literature in the context of the surgically repaired ACL injured knee. These data were obtained from the MEDLINE (1991-2007), CINAHL (1982-2007), and SPORTS DISCUS (1975-2007) databases, using the terms anterior cruciate ligament, exercise, and ligament, showed that two lines of research currently dominate this topic: (1) the role of open versus closed chain exercises approaches; (2) the impact of these exercises on knee stability and function post-ACL surgery. In light of the small number of studies and their methodological limitations, however, more research clearly is recommended to establish if closed-chain kinetic exercises are conclusively more efficacious than open-chain exercise for this condition, as predicted by the present literature base.

A biomechanical model of femoral forces during functional electrical stimulation after spinal cord injury in supine and seated positions

“…Frost's mechanostat theory supports that the greatest mechanical loading of bone is predominately due to muscle forces [22,55]. However, after periods of extended bed rest [56] or space flight [57,58] [42,[59][60][61]. The present study demonstrated that when quadriceps muscle force remains uniform across models, the supine model produces more shear force than the standing model which is consistent with ACL literature.…”

Anterior Cruciate Ligament Strain In Vivo

“…Besides this advantage, CKC exercises may reduce patellofemoral pain, 5 enhance knee proprioception, 5 and may be more effective for restoring normal knee function, including muscle strength and joint range of motion. 13 Individuals who perform predominantly CKC exercises during their rehabilitation also tend to be more satisfied with the end result. 15 …”

Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals

“…105 In general, rehabilitation programs after ACL reconstruction in adults have moved in a more aggressive direction, including early weight bearing, more powerful strength training, challenging neuromuscular and plyometric exercises, and an earlier return to sport. 12, 31,42,102 In contrast, the sparse descriptions of rehabilitation programs for skeletally immature individuals appear to advocate a more conservative approach, with longer periods of non-weight bearing and bracing, and a later return to sport. 66,67,100 The slower and more conservative protocols for skeletally immature patients who undergo ACL reconstruction may be due to the uncertainty regarding the strength of the graft and the risk of growth disturbances, as well as the lack of evidence-based practice guidelines.…”