Reasons for the Variability of Rehabilitation Programs and the Perspective of the Standardized Guidelines Development for Patients after Anterior Cruciate Ligament Reconstruction

Abstract

Summary. The following factors influence the choice of rehabilitation program after anterior cruciate ligament (ACL) reconstruction. Surgical factors: peculiarities of the tunnels drilling, method and quality of graft fixation, presence and type of additional distal fixation, as well as the presence or absence of additional reinforcement, graft diameter, graft material and quality, graft suturing method, type of ACL repair (single- or double-bundle), and other elements of the surgery. Patient factors: compliance, psychological readiness to move on to the next phase of rehabilitation, goals and objectives set by the patient; age, type, and level of activity and physical condition of the patient; motivation, expectations of the patient, the preoperative experience of the patient in performing rehabilitation exercises, weight and height of the patient, body proportions, in particular of the lower limb segments (different lever lengths), rotational and axial allignment of the lower limb bones, posterior tibial plateau slope, intercondylar notch width and notch roof slope, condition of the anterolateral ligament and other knee joint stabilizers, muscle tone and strength in general and at the time of surgery in particular, range of motion in the knee and adjacent joints. Given the need to consider at least the above factors, there should not be a single rehabilitation protocol for ACL reconstruction. Only close cooperation between the surgeon, rehabilitologist and physical therapist allows for the fastest and safest rehabilitation of such patients. The patient's subjective feelings and their ability to perform specific exercises are not the criteria for deciding to proceed to the next rehabilitation phase. There is a certain limit, determined by the speed of biological processes in the body, which we cannot yet overcome. It is a good practice for the surgeon to fill out a patient's rehabilitation card immediately after the surgery, indicating the exercises, the time they should start, and the allowed loads.