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 post-operative 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. 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.

Keywords: Criteria; Cruciate; Guideline; Knee; Progression; Rehabilitation.

Conflict of interest statement

Conflict of Interest

Both authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Figures

Fig. 1

Passive low load prolonged stretching utilizing a rolled towel under the ankle

Fig. 2

Active-assisted knee flexion/extension

Fig. 3

Short crank bicycle

Fig. 4

Quadricep stretching off the side of a plinth

Fig. 5

Underwater treadmill (Hudson Aquatic Systems LLC, Angola, IN)

Fig. 6

Gameready cold/compression device

Fig. 7

Isometric Knee Extension at 60° knee flexion

Fig. 8

Dynamic balance system (Biodex Corporation, Shirley, NY)

Fig. 9

Forward step down exercise off an 8″ step

Fig. 10

Unweighted treadmill (AlterG Inc., Fremont, CA)

Fig. 11

Quality movement assessment of a single leg squat exercise