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This guide describes the detail of the progression through the rehabilitation following ACL ligamanet reconstruction and should be read in conjunction with the other detailed guides from Mr. Johnson:
It is very important that patients take responsibility for their own rehabilitation, doing home exercises several times every day. Ask for help, advice or assistance, if you are not progressing as you would like to, or if you have any problems, from your physiotherapist, GP or Mr. Johnson. This guide is an outline for a standard ACL reconstruction patient in normal circumstances. It should be used in conjunction with advice from your physiotherapist and Mr. Johnson. Patients having more complicated or revision surgery will be advised to modify the protocol accordingly.
Evidence Based ACL Reconstruction Rehabilitation Protocol : References
Chmielewski T.L., Rudolph K.S., Snyder- Mackler L. (2002). Development of dynamic knee stability after acute ACL injury. Journal of Electromyography and Kinesiology 12. 267-274
Corry, I. MD, FRCS (Orth), Webb, J.M. FRCS (Orth),. Clingeleffer,A.J. Pinczewski, L. FRCS (1999)‘Arthroscopic Reconstruction of the Anterior Cruciate Ligament; A Comparison of patellar Tendon Autograft and Four-Strand hamstring Tendon Autograft’,. The American Journal of Sports Medicine, Vol. 27, No.3. American Orthopaedic Society for Sports Medicine.
Ejerhed, L. MD, Kartus, J. MD, PhD, Sernert, N. Kohler,K. Karlsson,J. MD, PhD (2003)‘Patellar Tendon or Semitendinosus Tendon Autografts for Anterior Cruciate Ligament Reconstruction? A Prospective Randomized Study with a Two-Year Follow-up’.The American Journal of Sports Medicine.
Halling A.H., Howard M.E., Cawley P.W., (1993) Rehabilitation of anterior cruciate ligament injuries. Clinics in Sports Medicine. Vol.12 no.2
Hooper D.M., Morrissey M.C., Drechsler W.I., Clark N.C., Coutts F.J., McAuliffe T.B. (2002), Gait analysis 6 and 12 months after ACL reconstruction surgery. Clinical Orthopaedics and Related Research, 403:168-178
Howell, Colonel, Taylor, Lieutenant S, Medical Corps, united States Air Force Reserve ‘Brace-free Rehabilitation, with Early Return to Activity, for Knees Reconstructed with a Double-Looped Semitendinosus and Gracilis Graft’, Journal of Bone and Joint Surgery – American 1996 – 1998, June 1996, Vol 78-A, Number 6
Hrubesh R., Rangger C., Reichkendler M., Sailer R.F., Gloetzer W., Eibl G. (2000), Comparison of score evaluations and instrumented measurement after ACL reconstruction. American Journal of Sports Medicine.
O’Neill D.B. (1996) Arthroscopically assisted reconstruction of the anterior cruciate ligament: A prospective randomised analysis of three techniques. Journal of Joint Surgery Am: 78: 803-813
Pinczewski, L. FRACS, Deehan, D.J. MD, Salmon,L. J. BappSci (Phty), Russell,V.J. BSc (Biomed), Clingeleffer, A. BappSci (2002)‘ A Five-Year Comparison of Patellar Tendon Versus four-Strand Hamstring Tendon Autograft for
Arthroscopic Reconstruction of the Anterior Cruciate Ligament.’. The American Journal of Sports Medicine, vol. 30, No4. American Orthopaedic Society for Sports medicine.
Reid D.C., Current concepts in rehabilitation of the ACL deficient knee. Current Orthopaedics
Risberg M.A., Lewek M., Snyder-Mackler L. (2004).A Systematic review of evidence for anterior cruciate ligament rehabilitation: how much and what type? Physical Therapy in Sport 5, 125-145
Ross M.D., Denegar C.R., Winzenried J.A., (2001). Implementation of open and closed kinetic chain quadriceps strengthening exercises after ACLreconstruction. Journal of Strength and Conditioning Research, 15(4), 466-473
Shaw T., Chipchase L.S., Williams M.T. (2004) A users guide to outcome measurement following ACL reconstruction. Physical Therapy in Sport 5, 57-67.
Stanish W.D., Lai A., (1993) New concepts of rehabilitation following anterior cruciate reconstruction. Clinics in Sports Medicine. Vol. 12. no.1.
Shelbourne K.D., Trumper R.V. (1997). Preventing anterior knee pain after anterior cruciate ligament reconstruction. The American Journal of Sports Medicine, vol.25, no. 1.
Shelbourne K.D., Klootwyk T.E., DeCarlo M.S., (1992) Update on Accelerated rehabilitation after anterior cruciate ligament reconstruction. Journal of Sports Physical Therapy. Vol. 15. no. 6
Shelbourne K.D., Davis T.J., (1999), Evaluation of knee stability before and after participation in a functional sports agility program during rehabilitation after ACL reconstruction. The American Journal of Sports Medicine, vol. 27, no. 2.
Shelbourne K.D., Patel, (1999), Treatment of limited motion after ACLreconstruction. Knee surgery in Sports traumatology and arthroscopy. 7, 85-92.
Shelbourne K.D., Rask B.P., (1998). Controversies with ACL surgery and rehabilitation. American Journal of knee surgery. Vol 11, no.2
Shelburne, K.B., Pandy M.G., (1998), Determinants of cruciate loading during rehabilitation exercise. Clinical Biomechanics, 403-413
Tovin B.J., Tovin T.S., Tovin M., (1992) Surgical and Biomechanical considerations in rehabilitation of patients with intra articular ACLreconstructions. Journal of Sports Physical Therapy. Vol. 15. no.6.
Williams III, R.J. MD, Hyman, J. MD, Petrigliano, F. MD, Rozental, T. MD, Wickiewicz, T.L. MD (2004)‘ Anterior Cruciate Ligament Reconstruction With A Four-Strand Hamstring Tendon Autograft’. The Journal of Bone and Joint surgery.
Yunes, M. M.D., Richmond,J.C. MD. Engels,E. M.D.,M.P.H. Pinczewski, L. F.R.A.C.S(2001) ‘Patellar Versus Hamstring Tendons in Anterior Cruciate Ligament Reconstruction: A Meta-analysis’,. Arthroscopy: the Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March): pp 248-257.
© D P Johnson 2008 www.Bristol-Knee-Clinic.co.uk
DAVID P JOHNSON
MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon
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