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This update on ACL rehabilitation was kindly written and put together by Mark De Carlo and his team, exclusively for Chester Knee Clinic website, for which we are very grateful

Rehabilitation following anterior cruciate ligament (ACL) reconstruction has changed dramatically over the past few decades. The staff of Methodist Sports Medicine Center in Indianapolis has over 15 years experience with patients sustaining injury to the anterior cruciate ligament.

Over this time we have developed a progressive philosophical approach to rehabilitation following ACL reconstruction. Our present philosophy on rehabilitation following ACL reconstruction has evolved through observation of our patients and documented clinical results. We have continually attempted to modify and update our protocol as a means of improving patients’ final outcome following surgical reconstruction. The ideal situation is one in which the patient with ACL deficiency undergoing surgical reconstruction will ultimately have a result of excellent stability, full range of motion and strength, and normal function. Conventional rehabilitation emphasized early protection of the ACL reconstructed knee by restricting knee motion, weight bearing, and rate of return to functional activities.

In 1982, the surgical leg was placed in a cast at 30 degrees of flexion to avoid excessive graft stress. Weight bearing without a brace was not allowed for 6-8 weeks following surgery and most patients were restricted from full participation in sports activities for the first year. The high rate of postoperative complications, including permanent knee stiffness, knee pain and low predictability with return to high level sports, has brought about a number of changes in ACL postoperative rehabilitation. In 1985, we conducted a study comparing compliant patients with those who progressed more rapidly than we recommended (noncompliant patients).

To our surprise, the noncompliant patients demonstrated fewer long-term knee motion problems and fewer subjective complaints than their compliant counterparts, without difference in long-term stability. Through this process, we learned that:

• an early loss of knee extension often led to long-term loss of extension accompanied by subjective symptoms,
• patients who failed to regain early leg control often struggled with regaining full quadriceps muscle strength later on, and
• patients who returned to sporting activities before recommended had similar knee stability to patients who were compliant with our restrictions.

This helped us to place emphasis on factors felt to be of primary importance. These include:

• restoration of full hyperextension equal to the uninvolved knee,
• regaining of good quadriceps muscle leg control, and
• allowing for early wound healing.

For more information head to : http://www.kneeclinic.info/rehab_markdecarlo.php

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