![acl protocol acl protocol](https://i.ytimg.com/vi/8inJOnO9Puo/hqdefault.jpg)
Patients with full knee extension range of motion (ROM), absent or minimal effusion, and no knee extension lag during a straight leg raise preoperatively have better postsurgical outcomes, such as returning to previous levels of activity and demonstration of normal knee function. 17, 22, 23, 47, 49, 50, 81, 83 The updated guidelines include preoperative milestones to reflect the importance of such factors on postoperative outcomes. Knee function prior to surgery is important in expected and final outcomes after ACL reconstruction. Maintaining or gaining quadriceps strength Progress exercise in intensity and duration Use of cycle/stair climber without difficulty The purpose of this paper is to revisit the rehabilitation guidelines to reflect the most current evidence on management of patients following ACL reconstruction. Further literature and understanding of secondary surgeries and their impact on ACL reconstruction call for further clarification of their impact on postsurgical treatment and outcomes.
![acl protocol acl protocol](https://orthoinfo.aaos.org/contentassets/4824f94e1f0d417f9cd73b2f1f151ad1/knee-test.jpg)
33, 37 Modifications of the surgery over the past 16 years (eg, soft tissue fixation) warrant a re-examination of the rehabilitative management of patients after ACL reconstruction. Rehabilitation after ACL reconstruction has continued to move away from surgery-modified rehabilitation, in which surgery constrains the rehabilitation progression, and toward rehabilitation-modified surgery, in which the reconstruction techniques are robust enough to withstand early mobilization and strengthening. Since the original guidelines were published in 1996, there have been considerable advancements in ACL reconstruction surgical procedures and common secondary surgical interventions to address injuries often associated with ACL tears.
![acl protocol acl protocol](https://d3i71xaburhd42.cloudfront.net/591138685560074818982b2512ea0e192fdca672/2-Table1-1.png)
Based on sound principles and current evidence, the original guidelines have continued to guide rehabilitative care to successful outcomes.Īdvancements in surgical procedures directly impact postoperative rehabilitation. The goal of any criterion-based guideline is to maximize the patient’s response to exercise at the current level of function, while minimizing the risk of injury to the healing tissue. In 1996, the University of Delaware published criterion-based rehabilitation guidelines, 58 in which a progression was established with specific clinical milestones following tissue-healing time frames. 8 A consistent approach to rehabilitation after ACL reconstruction can yield predictably good outcomes, such as a return to previous levels of activity and normal knee function. More than 200 000 anterior cruciate ligament (ACL) injuries occur each year in the United States, and approximately 65% of these injuries are treated with reconstructive surgery. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology.
ACL PROTOCOL UPDATE
The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. The management of patients after anterior cruciate ligament reconstruction should be evidence based.