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Rehabilitation after ACL reconstruction

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One month ago Niko Sherazadishvili announced on his social media “Surgery went well. Overwhelmed by all the love and support everyone sent my way”. During Master competition in Jerusalem he suffered a torn anterior cruciate ligament (IJF article) and on 3rd January he was operated successfully.

High prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported previously (Koshida et al. 2010), and a research carried out by Lambert et al. (2020) about the return to competition after ACL injury concluded that significant discrepancies between the medical treatment regarding the recommendations of doctors and physiotherapists compared to athletes behavior.

Kotsifaki et al. (2023) have just published an interesting guideline that was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR). Check out here the recommendations for the components of rehabilitation after ACL surgery based on the available evidence.

ABSTRACT

This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.

The guideline targets patients during rehabilitation
after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone
or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose–response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.

While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.

Download the full article HERE.


Summary of the recommendations on rehabilitation after anterior cruciate ligament reconstruction.

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