Authors: K. E. Wilk, L. C. Macrina, E.L. Cain, J. R. Dugas and J. R. Andrews

Journal of Orthopaedic and Sports Physical Therapy 42(3), March 2012

Commentary by Bruce Craven

With almost 200,000 Anterior Cruciate Ligament (ACL) injuries occurring annually in the United States and nearly half of them requiring reconstructive surgery, years of research have been conducted on this common orthopaedic surgery. Following the surgical procedure, the need for a scientifically based rehabilitation program and a well-designed return to sport plan are essential. This article provides the reader with a review of the recent advancements and treatment goals for a successful rehabilitation following ACL surgery.

The success of the accelerated rehabilitation program was reported by Shelbourne and Nitz in 1990, indicating that the patients exhibited better strength and range of motion (ROM) with fewer complications and secondary knee complaints following surgery when compared to the conservative rehabilitation approach. To have success with the accelerated rehabilitation program there are 9 goals that should be attained:

1. Start Rehabilitation before Surgery

Post-operative Goals

2. Regain full passive knee extension

3. Restore Patellar Mobility

4. Reduce Post-operative Inflammation

5. Range of Motion

6. Voluntary Quadriceps Control

7. Restore Neuromuscular Control

8. Gradually Increase Applied Loads

9. Progress to Sport-Specific Training

This article by Wilke et al, goes further to discuss the specific rehabilitation issues surrounding the female athlete, non-isolated ACL injuries with concomitant procedures and/or cartilage lesions. Further discussion is provided around the different surgical procedures to repair the ACL based on these secondary conditions. The authors state that following surgery the rehabilitation program needs to be altered based on the type of graft used, any concomitant procedures performed and the presence of any articular cartilage lesion. Current rehabilitation programs must not only focus on strength but more importantly the development of range of motion, proprioception and neuromuscular control drills to develop the dynamic stability necessary for successful return to sport and competition.

This article has a very good reference list and series of tables and figures outlining the current trends in the rehabilitation of anterior cruciate ligament injuries.

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