Ideal Rehabilitation Programme after Anterior Cruciate Ligament Injury: Review of Evidence

Abstract

Knee injuries are the second most common musculoskeletal injuries in primary care, with anterior cruciate the most commonly injured ligament. It is caused by contact / non-contact and accelerating/decelerating twisting injury of the knee. Typical presentation includes trauma with pain and swelling, with laxity of the knee joint. Management includes rehabilitation alone or surgery combined with rehabilitation. Pre-surgery rehabilitation with graded physiotherapy programme results in improved postoperative recovery, reduced pain, swelling, better stability and improved range of movement. No consensus exists on an ideal rehabilitation programme, as various factors, including injury to other knee structures, choice of graft, type of surgery performed and patient preference exist. Rehabilitation includes accelerated vs. conservative, closed vs. open kinetic chain and techniques involving bracing, neuromuscular training and cryotherapy. Ideal personalised rehabilitation plan should include educating athletes to improve adherence, providing realistic strategies and approximate time frame for a return to sport. Studies support accelerated rehabilitation before and after surgery, in a clinic and home setting, with combined kinetic exercises. Accelerated rehabilitation protocol involving exercises to increase muscle strength, knee ROM and proprioception along with reducing pain, inflammation and swelling can lead to better knee stability and a less complicated rehabilitation course