Outcome and progression measures in rehabilitation following anterior cruciate ligament injury

Abstract

There are a variety of measurements of functional recovery used in clinical practice to determine the relative success of treatment following anterior cruciate ligament (ACL) injury. These include joint laxity measures, strength testing, patient-reported measures, functional testing and proprioception testing, depending on the underlying theory of joint stability favoured. There is conflicting evidence as to which individual or combination of tests is the most useful in assessing recovery rate or functional activity level. Adequate performance of jumping, running and cutting skills involves various components of functional knee stability such as concentric strength for propulsion, eccentric strength for force absorption and proprioceptive ability to assist neuromuscular control. Although strength and proprioception tests assess these individual components, their relationship to function when tested in isolation has been questioned. Functional tests tend to be global in that they do not highlight which component may be at fault. A reduced score in a functional rating system might reflect any or all of these parameters. It appears that a combination of measurements is important to fully assess functional ability after ACL injury. Future research will be required to determine what the optimal combination of measurements is, preferably on the basis of a better understanding of the protective mechanisms of joint stability.