Standards in rehabilitation following anterior cruciate ligament reconstruction in the German-speaking world

Abstract

Rehabilitation protocols following anterior cruciate ligament (ACL) reconstruction often differ among orthopaedic surgeons. The primary aim of this study was to investigate which follow-up treatment is recommended by "AGA instructors" certified by the German-speaking Association for Arthroscopic and Open Joint Surgery (AGA). The secondary aim was to compare these findings with the current literature. A structured anonymous online survey was performed with "AGA instructors" specialised in knee or ACL surgery. All participants were asked about their recommendations for rehabilitation following isolated ACL reconstruction using a questionnaire containing 23 items. 117 out of 218 mail questionnaires were fully completed and analysed. 96.5 % of all surgeons allowed full weight-bearing after 4 weeks or earlier, 52.6 % put a limit on knee flexion, 9.7 % on knee extension after the operation. A brace was prescribed by 82.8 % of all participants. During the first six weeks, isometric training and closed-chain exercises were recommended by the majority of surgeons. Riding a bicycle or driving a car after 6 weeks or earlier was permitted by 78.5 % and 86.2 %, respectively. Jogging (65.5 %) or jumping activities (67.0 %) were allowed after 3 months or earlier. Skiing (53.0 %) or contact/team sport (55.2 % / 46.2 %) was often permitted after 12 months. 82.6 % of all surgeons would like to use return-to-sport test protocols. Rehabilitation protocols differ significantly even among experienced knee surgeons working as instructors. Their recommendations are often not evidence-based considering the current literature.