A review of the literature was conducted to assess the effects of a combined aquatic and land-based intervention versus the traditional land-based therapy only for female soccer players in rehabilitation post anterior cruciate ligament (ACL) reconstruction. Female soccer players have an increased tendency to experience ACL injuries because of the mechanism of injury as well as internal contributors of the female anatomy. Many protocols for rehabilitation have been released, but few studies have examined the effects of a combined aquatic and land-based program. Aquatic therapy has been shown to have many positive effects, including the allowance for early intervention, but is inconclusive for early re-entry for sport-specific activities. Peer reviewed journal articles and systematic reviews of ACL rehabilitation were initiated via electronic searches of AcademicOneFile, PubMed, PEDro, PTnow, EBSCOHost, Academic Premier, and CINAHL. Four reviewers independently selected the studies, extracted data, and applied quality criteria. Study quality was assessed by the levels of evidence ranking system, and the evidence synthesis ordered them in importance. Five systematic reviews, six randomized control trials, six case-controlled studies, and one literature review were included. All data was used to assess eight ACL rehabilitation components needed to return to sport-specific activities: pain management, ROM, edema control, muscular strength, neuromuscular function, and improved gait patterns. There was evidence to support the combination of aquatic and land-based therapy as a better intervention for achieving the goals of ROM and strength, and also showed evidence of improved edema control and pain management. These improvements have the potential to assist soccer players in returning to sport-specific activities, yet there was no consensus for a specific timeline for early re-entry into those activities. Recommendations for clinical practice are to consider adding early intervention aquatic therapy for earlier re-entry to sport-specific activities in female soccer players post ACL reconstruction as a safe intervention for improved ROM, strength, pain control, and edema control. Further research must be conducted to generalize these findings to a more diverse population, and for a timeline for re-entry to sport-specific activities.
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