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Review
. 2022 May-Jun;14(3):424-432.
doi: 10.1177/19417381211032949. Epub 2021 Aug 3.

Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair

Jocelyn Wu  1 , Jamie L Kator  2 , Michael Zarro  3 , Natalie L Leong  1   4
Affiliations
Review

Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair

Jocelyn Wu et al. Sports Health. 2022 May-Jun.

Abstract

Context: Injury to the anterior cruciate ligament (ACL) is among the most common orthopaedic injuries, and reconstruction of a ruptured ACL is a common orthopaedic procedure. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Along with surgery, intense postoperative physical therapy is needed to restore function to the injured extremity. ACL reconstruction (ACLR) has been the standard of care in recent decades, and advances in surgical technology have reintroduced the prospect of augmented primary repair of the native ACL via a variety of methods.

Evidence acquisition: A search of PubMed database of articles and reviews available in English was performed through 2020. The search terms ACLR, anterior cruciate ligament repair, bridge enhanced acl repair, suture anchor repair, dynamic intraligamentary stabilization, internal bracing, suture ligament augmentation, and internal brace ligament augmentation were used.

Study design: Clinical review.

Level of evidence: Level 5.

Results: No exact consensus exists on effective rehabilitation protocols after ACL repair techniques, as the variation in published protocols seem even greater than the variation in those for ACLR. For some techniques such as internal bracing and dynamic interligamentary stabilization, it is likely permissible for the patients to progress to full weightbearing and discontinue bracing sooner. However, caution should be applied with regard to earlier return to sport than after ACLR as to minimize risk for retear.

Conclusion: More research is needed to address how physical therapies must adapt to these innovative repair techniques. Until that is accomplished, we recommend that physical therapists understand the differences among the various ACL surgery techniques discussed here and work with the surgeons to develop a rehabilitation protocol for their mutual patients.

Strength of recommendation taxonomy (sort): C.

Keywords: anterior cruciate ligament repair; bridge-enhanced ACL repair; dynamic intraligamentary stabilization; internal bracing; physical therapy; postoperative rehabilitation; suture anchor repair.

PubMed Disclaimer

Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this article.

Figures

Figure 1.
Figure 1.
Depiction of anterior cruciate ligament reconstruction with graft pictured inserting in femoral and tibial tunnels.
Figure 2.
Figure 2.
Depiction of suture anchor repair with femoral anchors securing the repaired anterior cruciate ligament.
Figure 3.
Figure 3.
Depiction of internal brace repair with synthetic tape bracing the repaired anterior cruciate ligament.
Figure 4.
Figure 4.
Depiction of dynamic intraligamentary stabilization with tibial spring-loaded construct traversing the repaired anterior cruciate ligament.
Figure 5.
Figure 5.
Depiction of bridge-enhanced anterior cruciate ligament (ACL) reconstruction with bio-scaffold encircling the repaired ACL.
See this image and copyright information in PMC

References

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