Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction

Abstract

Despite advancements in our understanding of anterior cruciate ligament (ACL) injury prevention and nonsurgical management, ACL reconstruction continues to occur at an alarming rate. Among athletic patients, individuals participating in basketball, soccer, and football have the highest incidence of ACL injury, often requiring surgical intervention. To ensure the optimal treatment strategy for return to sport and prevention of secondary graft re-tear, it is important to tailor to the specific demands of the injured athlete and apply evidence-based best practices and rehabilitation principles. The purpose of this review is to provide readers with a brief background regarding ACL injuries, a focused review of clinical outcome studies after ACL reconstruction, and an updated framework with expert-guided recommendations for postoperative rehabilitation and return to sporting activity. Currently, there is no gold standard for rehabilitation after ACL reconstruction, highlighting the need for robust studies evaluating the best modalities for athlete rehabilitation, as well as determining the efficacy of new tools for improving therapy including blood flow restriction therapy and neuromuscular electrical stimulation. Based on clinical experience, a renewed focus on objective, criteria-based milestones may maximize the ability of return to preinjury levels of athletic function.

Fig. 1

Arthroscopic view of a right knee demonstrates both the anteromedial (AM) and posterolateral (PL) bundles of the ACL in proximity to the lateral femoral condyle (LFC).

Fig. 2

Illustration of a right knee demonstrating the AM and PL bundles attachment sites anterolaterally to the medial intercondylar tubercle.

Fig. 3

Images demonstrating tests for returning to sport including Y-balance assessment (top left), single-leg squatting to 45° of knee flexion (top right), and heel-elevated bridges with the knee flexed to 30° (bottom).