Fatigue-induced modifications in lower-limb control may increase the risk of noncontact ACL injury during landings. Gender dimorphic abduction loading in the presence of fatigue also may explain the increased injury risk in women. Understanding fatigue effects at both the central and peripheral levels will further afford elucidation of the ACL injury mechanism and, hence, more successful prevention strategies.
Context:Anterior cruciate ligament (ACL) reconstruction rehabilitation has evolved over the past 20 years. This evolution has been driven by a variety of level 1 and level 2 studies.Evidence Acquisition:The MOON Group is a collection of orthopaedic surgeons who have developed a prospective longitudinal cohort of the ACL reconstruction patients. To standardize the management of these patients, we developed, in conjunction with our physical therapy committee, an evidence-based rehabilitation guideline.Study Design:Clinical review.Level of Evidence:Level 2.Results:This review was based on 2 systematic reviews of level 1 and level 2 studies. Recently, the guideline was updated by a new review. Continuous passive motion did not improve ultimate motion. Early weightbearing decreases patellofemoral pain. Postoperative rehabilitative bracing did not improve swelling, pain range of motion, or safety. Open chain quadriceps activity can begin at 6 weeks.Conclusion:High-level evidence exists to determine appropriate ACL rehabilitation guidelines. Utilizing this protocol follows the best available evidence.
All bone bruises identified in our study with magnetic resonance imaging at the time of initial injury had resolved at 12-year follow-up. The presence of a bone bruise at the time of initial injury did not significantly alter the patient-oriented outcome by International Knee Documentation Committee after anterior cruciate ligament reconstruction. Additionally, articular cartilage abnormality on magnetic resonance imaging did not influence the International Knee Documentation Committee score.
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