Purpose of Review With the increase of publications available to the rehabilitation specialist, there is a need to identify a progression to safely progress the patient through their postoperative ACL reconstruction rehabilitation program. Rehabilitation after ACL reconstruction should follow an evidence-based functional progression with graded increase in difficulty in activities. Recent Findings Clinicians should be discouraged not to use strict time frames and protocols when treating patients following ACL reconstruction. Rather, guidelines should be followed that allow the rehabilitation specialists to progress the patient as improvements in strength, edema, proprioception, pain, and range of motion are demonstrated. Prior to returning to sport, specific objective quantitative and qualitative criteria should be met. The time from surgery should not be the only consideration. Summary The rehabilitation specialist needs to take into account tissue healing, any concomitant procedures, patellofemoral joint forces, and the goals of the patient in crafting a structured rehabilitation program. Achieving symmetrical full knee extension, decreasing knee joint effusion, and quadriceps activation early in the rehabilitation process set the stage for a safe progression. Weight bearing is begun immediately following surgery to promote knee extension and hinder quadriceps inhibition. As the patient progresses through their rehabilitative course, the rehabilitation specialist should continually challenge the patient as is appropriate based upon their goals, their levels of strength, amount of healing, and the performance of the given task.
Forests function as a major global C sink, and forest management strategies that maximize C stocks offer one possible means of mitigating the impacts of increasing anthropogenic CO2 emissions. We studied the effects of thinning, a common management technique in many forest types, on age-related trends in C stocks using a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands ranging from 9 to 306 years old. Live tree C stocks increased with age to a maximum near the middle of the chronosequence in unmanaged stands, and increased across the entire chronosequence in thinned stands. C in live understory vegetation and C in the mineral soil each declined rapidly with age in young stands but changed relatively little in middle-aged to older stands regardless of management. Forest floor C stocks increased with age in unmanaged stands, but forest floor C decreased with age after the onset of thinning around age 40 in thinned stands. Deadwood C was highly variable, but decreased with age in thinned stands. Total ecosystem C increased with stand age until approaching an asymptote around age 150. The increase in total ecosystem C was paralleled by an age-related increase in total aboveground C, but relatively little change in total belowground C. Thinning had surprisingly little impact on total ecosystem C stocks, but it did modestly alter age-related trends in total ecosystem C allocation between aboveground and belowground pools. In addition to characterizing the subtle differences in C dynamics between thinned and unmanaged stands, these results suggest that C accrual in red pine stands continues well beyond the 60-100 year management rotations typical for this system. Management plans that incorporate longer rotations and thinning in some stands could play an important role in maximizing C stocks in red pine forests while meeting other objectives including timber extraction, biodiversity conservation, restoration, and fuel reduction goals.
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