Delayed versus Accelerated Weight-bearing Rehabilitation Protocol Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Abstract

Objective: To compare accelerated and delayed weight-bearing rehabilitation of anterior cruciate ligament reconstruction regarding clinical outcome measures of knee function (International Knee Documentation Committee Subjective Knee Form (IKDC), Lysholm Knee Scoring Scale, Tegner Activity Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS)), knee laxity, range of movement, quadriceps, and bone tunnel enlargement.
 Design: Systematic review and meta-analysis.
 Methods: Systematic searches of Embase, MEDLINE, CINAHL, and the Cochrane Library databases, from inception to February 2021, for studies comparing delayed or accelerated weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction in adult patients.
 Results: Nine studies met the eligibility criteria. A meta-analysis revealed a higher risk of knee laxity in the accelerated weight-bearing group. Accelerated weight-bearing may be related to higher IKDC scores, while there was no statistical difference for Lysholm, Tegner, and KOOS scores at a follow-up within 2 years. Four of 5 studies reported no statistical difference for quadriceps strength and range of movement scores, while 2 studies reported bone tunnel enlargement in the accelerated weight-bearing group.
 Conclusion: This systematic review confirmed that accelerated weight-bearing caused more serious knee laxity and bone tunnel widening than delayed weight-bearing after anterior cruciate ligament reconstruction. We therefore recommend that clinicians should select postoperative rehabilitation programmes with caution.

A non‐weight bearing protocol after ACL reconstruction improves static anterior tibial translation in patients with elevated slope and increased weight bearing tibial anterior translation

“…As the principle aim of the present study was mainly radiographic assessment, it only reports on the radiographic outcomes and does not correlate these findings directly to clinical outcomes. However, the recent meta‐analysis conducted by Fan et al [12] did not reveal statistically significant differences between the WB and NWB group in terms of clinical scores such as Lysholm, Tegner, and KOOS. Only the subjective IKDC score exhibited higher values in the WB group.…”

“…The importance of evaluating the post-operative WB has also been previously the subject of intense debate [ 12 , 16 , 36 – 38 ]. In recent years, there has been a consensus in favour of early WB for these patients, as numerous studies have demonstrated its positive impact on clinical outcomes, resumption of daily activities, and return to sports [ 15 , 17 , 19 , 39 ].…”

“…However, it is important to consider this issue in the comprehensive evaluation of patients after ACL reconstruction, as highlighted by other authors. A recent meta-analysis conducted by Fan et al revealed a significant association between early WB in the rehabilitation program and increased anteroposterior laxity in the short-term follow-up [ 12 ]. Moreover, while the NWB rehab protocol is accepted for meniscal tears, such as radial or root, its use for preoperative laxity or any intrinsic risk factors is not widely practiced.…”

“…However, the factors influencing postoperative laxity are not yet fully understood. One of the debated factors is post-operative weight-bearing (WB) [ 12 ].…”

Increased Bone Plug Depth From the Joint Increases Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft With Suspensory Femoral Fixation

“…Tunnel enlargement has been associated with by several factors, including tunnel location, 18 , 19 type of fixation device, 8 , 12 , 16 biologic factors such as synovial fluid leakage into the tunnel and cell necrosis from drilling, 20 , 21 low-grade infection, 22 accelerated rehabilitation, 7 , 23 , 24 and bone plug position within the tunnel. 1 , 3 , 4 , 9 Among these, bone plug position is a variable, which can be adjusted during the operation.…”