Treatment of Anterior Cruciate Ligament Injuries, Part 2

Abstract

Anterior cruciate ligament tears, common among athletes, are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. A total of 3810 studies published between January 1994 and the present were identified and reviewed to determine the current state of knowledge regarding the treatment of anterior cruciate ligament injuries. Part 1 of this article focused on studies pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of and risk factors for injuries related to it, the natural history of the ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, indications for the treatment of anterior cruciate ligament injuries, as well as nonoperative and operative treatments. Part 2 includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after anterior cruciate ligament reconstruction, and the effects of sex, age, and activity level on the outcome of such reconstructive surgery.

Motion Alterations After Anterior Cruciate Ligament Reconstruction: Comparison of the Injured and Uninjured Lower Limbs During a Single-Legged Jump

“…1 Ligament reconstruction often requires a long period of recovery, with a return to sport typically around 6.2 months after surgery. 2 However, the return to high-performance pivoting sports is not ensured. Sixtyseven percent were unable to return to their preinjury sport participation levels by 12 months after surgery.…”

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

“…It must be stressed that each of these studies included some form of formalized physical therapy in a supervised fashion and none of these protocols were completely unsupervised. These reports would suggest that ACL rehabilitation may not need continuous monitoring on a daily or weekly basis, but attending physical therapy for the purpose of education, assessment, monitoring function and progression of treatment plan remain a critical aspect of a safe and effective rehabilitation program [4]. Future randomized controlled trials without any formal therapy will be needed to determine if a simple home exercise program is truly comparative to formal therapy.…”

“…These injuries are very common as they occur among both professional and recreational athletes. Since the ACL is the primary stabilizer for anterior tibial displacement and the secondary stabilizer for tibial rotation, an ACL-deficient knee can often lead to devastating consequences such as articular cartilage injuries, meniscus tears, functional instability and the potential for early-onset osteoarthritis [3,4]. The role of physical rehabilitation of a patient following ACL rehabilitation is to return the athlete back to their premorbid functional level.…”

“…Because autograft tissues (bone patellar-tendon bone (BPTB) and hamstring) are considered gold standards and most commonly used, this article will follow rehabilitation using autograft tissue. Recent evidence has shown only marginal clinical and functional differences in outcomes between bone patellar tendon bone and four-stranded semitendinosus/gracilis tendon autografts [3,4,10]. Certainly allograft tissue and synthetic grafts are sometimes used, but their use is less common in comparison to autograft tissue.…”

“…Emphasis is placed on ability to produce a full sustained contraction of the quadriceps muscle. Several trials have demonstrated the benefits of high intensity electrical stimulation to improve quadriceps strength and gait parameters [3,4,[59][60][61][62][63][64]. It is not uncommon for patients to have poor quadriceps tone during the first postoperative visit.…”