Anterior Cruciate Ligament - Clinical Guidelines - Facts!
The main objectives of rehabilitation of a soccer player after undergoing a reconstruction of the anterior cruciate ligament (ACL) are to restore the stability of the knee and allow a return to the same pre-injury athletic level.
Clinicians follow specific criteria for progressing through rehabilitation.
The decisions to progression and return to competition must be supported in clinical criteria, subjective, objectives, chronobiological and functional. However, there is substantial heterogeneity in the rehabilitation protocols used for rehabilitation after reconstruction of the anterior cruciate ligamentThis is one possible reason for the difference in the results achieved.
We developed a systematic review to assess the quality of internationally available clinical guidelines for rehabilitation after anterior cruciate ligament reconstruction. The quality of the clinical guidelines was generally good, but they had poor applicability (external validity), meaning that they may be difficult for clinicians to implement in their daily clinical practice. The guidelines fail to identify and describe potential facilitators, barriers, and the financial implications that arise from their implementation. We also suggest that the written language used to recommend rehabilitation approaches be standardized according to the strength of the recommendations. This is to guide rehabilitation - what clinicians exactly should and should not do.
In the review we highlight common topics that should be considered when execution of a rehabilitation plan.
- Clinical guidelines recommend immediate mobilization and strength/neuromuscular training.
- Cryotherapy and neuromuscular electrostimulation, early introduction of open and closed kinetic chain exercises, and full-load exercises can be used depending on individual circumstances.
- The use of continuous passive mobilization and orthotics should be avoided.
- The dosage of interventions, criteria for progression and return were often omitted or vaguely mentioned. However, some criteria that clinicians can use as milestones to progress in rehabilitation and decide on sports resumption were focused on. These included clinical criteria (e.g., KOOS, IKDC, or Lysholm scores), functional criteria (e.g., battery of hop tests) and psychological (eg, ACL-RSI).
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Reference
1Andrade R, Pereira R, van Cingel R, Staal JB and Espregueira-Mendes J (2019). How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II) BJSM Published Online First: 07 June 2019. doi: 10.1136/bjsports-2018-100310
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