A Systematic Review of ACL Reconstruction Rehabilitation | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 7, Volume 68, Issue 1, July 2017, Page 845-864 PDF (282.85 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.12816/0038184 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Obada Bashir Awad1; Sami Amer M Alqarni2; Hani Mousa Alkhalaf3; Faris Ali Alnemer4; Khalid Ayed Abdullah Alahmari2; Saeed Mubarak Saeed Alshahrani2; Sami Aoudah Tami Alahmari2; Mohammad Abdul Majeed Abdul Ahad1; Haitham Sulaiman A Habtar2; Mohammed Ali S Almousa4; Abrar Abdulrahman M Alarabi1; Salem Baty D Alshahrani2; Fawaz Nawaf Alshaalan5; Mohammed Thamer Shaker Alghalibi6; Mohammad Abdullah M Alshahrani2; Abdullghany Mohammed Dowaikh | ||||
| 1Almaarefa University | ||||
| 2King Khalid University | ||||
| 3Intern King Faisal University | ||||
| 4King Abdulaziz University | ||||
| 5Prince Sattam Bin Abdulaziz University | ||||
| 6Taif University | ||||
| Abstract | ||||
| Background: Anterior Cruciate Ligament (ACL) reconstruction is a well-known surgical knee procedure performed by orthopaedic surgeons. There is a general consensus for the effectiveness of a postoperative ACL reconstruction rehabilitation program, however there is little consensus regarding the optimal components of a program Objective of the Study: to assess the merits and demerits of current ACL reconstruction rehabilitation programs and interventions based on the evidence supported by previously conducted systematic reviews. Methods: a Systematic search in the scientific database (Medline, Scopus, EMBASE , and Google Scholer) between 1970 and 2017 was conducted for all relevant Systematic reviews discussing the primary endpoint ( ACL reconstruction rehabilitation ) studies were analyzed and included based on the preset inclusion and exclusion criteria. Study screening and quality was assessed against PRISMA guidelines and a best evidence synthesis was performed. Results: the search results yielded five studies which evaluated eight rehabilitation components (bracing, Continuous passive motion (CPM), neuromuscular electrical stimulation (NMES), open kinetic chain (OKC) versus closed kinetic chain (CKC) exercise, progressive eccentric exercise, home versus supervised rehabilitation, accelerated rehabilitation and water based rehabilitation). A strong evidence suggested no added benefit of short term bracing (0-6 weeks post-surgery) compared to standard treatment. Whilst a moderate evidence reinforced no added advantage of continuous passive motion to standard treatment for boosting motion range. Furthermore, a moderate evidence of equal effectiveness of closed versus open kinetic chain exercise and home versus clinic based rehabilitation, on a range of short term outcomes. There was inconsistent or limited evidence for some interventions including: the use of NMES and exercise, accelerated and non-accelerated rehabilitation, early and delayed rehabilitation, and eccentric resistance programs after ACL reconstruction. Conclusion: short term post-operative bracing and continuous passive motion (CPM) introduce no benefit over standard treatment and thus not recommended. A moderate evidence suggested equal efficiency for 1) CKC and OKC are equally effective for knee laxity, pain and function, at least in the short term (6-14 weeks) after ACL reconstruction and 2) home based and clinic based rehabilitation. Nevertheless, the degree of physiotherapy input remains unclear. | ||||
| Keywords | ||||
| ACL rehabilitation; pre-operative rehabilitation; post-operative rehabilitation | ||||
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