Differential Effects of 2 Rehabilitation Programs Following Anterior Cruciate Ligament Reconstruction

Context: The muscular function restoration related to the type of physical rehabilitation followed after anterior cruciate ligament reconstruction (ACLR) using autologous hamstring tendon graft in terms of strength and cross-sectional area (CSA) remain controversial. Objective: To analyze the CSA and force output of quadriceps and hamstring muscles in subjects following either an Objective Criteria-Based Rehabilitation (OCBR) algorithm or the usual care (UCR) for ACL rehabilitation in Spain, before and 1 year after undergoing an ACLR. Design: Longitudinal clinical double-blinded randomized controlled trial. Setting: Sports-medicine research center. Patients: 40 recreational athletes (30 male, 10 female [24 +/- 6.9 y, 176.55 +/- 6.6 cm, 73.58 +/- 12.3 kg]). Intervention: Both groups conducted differentiated rehabilitation procedures after ACLR. Those belonging to OCBR group were guided in their recovery according to the current evidence-based principles. UCR group followed the national conventional approach for ACL rehabilitation. Main Outcome Measures: Concentric isokinetic knee joint flexor-extension torque assessments at 180 degrees/s and Magnetic Resonance Imaging (MRI) evaluations were performed before and 12 months after ACLR. Anatomical muscle CSA (mm(2)) was assessed, in Quadriceps, Biceps femoris, Semitendinous, Semimembranosus, and Gracilis muscles at 50% and 70% femur length. Results: Reduced muscle CSA was observed in both treatment groups for Semitendinosus and Gracilis 1 year after ACLR. At 1-year follow-up, subjects allocated to the OCBR demonstrated greater knee flexor and extensor peak torque values in their reconstructed limbs in comparison with patients treated by UCR. Conclusions: Objective atrophy of Semitendinosus and Gracilis muscles related to surgical ACLR was found to persist in both rehabilitation groups. However, OCBR after ACLR lead to substantial gains on maximal knee flexor strength and ensured more symmetrical anterior-posterior laxity levels at the knee joint.