A systematic review of evidence for anterior cruciate ligament rehabilitation: how much and what type?

This paper provides an evidence-based review of the effectiveness of various rehabilitation programs that have been used for surgically or non-surgically treated anterior cruciate ligament (ACL) injuries in adult patients. The methodological quality of the studies was assessed using specific criteria. The databases disclosed 33 randomized clinical trials (RCTs). Several of the RCTs in this systematic review have significant flaws, and limited evidence could be derived from them. The review of the literature revealed the following evidence for ACL rehabilitation: Immediate weight-bearing after ACL reconstruction is useful, rehabilitation programs must be monitored by a physical therapist, but continuously monitoring may not be necessary. The literature supports the use of closed kinetic chain exercises at knee joint motions of less than 60degrees and open kinetic chain exercises with knee flexion angles greater than 40degrees for quadriceps muscle strength training without increasing the strain on the ACL, and without increased stresses on the patellofemoral joint. There is evidence that high intensity neuromuscular electrical stimulation in addition to volitional exercises significantly improves isometric quadriceps muscle strength compared to volitional exercises alone. There is some evidence for neuromuscular training. Future studies should focus on high quality RCTs, reporting randomization procedures, power calculations, compliance to intervention programs, and long term follow-up results. (C) 2004 Elsevier Ltd. All rights reserved.