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Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction

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Abstract

Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).

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Authors and Affiliations

  1. Faculty of Sport, Technology and Health Sciences, St Mary’s University, London, TW1 4SX, Twickenham, UK

    Matthew Buckthorpe, Ross Wadey & Stephen Patterson

  2. Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy

    Matthew Buckthorpe, Alessandro Compagnin, Giovanni La Rosa & Francesco Della Villa

  3. Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany

    Alli Gokeler

  4. Centre for Human Sciences Research, University of Salford, Salford, UK

    Lee Herrington

  5. North Queensland Physiotherapy Centre, Townsville, QLD, Australia

    Mick Hughes

  6. II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Alberto Grassi

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Matthew Buckthorpe, Alli Gokeler, Lee Herrington, Mick Hughes, Alberto Grassi, Ross Wadey, Stephen Patterson, Alessandro Compagnin, Giovanni La Rosa and Francesco Della Villa have no conflicts of interest that are directly relevant to the content of this article.

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MB conceived the idea for the paper and wrote the first version of the manuscript. MB, MH, AC and GLR produced the supplementary video content. All authors have been involved in drafting the manuscript or revising it critically for important intellectual content. All authors read and approved the final version of the manuscript.

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Buckthorpe, M., Gokeler, A., Herrington, L. et al. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 54, 49–72 (2024). https://doi.org/10.1007/s40279-023-01934-w

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