Doha, Qatar: Aspetar, GCC and MENA’s first specialised orthopaedic and sports medicine hospital recently released a clinical practice guideline that focuses on the rehabilitation process following anterior cruciate ligament reconstruction (ACLR).
This guideline is designed to offer insights into the most effective approaches and interventions for patients recovering from ACLR and can serve as a fundamental resource for physiotherapists and healthcare professionals.
The primary objective of this Clinical Practice Guideline is to provide a detailed overview of the evidence supporting the various components of rehabilitation after ACLR. This information is intended to be a valuable resource for shaping ACLR rehabilitation protocols.
While the primary audience for this guideline is physiotherapists responsible for managing patients after ACLR in outpatient clinics, a wide range of healthcare professionals, including physicians, orthopaedic surgeons, athletic trainers, and nurse practitioners, can benefit from its insights, the document said.
The guideline delves into ACLR rehabilitation, exploring the effectiveness of available interventions, either in isolation or in combination. It emphasises that exercise interventions should form the cornerstone of the ACLR rehabilitation. However, the document also acknowledges the scarcity of evidence concerning the relationship between exercise volume, intensity, and rehabilitation outcomes.
Physical therapy modalities are deemed beneficial, especially in the early stages of rehabilitation when pain, swelling, and range of motion limitations are prevalent. These modalities can pave the way for pain-free initiation of exercise rehabilitation. Despite this, there is a notable absence of evidence guiding the progression and discharge criteria for rehabilitation.
The recommendations presented in the guideline revolve around individualised rehabilitation protocols, criteria-based progression, and patient monitoring. The guideline also recognises the potential need for unsupervised rehabilitation for certain patients, provided they receive a personalised programme and are monitored for adverse events.
“Pre-operative rehabilitation might improve post-operative quadriceps strength, knee range of motion, and may decrease the time to return to sport.”
Key elements of exercise initiation include active knee motion, early weight-bearing, isometric quadriceps exercises, leg press, and open kinetic chain exercises. Plyometric and agility training, motor control training, isotonic and isokinetic training, core stability exercises, and aquatic therapy are recommended for strength and motor control training.
As for the return to activities, the guideline offers guidance on resuming driving, running, and sports participation. Notably, it specifies that the duration of rehabilitation should be individual-specific, with a focus on safely returning patients to their pre-injury activity levels.
Moreover, Aspetar endorses specific physical therapy modalities, including cryotherapy, neuromuscular electrical stimulation, and low load blood flow. However, it advises against continuous passive motion, whole-body vibration, and dry needling.
The Clinical Practice Guideline for ACL reconstruction rehabilitation is available for free download on Aspetar’s official website, aspetar.com.
