Anterior Cruciate Ligament Rehabilitation

The purpose of this literature review was to evaluate the research on alternative rehabilitation methods for anterior cruciate ligament (ACL) reconstruction. The anterior cruciate ligament is one of the four ligaments that stabilize the knee. Poster to the patella, the ACL prevents the knee joint from moving during quick changes in movement. Pivoting and cutting are the most common movements that cause the ACL to rupture.1 ACL tears were found to be the knee’s most commonly diagnosed sports injury, and the protocol is reconstructive surgery.2 The rehabilitation process begins shortly after surgery. Standard rehabilitation has been based around strength building exercises like: leg press, hamstring curls, and leg extensions. Knee joint flexibility

Sixteen male athletes who underwent ACL reconstruction were separated into two groups: a control, and experimental group. The control group had rehabilitation sessions three times a week of mild intensity, the standard. The experimental group received two sessions of rehabilitation at a higher intensity, including more jumping and agility. Both groups had the same rehabilitation until four months post operation when the study began. The methods were listed in detail with the specific exercises performed. Patients were tested six months after surgery on single leg hops, five jump hops, triple jump, T-test (agility) and FTG.5 Power tests were also conducted. Means and standard deviations were calculated and a MANOVA was used to examine differences in performance with two factors, group and training intervention.5 A 95% confidence interval was used, with effect sizes published and statistical power reported at .84. The reported analysis characteristics were consistent with a good study. The results showed a significant difference from the standard rehabilitation group in a positive way. The results showed that a better outcome could be achieved for a patient in a shorter amount of time if a higher intensity workout was done.5 Implications are listed but no limitations were given, degrading the

Half of the patients were in the control group that received six months of standard lower extremity strength building exercises. The other half received specialized neuromuscular training that emphasized dynamic joint stability, plyometrics, and sport specific exercises.8 Specific exercises were given in the methods, but the exact training regimen was not provided. Patients were tested on their results in hop tests, muscle strength tests, proprioception, Cincinnati Knee Scores (continuous variable), and VAS.8 The data was analyzed with ANOVA to compare the 3-month results with the 6-month data for the same tests. To compare the control and experimental group, t tests were used correctly. The study also reports that Mann-Whitney U tests were used if parametric assumptions were not met. An alpha level of .05 was used. The results showed a significant difference for the neuromuscular group at six months compared to the control group in the Cincinnati Knee Score. The Cincinnati Knee Score measures all aspects of the knee, including functionality, pain, and strength.8 There were no significant differences between the groups in balance or strength tests. Limitations given were a lack of power calculations and a smaller than needed sample size to prove significance in static tests.8 These limitations could reduce the