Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 22 (1), 54-64

Anterior Cruciate Ligament Injury Rehabilitation in Athletes. Biomechanical Considerations

Affiliations
Review

Anterior Cruciate Ligament Injury Rehabilitation in Athletes. Biomechanical Considerations

B D Beynnon et al. Sports Med.

Abstract

Postoperative rehabilitation is a major factor in the success of an anterior cruciate ligament (ACL) reconstruction procedure. Clinical investigations of patients after ACL reconstruction have shown that immobilisation of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the articular, ligamentous, and musculature structures that surround the knee. Early joint motion is beneficial for; reducing pain, capsular contractions, articular cartilage, and for minimising scar formation that limit joint motion. These findings, combined with graft materials that have biomechanical properties similar to the normal ACL, and adequate fixation strength, have led many to recommend aggressive rehabilitation programmes that involve contraction of the dominant quadriceps muscles. Recently, a prospective, randomised study of rehabilitation following ACL reconstruction has presented evidence that a closed kinetic chain exercise programme (foot fixed against a resistance) results in anterior-posterior knee laxity values that are similar to the contralateral normal knee. Also, open kinetic chain exercises (foot not fixed against a resistance) result in increased anterior-posterior knee laxity compared with the normal knee. Criteria must be observed because the relationship between rehabilitation exercises and the healing response of an ACL graft is unknown at present. Biomechanical studies of healing ACL grafts performed in animals have shown that the graft requires a long time to revascularise and heal, and that the biomechanical behaviour of the graft never returns to normal. Functional knee braces provide a protective strain-shielding effect on the ACL when anterior shear loads and internal torques are applied to the knee in the non-weight-bearing condition. However, the strain shielding effect of functional braces decrease as the magnitude of anterior shear and internal torque applied to the knee increase. Future studies should strive to determine the actual loads transmitted across the knee and ACL graft strain during various rehabilitation exercises and relate these to the healing response of the knee and graft.

Similar articles

See all similar articles

Cited by 10 PubMed Central articles

See all "Cited by" articles

References

    1. Am J Sports Med. 1987 Mar-Apr;15(2):149-60 - PubMed
    1. Iowa Orthop J. 1995;15:29-42 - PubMed
    1. J Bone Joint Surg Br. 1991 Sep;73(5):833-7 - PubMed
    1. J Bone Joint Surg Am. 1991 Feb;73(2):201-13 - PubMed
    1. Exp Mol Pathol. 1988 Oct;49(2):267-78 - PubMed

LinkOut - more resources

Feedback