Purpose
To assess the quality and variability found across anterior cruciate ligament (ACL)
rehabilitation protocols published online by academic orthopaedic programs.
Methods
Web-based ACL physical therapy protocols from United States academic orthopaedic programs
available online were included for review. Main exclusion criteria included concomitant
meniscus repair, protocols aimed at pediatric patients, and failure to provide time
points for the commencement or recommended completion of any protocol components.
A comprehensive, custom scoring rubric was created that was used to assess each protocol
for the presence or absence of various rehabilitation components, as well as when
those activities were allowed to be initiated in each protocol.
Results
Forty-two protocols were included for review from 155 U.S. academic orthopaedic programs.
Only 13 protocols (31%) recommended a prehabilitation program. Five protocols (12%)
recommended continuous passive motion postoperatively. Eleven protocols (26%) recommended
routine partial or non–weight bearing immediately postoperatively. Ten protocols (24%)
mentioned utilization of a secondary/functional brace. There was considerable variation
in range of desired full-weight-bearing initiation (9 weeks), as well as in the types
of strength and proprioception exercises specifically recommended. Only 8 different
protocols (19%) recommended return to sport after achieving certain strength and activity
criteria.
Conclusions
Many ACL rehabilitation protocols recommend treatment modalities not supported by
current reports. Moreover, high variability in the composition and time ranges of
rehabilitation components may lead to confusion among patients and therapists.
Level of Evidence
Level II.
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Article info
Publication history
Published online: March 28, 2016
Accepted:
January 14,
2016
Received:
August 5,
2015
Footnotes
See commentary on page 1622
The authors report the following potential conflicts of interest or sources of funding: E.C.M. receives support from Physalife, as well as publishing royalties from Springer. N.N.V. receives support from Arthrex, Arthroscopy, Arthroscopy Association Learning Center, Arthrosurface, Cymedica, DJ Orthopaedics, Journal of Knee Surgery, Minivasive, Omeros, Slack, Smith and Nephew, Athletico, ConMed Linvatec, Miomed, Mitek, and Vindico Medical-Orthopedics Hyperguide. C.S.A. receives support from Arthrex, Stryker, and Major League Baseball. B.J.C. receives support from Aesculap/B.Braun, the American Journal of Orthopedics, the American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthrex, Arthroscopy, Arthroscopy Association of North America, Athletico, Carticept, Cytori, DJ Orthopaedics, Elsevier Publishing, International Cartilage Repair Society, Journal of Bone and Joint Surgery-American, Journal of Shoulder and Elbow Surgery, Journal of the American Academy of Orthopaedic Surgeons, Medipost, National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development), Ossur, Regentis, Saunders/Mosby-Elsevier, Slack, Smith & Nephew, Tornier, and Zimmer. B.R.B. receives support from Arthrex, Smith & Nephew, Conmed Linvatec, Tornier, Ossur, Mitek, Athletico, the American Orthopaedic Society for Sports Medicine Medical Publishing Group Board of Directors, and Slack.
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© 2016 by the Arthroscopy Association of North America
