The modifying factors that help improve anterior cruciate ligament reconstruction rehabilitation: a narrative review - 29/10/21

Doi : 10.1016/j.rehab.2021.101601

Alexandre JM Rambaud ^1,^2,^3,^⁎ , Thomas Neri ^1,⁴, Bart Dingenen ⁵, David Parker ^6,⁷, Elvire Servien ^8,⁹, Alli Gokeler ¹⁰, Pascal Edouard ^1,¹¹
¹ Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France
² Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
³ SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes du Sport, Pierrefitte/Seine, France
⁴ Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Faculty of medicine Saint-Etienne, France
⁵ Reval Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan A, 3590 Diepenbeek, Belgium
⁶ Sydney Orthopaedic Research Institute, Sydney, Australia
⁷ The University of Sydney, Sydney, Australia
⁸ Univ Lyon, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Lyon, France
⁹ Department of orthopaedic surgery and sports medicine, FIFA medical center of excellence, Lyon University Hospital
¹⁰ Exercise Science & Neuroscience Unit, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
¹¹ Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of medicine, Saint-Etienne. France

^⁎Corresponding author. Université de Lyon, UJM-Saint-Etienne, Laboratoire Inter-universitaire de Biologie de la Motricité, EA 7424, Campus Santé Innovations IRMIS 42270 Saint-Priest en Jarez, France Tel.: 0622761862, Fax: 0477307655Université de Lyon, UJM-Saint-Etienne, Laboratoire Inter-universitaire de Biologie de la MotricitéCampus Santé Innovations IRMIS 42270Saint-Priest en JarezEA7424France

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Highlights

•	Rehabilitation differs only in the early postoperative phase depending on the graft type.
•	Rehabilitation after combined extra-articular procedures is basically the same.
•	Rehabilitation of meniscus or cartilage repair will be a priority after the surgery.
•	The rehabilitation program must be gradual and meet the sport's specific requirements.
•	Psycho-socio-contextual factors should be managed to individualize rehabilitation.

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Abstract

Background

: The goal of a rehabilitation programme after anterior cruciate ligament (ACL) reconstruction is to manage a patient's goals and expectations (i.e., returning to physical activities and sports) while minimizing the risk of new injury, particularly a new ACL injury. Although general rehabilitation programmes have been proposed, some factors can lead to adapting each programme to each patient.

Objective

: To describe how different variables, including surgical techniques, sports participation, psycho-social and contextual factors can modify the rehabilitation programme.

Methods

: We performed a narrative review with input from experts in the field (level of evidence 5).

Conclusions

: Modifying factors of the ACL rehabilitation programme are related to the initial lesion or surgery, to sports, or to psychological or social aspects. Regarding the type of graft, the rehabilitation is mainly different in the early postoperative phase; the other phases are not graft-based but rather goal-based rehabilitation. Depending on the meniscal or cartilage repair, the rehabilitation protocol will initially take priority over the anterior cruciate ligament reconstruction protocol. The ACL reconstruction rehabilitation programme should meet the requirements of the anticipated sports, to optimize the athlete's ability to return to the expected level and minimize the risk of reinjury. Psycho-social and contextual factors must also be considered in rehabilitation care to individualize and optimize each patient's programme.

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