The aim of this scoping review was to describe the available literature that presents recommendations or guidelines regarding rehabilitation that involves actively loading the knee joint and surrounding tissues after primary ACLR. Specifically, graft-specific recommendations were sought, limited to the three most used autografts, those harvested from the quadriceps tendon (QT), semitendinosus tendon (ST) or patellar tendon (PT).
The protocol was published in an open science registry prior to the search, which was conducted as per the PRISMA extension for scoping reviews. The PubMed/MEDLINE, Clarivate/Web of Science, and EBSCO (CINAHL) electronic databases were searched for primary research studies, systematic, scoping or narrative reviews, and protocols, commentaries or technical notes involving post-surgical rehabilitation guidelines for adults undergoing primary ACLR. Publications had to present clear statements regarding the authors’ recommendations and be published internationally after 2013 in English, Danish, Norwegian, German, Icelandic, Swedish, or Italian. Terms used included variations of: #1 Anterior cruciate ligament reconstruction; #2 Rehabilitation; #3 Clinical guidelines. The Boolean “OR” operator term was used between terms within the same search string, while the “AND” operator term was used to combine the three. All findings were imported and further evaluated using the Covidence online software. Two independent reviewers screened titles and abstracts to determine which full texts to evaluate for inclusion/exclusion. A third reviewer assessed any conflicts of those two steps for final decision making. Data of the final included studies were then extracted.
A total of 1081 publications were identified, of which 299 duplicates were removed. Of the 782 publications screened, 89 went through full text screening, of which 15 publications provided data for extraction. The most common reasons for exclusion were that the publications were primarily surgical, did not include clearly stated guidelines or recommendations for different phases of rehabilitation, or focused on the wrong population (children) or parameters (e.g. return-to-sports criteria). Ten of 15 publications mentioned at least one consideration. The most common recommendation was to limit strain on: a) the graft during the first 4-8 post-operative weeks by controlling load and knee angle (regardless of graft type); the ST harvest site during the first 4-16 weeks. Disparity in recommendations identified reflects paucity of research on this topic.
Recommendations are rarely presented within published clinical practice guidelines regarding when and how the graft and harvest site should be loaded after ACLR. The few recommendations found during this scoping review are not based on strong evidence.
More basic science and clinical studies are needed to build a stronger knowledge base to support clinicians in providing the appropriate loading of the graft and its harvest site during post-surgical rehabilitation of their clients.
active rehabilitation
sports physical therapy
