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More randomized studies on ACL rehabilitation needed
But therapists stand by proven approaches and embrace new models.
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INNSBRUCK, AUSTRIA — Although there are scarce long-term clinical and functional data on rehabilitation programs for ACL injuries, clinicians and physical therapists do have some effective approaches.
For instance, gait analysis can help patients change their walking or running patterns and avoid reinjury, according to May Arna Risberg, PhD, a physical therapist in Oslo. Other effective rehabilitation and preventive measures include strength training, and both closed and open kinematic chain exercises, she added.
Risberg participated in a rehabilitation symposium here at the European Society of Sports, Traumatology and Knee Arthroscopy 12th Congress. Other panel members included Roland Biedert, PhD, of Switzerland, Suzanne Werner, PhD, of Sweden, and Wendy Hurd, a physical therapist and doctoral candidate from the United States.
According to Biedert, using clear preoperative rehabilitation goals, such as maintained function, pain relief and stability, offer good short-term outcomes at three to six months.
Werner also suggested considering criterion-based vs. time-based rehabilitation approaches. Criterion-based approaches include finite measures, such as range of motion and stability. In contrast, time-based models focus on the time needed for healing before a patient returns to sports or other activities. She stressed watching for arthrofibrosis, and noted weight-bearing and kinematic loads are key to strengthening ACL grafts.
Immediate extension is also critical after an ACL injury, regardless of the patient's sport, Hurd added. Quadriceps strengthening and electrical stimulation are also effective, but rehabilitation should be tailored to the patient's sport, she said.
However, the panelists noted that there is a lack of lack of biomechanical study data to guide ACL rehabilitation protocols and called for more randomized, controlled studies.
For more information:
- Biedert R, Hurd W, Lorenzini M, Risberg MA, Werner S. Rehabilitation Symposium: Knee rehabilitation, from ACL injury to knee OA. Presented at the European Society for Sports Traumatology and Knee Arthroscopy 12th Congress. May 24-27, 2006. Innsbruck, Austria.