BIOLOGICAL, BIOMECHANICAL AND CLINICAL CO NCEPTS IN REHABILITATION AFTER LIGAMENT SURGERY ON THE KNEE

Rehabilitation of the anterior cruciate ligament (ACL) continues to be a topic of intense interest among surgeons and therapists. Numerous e xperimental studies have demonstrated that motion and a certain amount of stress are necessary for ligament healing. In experimental and cli nical studies closed kinetic chain exercises have been proven to be sa fe already in the early phase of rehabilitation. Since 1987, over 2900 patients who have undergone ACL reconstruction using the central one- third of the bone patellar tendon bone graft have followed our acceler ated rehabilitation protocol. Follow-up of the patients reveals early return to athletic activity and maintenance of long-term stability. Ou r 1987 accelerated rehabilitation program continues to be modified, wi th less constraints placed on the postoperative patient in our present rehabilitation protocol. Past patient noncompliance to previously est ablished protocols still yielded excellent results that demanded furth er investigation. Gradually we developed a four-phase rehabilitation p rotocol. The initial phase encompasses the preoperative period with th e goal of resolving swelling and regaining full motion. The second pha se involves the initial two weeks post ACL recontruction and focuses p rimarily on wound healing, full extension, control of swelling, and le g control. The third phase (two to five weeks) involves increasing fle xion, developing a functional gait, and resuming activities of daily l iving. The fourth phase (> five weeks) identifies a safe return to com petitive athletics. With this accelerated rehabilitation protocol a de creased postoperative morbidity was noted without jeopardizing the lon g term stability of the ACL reconstructed knee.