The purpose of this Clinical Practice Guideline document is to describe the evidence of effectiveness for the components of rehabilitation after anterior cruciate ligament reconstruction (ACLR). This information can be then used to inform ACLR rehabilitation protocols. This guideline is intended to be used by physiotherapists managing patients after ACLR in outpatient clinics. Physicians, orthopaedic surgeons, athletic trainers, nurse practitioners, and other healthcare professionals may also benefit from this guideline. Insurance payers, governmental bodies, and health-policy decision makers may also find this guideline to be useful as an evolving standard of evidence regarding rehabilitation after ACLR. Additional key users of this guideline include researchers, since this document may highlight gaps in the literature and grey areas that require further research.
The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (e.g., exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling, and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used