Rehabilitation After Anterior Cruciate Ligament Injury

Impact on Proprioception and Functional Outcomes

The British Journal of Sports Medicine recommends that exercises of central stability be added to the conventional rehabilitation protocol to improve gait and subjective knee function, although it does not offer benefits for pain 1, 2
Alterations in gait persist even after successful anterior cruciate ligament reconstruction, requiring specific motor control exercises to improve movement patterns 3
Motor control training, including backward walking on an inclined treadmill, results in significant improvement in knee proprioception during the initial and intermediate phases of rehabilitation 4

There is no conclusive evidence that balance and proprioception exercises alone improve pain after anterior cruciate ligament reconstruction 1
The combination of plyometric and eccentric training shows significant improvement in balance and functional activities compared to the usual rehabilitation protocol, but with no significant differences in pain 2
Plyometric and agility training does not demonstrate differences in pain compared to the usual rehabilitation protocol 3

The SpeedCourt system shows significant improvement in calf muscle atrophy after anterior cruciate ligament reconstruction 1, 4
Isotonic and isokinetic exercises significantly improve strength outcomes, with a mixed isokinetic-isotonic program achieving better strength results and reducing atrophy 4
Cross-training (exercises with the contralateral limb) does not demonstrate an effect on hamstring strength, balance, and proprioception 1, 2

The British Journal of Sports Medicine suggests that strength and motor control training should be combined in the rehabilitation protocol, as one cannot replace the other to optimize proprioception and function recovery after anterior cruciate ligament injury 5
Adding a motor control training program (including unstable surface training, backward walking on an inclined treadmill, and dynamic balance exercises with one leg) results in significant improvement in knee joint proprioception 1, 6
The combination of eccentric and plyometric exercises is more effective in improving balance, functional activities, and subjective knee function than eccentric or plyometric training alone 4

Proprioceptive deficits can affect not only the injured knee but also the non-injured contralateral knee, suggesting alterations in central neuromuscular control 5
A phase of transition with progressive and controlled exposure to sports should be included before clearance for unrestricted competition, as complete rehabilitation and clearance for return to sports are not the same as return to competition 5
Patient adherence is one of the greatest challenges during rehabilitation after anterior cruciate ligament reconstruction, and patient expectations should be discussed, with the long rehabilitation journey explained, ideally before surgery 5