Rehabilitation Guidelines for Patellar Tendon Weakening Following BPTB ACL Reconstruction

Rehabilitation Considerations

The British Journal of Sports Medicine recommends starting open kinetic chain exercises cautiously from 4 weeks postoperative in a restricted range of motion (90°-45°) 1
Gradual progression of range of motion is recommended: 90°-30° in week 5, 90°-20° in week 6, 90°-10° in week 7, and full ROM by week 8 1
Early mobilization can reduce patellofemoral pain in BPTB graft patients (from 35% to 8%) compared to patients who remain non-weight-bearing for 2 weeks 2, 3
Closed kinetic chain exercises can be safely performed from week 2 postoperative 1
Isometric quadriceps exercises including static quadriceps contractions and straight leg raises can be safely prescribed during the first 2 postoperative weeks 2, 3

Open kinetic chain exercises might induce more anterior knee pain compared with closed kinetic chain exercises in BPTB graft patients 4

Both concentric and eccentric training improve quadriceps strength without significant differences between training types 4
A combination of eccentric and plyometric exercises is more effective in improving balance, functional activities, and subjective knee function than either training method alone 4

Regular assessment of anterior knee pain during rehabilitation is essential, as it may indicate excessive strain on the weakened patellar tendon 2, 4
For return to pivoting/contact sports, a Limb Symmetry Index (LSI) of 100% is recommended to ensure adequate healing and strength of the patellar tendon 1
Neuromuscular training should be added to strength training to optimize outcomes and prevent reinjuries 1

Healing progresses from an initial inflammatory phase to a remodeling phase, with most patients requiring at least 19 weeks of rehabilitation for adequate tendon healing, as recommended by the British Journal of Sports Medicine 5
A 19-week rehabilitation protocol has shown no differences in knee laxity or other outcomes, such as strength, functional, proprioception, and subjective function, compared with longer duration protocols, according to the British Journal of Sports Medicine 5