Anterior Cruciate Ligament Reconstruction Rehabilitation

Context: Anterior cruciate ligament (ACL) reconstruction rehabilitation has evolved over the past 20 years. This evolution has been driven by a variety of level 1 and level 2 studies. Evidence Acquisition: The MOON Group is a collection of orthopaedic surgeons who have developed a prospective longitudinal cohort of the ACL reconstruction patients. To standardize the management of these patients, we developed, in conjunction with our physical therapy committee, an evidence-based rehabilitation guideline. Results: This review was based on 2 systematic reviews of level 1 and level 2 studies. Recently, the guideline was updated by a new review. Continuous passive motion did not improve ultimate motion. Early weightbearing decreases patellofemoral pain. Postoperative rehabilitative bracing did not improve swelling, pain range of motion, or safety. Open chain quadriceps activity can begin at 6 weeks. Conclusion: High-level evidence exists to determine appropriate ACL rehabilitation guidelines. Utilizing this protocol follows the best available evidence. A nterior cruciate ligament (ACL) reconstruction is a frequently performed procedure in this country. While surgical aspects are critical to the success of the patient, rehabilitation following surgery is just as crucial. The best surgically reconstructed ACL can be ruined by inappropriate or ineffective rehabilitation. Our goal with this publication is to present the Multicenter Orthopaedic Outcomes Network (MOON) ACL rehabilitation guidelines (see Appendix, available at http://sph.sagepub.com/content/suppl) and the clinical evidence used to formulate the guidelines. The MOON group began in 2001 as a 10-member group of orthopaedic sports medicine specialists at 7 sites that assembled to study outcomes of lower extremity injuries and surgeries. It is now a National Institutes of Health–funded group of greater than 20 clinicians who have developed a longitudinal prospective cohort of more than 3000 ACL reconstructions. Shortly following formation of the group, it was acknowledged that standardized rehabilitation guidelines were important for analyzing and reporting our reconstruction outcomes. We undertook a groupwide systematic review to determine the best evidence to guide the formation of an ACL reconstruction rehabilitation protocol. 74,75 Following a review of the evidence and an agreement on important milestones and approaches to rehabilitation, we engaged the physical