Journal of Physical Therapy and Sports Medicine

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Editorial - Journal of Physical Therapy and Sports Medicine (2025) Volume 9, Issue 1

Rehabilitation of ACL Injuries: Best Practices and Outcomes

Vanit Pouley *

Discipline of Occupational Therapy, University of Medicine Trinity College Dublin, Ireland

*Corresponding Author:
Vanit Pouley
Discipline of Occupational Therapy, University of Medicine Trinity College Dublin, Ireland
E-mail: vpouley009@mail.ru

Received: 02-Jan-2025, Manuscript No. AAJPTSM-25-162871; Editor assigned: 03-Jan-2025, PreQC No. AAJPTSM-25-162871 (PQ) Reviewed:17-Jan-2025, QC No. AAJPTSM-25-162871Revised:24-Jan-2025, Manuscript No. AAJPTSM-25-162871 (R); Published:28-Jan-2025, DOI: 10.35841/aajptsm-9.1.245

Citation: Pouley V. Rehabilitation of ACL Injuries: Best Practices and Outcomes. J Phys Ther Sports Med. 2024; 9(1):245

 

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Introduction

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating injuries in athletes, particularly those involved in sports that require sudden changes in direction, jumping, and pivoting, such as soccer, basketball, and skiing [1]. The ACL plays a crucial role in stabilizing the knee joint by preventing the tibia from sliding forward relative to the femur and controlling rotational movements. An ACL injury can severely impair an athlete's function, and without appropriate rehabilitation, it can lead to long-term knee instability and premature osteoarthritis. This mini-review explores the best practices in the rehabilitation of ACL injuries and their outcomes [2]

Overview of ACL injury and treatment

An ACL injury typically occurs as a result of a sudden stop, twist, or change in direction, causing the ligament to overstretch or tear. The injury is often accompanied by significant pain, swelling, and a feeling of instability in the knee. In some cases, surgical intervention is required to repair the torn ligament, while in others, conservative management may be adequate for less severe injuries [3]. Regardless of the treatment approach, rehabilitation is critical to ensure full recovery and return to sport.

Phases of ACL rehabilitation

Rehabilitation for ACL injuries is typically divided into three main phases: the acute phase, the recovery phase, and the return-to-sport phase. Each phase aims to restore function, strength, and stability to the knee while minimizing the risk of re-injury [4].

Acute Phase is the primary focus during the acute phase is to manage pain and swelling, protect the injured area, and begin restoring range of motion (ROM). This phase typically involves rest, ice, compression, and elevation (RICE), along with gentle mobility exercises. For those undergoing surgery, immediate post-surgical care includes immobilization of the knee and early range-of-motion exercises to prevent joint stiffness [5]. Physical therapy at this stage aims to restore full extension of the knee and begin strengthening the quadriceps and hamstrings without compromising the healing ligament.

Recovery Phase, the focus shifts to improving strength, flexibility, and neuromuscular control. Rehabilitation exercises such as leg presses, squats, lunges, and closed-chain exercises are introduced to strengthen the muscles around the knee, particularly the quadriceps and hamstrings. Proprioceptive training, which improves the athlete’s ability to sense the position of the knee joint and control movement, is also a key component during this phase. As the knee stabilizes and strength improves, sport-specific drills with gradual load increases may be introduced [6]

Return-to-Sport Phase is the final phase of ACL rehabilitation focuses on returning the athlete to their sport while minimizing the risk of re-injury. This phase involves more advanced strength training, plyometric exercises, agility drills, and sport-specific movements. Functional testing is crucial at this stage to assess strength, balance, and the athlete’s ability to move and react quickly under pressure. If an athlete achieves near-normal knee function and meets the criteria for sport-specific movements, they may be cleared for return to play [7].

Best practices in ACL rehabilitation

One of the best practices in ACL rehabilitation is the early initiation of range-of-motion (ROM) exercises. This is essential for preventing joint stiffness and promoting fluid movement of the knee. Additionally, activating the quadriceps muscle as soon as possible after injury or surgery is critical to prevent muscle atrophy and promote optimal knee function. Strengthening the muscles surrounding the knee joint, particularly the quadriceps, hamstrings, and calf muscles, is essential in ACL rehabilitation. Weak muscles can lead to improper movement patterns, increasing the risk of future injuries. Closed-chain exercises (such as squats and leg presses), which involve weight-bearing movements, are particularly effective for strengthening the muscles without putting undue stress on the healing ACL [8].

Proprioception training is a key component in preventing re-injury. Exercises that challenge balance and coordination, such as standing on unstable surfaces (e.g., balance boards or wobble boards), are effective in improving joint stability and function. Additionally, neuromuscular training that integrates speed, agility, and coordination is important for athletes preparing to return to sports. Progressive loading is essential in the recovery process to avoid overloading the knee. Rehabilitation exercises should gradually increase in intensity and complexity to allow the tissues to adapt. Sudden or aggressive loading can compromise the healing ACL and increase the risk of reinjury. Proper progression ensures that the knee is prepared for the demands of athletic movements [9]

Outcomes of ACL rehabilitation

Outcomes of ACL rehabilitation are generally positive when best practices are followed. The goal of rehabilitation is to restore the patient to pre-injury function and reduce the likelihood of re-injury. Research shows that patients who undergo rigorous rehabilitation post-ACL reconstruction can return to their pre-injury sport level in approximately 6 to 12 months, depending on the individual’s progress. However, return-to-sport rates vary depending on several factors, including the severity of the injury, the rehabilitation protocol, and the athlete’s age and fitness level. Studies indicate that up to 80% of athletes may return to competitive sports following ACL surgery, but a significant portion (up to 20-30%) may experience re-injury, often due to inadequate rehabilitation or premature return to sports. Therefore, comprehensive rehabilitation that includes strength training, neuromuscular re-education, and gradual progression is essential for optimal outcomes [10]. Moreover, individuals who do not undergo surgical intervention and instead rely on conservative treatment may experience suboptimal outcomes, particularly in terms of knee stability and long-term knee health. While conservative management can work for some individuals, the standard for athletes, especially those who wish to return to high-impact sports, remains surgical reconstruction followed by comprehensive rehabilitation.

Conclusion

Rehabilitation of ACL injuries is a critical component in the recovery process and plays a significant role in the long-term success of the individual. Best practices in ACL rehabilitation, such as early range of motion exercises, strength training, proprioception exercises, and gradual load progression, are vital to achieving optimal outcomes. When these strategies are followed, athletes are more likely to return to their pre-injury performance levels while minimizing the risk of re-injury. Given the growing evidence supporting the importance of comprehensive rehabilitation, it remains a cornerstone of ACL injury recovery, ensuring both short-term recovery and long-term joint health.

References

  1. Pledger C. Discourse on disability and rehabilitation issues: Opportunities for psychology. American psychologist. 2003;58(4):279.

    2. Indexed at, Google Scholar, Cross Ref

  2. Kumar SG, Roy G, Kar SS. Disability and rehabilitation services in India: Issues and challenges. J Family Med Prim Care. 2012;1(1):69.

    3. Indexed at, Google Scholar, Cross Ref

  3. Cohen HS. Disability and rehabilitation in the dizzy patient. Curr Opin. Neurol. 2006;19(1):49-54.

    4. Indexed at, Google Scholar, Cross Ref

  4. Nagi SZ. A study in the evaluation of disability and rehabilitation potential: concepts, methods, and procedures. Am. J. Public Health Nations Health. 1964;54(9):1568-79.

    5. Indexed at, Google Scholar, Cross Ref

  5. Imrie R. Rethinking the relationships between disability, rehabilitation, and society. Disabil. Rehabil. 1997;19(7):263-71.

    6. Indexed at, Google Scholar, Cross Ref

  6. Wilson PN, Foreman N, Stanton D. Virtual reality, disability and rehabilitation. Disabil. Rehabil. 1997;19(6):213-20.

    7. Indexed at, Google Scholar, Cross Ref

  7. Kroll T, Neri MT, Miller K. Using mixed methods in disability and rehabilitation research. Rehabilitation Nursing. 2005;30(3):106-13.

    8. Indexed at, Google Scholar, Cross Ref

  8. Rathore FA, New PW, Iftikhar A. A report on disability and rehabilitation medicine in Pakistan: past, present, and future directions. Arch Phys Med Rehabil. 2011;92(1):161-6.

    9. Indexed at, Google Scholar, Cross Ref

  9. Groce N. Immigrants, disability, and rehabilitation. Culture and disability: Providing culturally competent services. 2005:1-4.

    10. Indexed at, Google Scholar, Cross Ref

  10. Pledger C. Discourse on disability and rehabilitation issues: Opportunities for psychology. American psychologist. 2003;58(4):279.

    11. Indexed at, Google Scholar, Cross Ref

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