Current Standards of Early Rehabilitation after Anterior Cruciate Ligament Reconstruction in German Speaking Countries—Differentiation Based on Tendon Graft and Concomitant Injuries

Clemens Memmel, Werner Krutsch, Dominik Szymski, Christian Pfeifer, Leopold Henssler, Borys Frankewycz, Peter Angele, Volker Alt and Matthias Koch
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Clemens Memmel: Department of Paediatric Surgery and Orthopaedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Paediatric University Medical Centre and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Werner Krutsch: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Dominik Szymski: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Christian Pfeifer: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Leopold Henssler: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Borys Frankewycz: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Peter Angele: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Volker Alt: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
Matthias Koch: Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany

IJERPH, 2022, vol. 19, issue 7, 1-11

Abstract: Background : Although anterior cruciate ligament reconstruction (ACLR) is a well-established procedure and is standardly performed by orthopedic surgeons all over the world, there does not seem to be a standard protocol for early rehabilitation. The purpose of this study was to give answers to the following questions: (i) Does (a) the use of a specific tendon graft, and (b) potentially additional therapy of concomitant pathologies influence surgeons’ choice of a distinct postoperative rehabilitation protocol after ACLR? (ii) To what extent do these rehabilitation recommendations differ? Methods : Retrospective analysis of currently used early rehabilitation protocols after ACLR in German-speaking countries (GER, AUT and SUI) was conducted. Rehabilitation criteria included weight bearing, range of motion (ROM), the utilization of braces, continuous passive/active motion therapy (CPM/CAM), rehabilitation training and sport-specific training. Tendon grafts were differentiated as hamstring (HAM) and bone–patellar tendon–bone grafts (BTB). Concomitant pathologies included meniscus injuries (+M) and unhappy triad injuries (+UTI). Results : Most of the surveyed protocols were differentiated according to the used tendon graft or additional therapy of concomitant injuries (ACLR-differentiated, n = 147 vs. ACLR without graft differentiation, n = 58). When comparing ACLR-HAM and ACLR-BTB, significant differences were found regarding weight bearing ( p = 0.01), ROM ( p = 0.05) and the utilization of braces ( p = 0.03). Regarding ACLR+M, an overall significant decelerated rehabilitation could be detected. After ACLR+UTI-therapy, a significant delayed start to full weight bearing ( p = 0.002) and ROM ( p < 0.001) was found. Conclusions : Most orthopedic surgeons from German-speaking countries differentiate early rehabilitation after ACLR according to the tendon graft used and therapy of concomitant pathologies. No consensus about early rehabilitation after ACLR is available. However, tendencies for an accelerated rehabilitation after ACLR-BTB and a more restrained rehabilitation of multiple injured knees were detected.

Keywords: anterior cruciate ligament reconstruction; early rehabilitation; hamstring tendon graft; bone tendon–bone graft; patella tendon graft (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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