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ANTERIOR CRUCIATE LIGAMENTRECONSTRUCTIONRehabilitationWhere are we in 2021?Oklahoma State Physical TherapyAssociation MeetingApril 17,2021121)2)34 Cavanaugh J. Anterior Cruciate Ligament Reconstruction. In: PostsurgicalRehabilitation Guidelines for the Orthopedic Clinician. Mosby, St. Louis, 2006. Moses B, Orchard J, Orchard J. Systemic review: annual incidence of ACLinjury and surgery in various populations. Res Sports Med. 2012;20:157-179.561

Miyasaka KC, et al. The incidence of knee ligament injuries in thegeneral population. Am J Knee Surg 1991;4:3-8. Gianotti SM, Marshall SW, Humer PA, et al. Incidence of anteriorcruciate ligament injury and other knee ligament injuries: a nationalpopulation-based study. J Sci Med Sport. 2009;12:622-627. Lephart SM, et al. Quadriceps strength and functional capacityafter anterior cruciate ligament reconstruction. Patellar tendonautograft versus allograft. Am J Sports Med. 1993;21:738-743. Johnson R. Prevention of cruciate ligament injuries. In: Feagin JJ (ed).The Crucial Ligaments: Diagnosis and Treatment of LigamentousInjuries about the Knee. New York, 1988. Churchill Livingstone.7Peterson RK, et al. Allograft versus autograft patellar tendonanterior cruciate ligament reconstruction; a 5 year follow-up.Arthroscopy. 2001;17:9-13.8 NOT INCREASED IN ALLO VS AUTO McAllister DR, Joyce MJ, Mann BJ, et al. Allograft update:the current status of tissue regulation, procurement,processing and sterilization. Am J Sports Med. 2007;35:21482158.9Greenberg DD, Robertson M, Vallurupalli S, et al. Allograft comparedwith autograft infection rates in primary anterior cruciate ligamentreconstruction. J Bone Joint Surg. 2010;92:2402-2408.10 Wasserstein D, Sheth U, Cabrera A, Spindler KP. A systematicreview of failed ACL reconstruction with autograftcompared with allograft in young patients. Am J Sports Med.2015;7(3):207-216.Balsly CR, et al. Effect of low does and moderate dose gammairradiation of the mechanical properties of bone and soft tissue allografts.Cell Tissue Bank. 2008;9:289-298.11122

Sun K, Zang J, Wang Y, et al. Arthroscopic antereior cruciate ligamentreconstruction with a least 2.5 years follow-up comparing hamstring tendonautograft and irradiated allograft. Arthroscopy. 2011;27:1195-1202.Wasserstein D, Sheth U, Cabrera A, Spindler KP. A systematicreview of failed ACL reconstruction with autograft comparedwith allograft in young patients. Am J Sports Med.2015;7(3):207-216.1314 SIGNAL/NOISE QUOTIENT ALLOGRAFTSIGNIFICANTLY HIGHER THAN AUTOGRAFT I NDICATING INFERIOR GRAFTMATURITYHong L, Tao H, Cho S, Chen S, Yau Z, Chen S. Difference in graft maturity of thereconstructed anterior cruciate ligament 2 years postoperatively. Am J Sports Med.2012;40:1519-1526.151617183

Wright RW, et al. A systematic review of anterior cruciate ligament reconstructionrehabilitation. Part II: Open versus closed kinetic chain exercises, neuromuscular electricalstimulation, accelerated rehabilitation, and misc topics. J Knee Surg 2008;21:225-234.Wright RW, et al. A systematic review of anterior cruciate ligament reconstructionrehabilitation. Part I: Continuous passive motion, early weight bearing, postoperativebracing, and home based rehabilitation. J Knee Surg 2008;21:217-224.1920 Wright RW, et al. Anterior Cruciate Ligament Reconstruction Rehabilitation: MOONGuidelines. Sports Health. 2015;7(3):239-243.2122 Cohn BT, et al. The effects of cold therapy in the postoperative management of pain in patientsundergoing anterior cruciate ligament reconstruction. Am J Sports Med 1989;17:344-349. Raynor MC, et al. Crotherapy after ACL reconstruction. A meta-analysis. J Knee Surg. 2005;18:123129.23244

Bransson S, et al. Post operative analgesic effects of an external cooling system and intra-articularbupivacaine/morphine after arthroscopic cruciate ligament surgery. Knee Surg Sports TraumatolArthrosc. 1996;4(4):200-205.Cohn BT, et al. The effects of cold therapy in the postoperative management of pain in patientsundergoing anterior cruciate ligament reconstruction. Am J Sports Med 1989;17:344-349.Dambros C, et al. Effectiveness of cryotherapy after anterior cruciate ligament reconstruction. ActaOrtop Bras. 2012;20(5):285-290.Murgier J, Cassard X. Cryotherapy with dynamic intermittent compression for analgesia after anteriorcruciate ligament reconstruction. Preliminary study. Orthop Traumatol Surg Res. 2014;100(3):309-312.Raynor MC, et al. Cryotherapy after ACL reconstruction. A meta-analysis. J Knee Surg.2005;18:123-129.2526 Beck PR, Nho S, Balin J, et al. Postoperative pain management after anterior cruciate ligamentreconstruction. J Knee Surg. 2004;17:18-23. Cina-Tschumi B. Evidence-based impact of cryotherapy on postoperative pain, swelling, drainage andtolerance after orthopedic surgery. Pflege. 2007;20:258-267. Ohkoshi Y, Ohkoshi M, Nagasaki S, et al. The effect of cryotherapy on intraarticular temperature andpostoperative care after anterior cruciate ligament reconstruction. Am J Sports Med. 1999;27:357-362.Warren TA, McCarty EC, Richardson AL, et al. Intra-articular knee temperature changes: Ice versuscryotherapy device. Am J Sports Med. 2004;32:441-445.27Lee CK, et al. Sever frostbite of knees after cryotherapy. Orthopedics. l 128 Lee CK, et al. Sever frostbite of knees after cryotherapy. therapy?full 129305

LESS PAIN; LESS PERIPHERAL EDEMA; GREATER ROM FASTER RECOVERY; LESSNSAID USE; FASTERRESOLUTION OF JOINTSWELLINGBenazzo F, et al. Effects of biophysical stimulation in patients undergoing arthroscopicreconstruction of anterior cruciate ligament: Prospective, randomized and doubleblinded study. Knee Surg Sports Tramautol. 2008;16(6):595-601.Jarit et al. The effects of home interferential therapy on post-operative pain,edema and range of motion of the knee. Clin J Sports Med. 2003;13(1):16-20.3132 Beynnon BD, et al. The science of anterior cruciate ligament rehabilitation.Clin Orthop 2002;9-20. Butler DL, et al. Mechanical properties of primate vascularized vs. nonvascularized patellar tendon grafts: change over time. J Orthop Res1989;7:68-79.3334 RELATIVELY EQUIVALENTSTABILITYMacaulay, AA, Perfetti DC, Levine WN. Anterior cruciate ligament graftchoices. Sports Health. 2012; 4(1):63-68.35366

3738 3940 BMD IN INVOLVEDLOWER EXTREMITYReiman MP, Rogers ME, Manske RC. Interlimb differences in lower extremity bonemineral density following ACLR. J Orthop Sports Phys Ther 2006;36(11):837-844.Reiman MP, Rogers ME, Manske RC. Interlimb differences in lowerextremity bone mineral density following ACLR. J Orthop Sports Phys Ther2006;36(11):837-844.41427

6.6% ATTROCHANTERIC REGION 4.0% FOR ENTIRE HIP 3.4% FOR INTERTROCHANTERICREGION Neitzel JA, Kernozek TW, Davies GJ. Loading response following ACLreconstruction during parallel squat exercise. Clin Biomech. 2002;17:551554.Reiman MP, Rogers ME, Manske RC. Interlimb differences in lower extremity bonemineral density following ACLR. J Orthop Sports Phys Ther 2006;36(11):837-844.4344 SIGNIFICANT DIFFERENCES (P 0.05) BETWEEN WITH GROUP INTERACTION WITH WEIGHT AND ANGLE Neitzel JA, Kernozek TW, Davies GJ. Loading response following ACLreconstruction during parallel squat exercise. Clin Biomech. 2002;17:551554.45Neitzel JA, Kernozek TW, Davies GJ. Loading response following ACLreconstruction during parallel squat exercise. Clin Biomech.2002;17:551-554.46 BENEFIT OF EARLY SINGLE-LEG EXERCISE DO NOT “UNLOAD”Neitzel JA, Kernozek TW, Davies GJ. Loading response following ACLreconstruction during parallel squat exercise. Clin Biomech.2002;17:551-554.Neitzel JA, Kernozek TW, Davies GJ. Loading response following ACLreconstruction during parallel squat exercise. Clin Biomech.2002;17:551-554.47488

SIGNIFICANT INCREASEWEIGHT BEARING GROUP Tyler T, et al. The effect of immediate weight bearing after anteriorcruciate ligament reconstruction. Clin Orthop 1998;357:141-148.49Tyler T, et al. The effect of immediate weight bearing after anteriorcruciate ligament reconstruction. Clin Orthop 1998;357:141-148.50 STATISTICALLY SIGNIFICANT DECREASE IN ANTERIOR KNEEPAIN PAIN IN 7/20 RESTRICTED WB PAIN IN 2/25 IMMEDIATE WB Tyler T, et al. The effect of immediate weight bearing after anteriorcruciate ligament reconstruction. Clin Orthop 1998;357:141-148.5152 Sachs R, et al. Patellofemoral problems after ACL reconstruction. Am J SportsMed 1989;17:760-7655.Gerber C, et al. The lower extremity musculature in chronic symptomaticinstability of the ACL. J Bone Joint Surg 1985, 67A:1034-1043.53549

Arvidssoon I, et al. Prevention of quadriceps wasting after immobilization: anevaluation of the effect of electrical stimulation. Orthopedics. 1986;9:15191528. Delitto A, et al. Electrical stimulation versus voluntary exercise in strengtheningthigh musculature after anterior cruciate ligament surgery. Phys Ther1988;68:660-663.Fitzgerald GK, et al. A modified neuromuscular electrical stimulation protocolfor quadriceps strength training following anterior cruciate ligamentreconstruction. J Orthop Sports Phys Ther 2003;33:492-501. Lieber RL, et al. Equal effectiveness of electrical and volitional strengthtraining for quadriceps femoris muscles after anterior cruciate ligamentsurgery. J Orthop Res 1996;14:131-138.Paternostro-Sluga T, et al. Neuromuscular electrical stimulation after anteriorcruciate ligament surgery. Clin Orthop 1999;368:166-175.5556Rebai H, et al. Effects of two electrical stimulation frequencies in thigh muscles afterknee surgery. Int J Sports Med 2002;23:604-609.Ross M, The effect of neuromuscular electrical stimulation during closed kinetic chainexercise on lower extremity performance following anterior cruciate ligamentreconstruction. Sports Med Train Rehabil 2000;9:239-251.Sisk TD, et al. Effect of electrical stimulation on quadriceps strength after reconstructivesurgery of the anterior cruciate ligament. Am J Sports Med 1987;15:215-220.Snyder-Mackler L, et al. Electrical stimulation of the thigh muscles after reconstruction ofthe anterior cruciate ligament. J Bone Joint Surg 1991;73A:1025-1035.Snyder-Mackler et al. Strength of quadriceps femoris muscle recovery afterreconstruction of the anterior cruciate ligament. J Bone Joint Surg 1995; 77A:1166-1173.Wigerstad-Lossing I, et al. Effects of electrical muscle stimulation combined withvoluntary contractions after knee ligament surgery. Med Sci Sports Exerc 1988;20:93-98.5758 KNEE MOTIONShelbourne KD, Gray T. Minimum 10- year results after anterior cruciate ligamentreconstruction. How the loss of normal knee motion compounds other factors relatedto the development of OA after surgery. Am J Sports Med 2009;37(3):471-480.59Shelbourne KD, Gray T. Minimum 10- year results after anterior cruciate ligamentreconstruction. How the loss of normal knee motion compounds other factors relatedto the development of OA after surgery. Am J Sports Med 2009;37(3):471-480.6010

I NTENSITY, FREQUENCY AND DURATIONCARTILAGE AND INTACT MENISCI HAD NORMAL RADIOGRAPHS TERT LOW LOAD LONG DURATION STRETCHING LLLD 98% OF PATIENTS WITH NORMAL MOTION, NORMAL ARTICULAR3-5 LOSS OF EXTENSIONShelbourne KD, Gray T. Minimum 10- year results after anterior cruciateligament reconstruction. How the loss of normal knee motion compoundsother factors related to the development of OA after surgery. Am J Sports Med2009;37(3):471-480.61Flowers K, Lastayo P. Effect of total end range time on improving passiverange of motion. J Hand Ther. 2012. 25(1):48-55.62 EVEN AFTER SURGERY (MUA) ATHLETES STILL HAVE STRENGTH LOSS AND DECREASED FUNCTIONAL ABILITIES NEED TO RETURN FULL HYPER-FLEXION TO UNINVOLVED SIDEWorsham J, Lowe W Copa D, et al. Subsequent surgery for loss of motionafter anterior cruciate ligament reconstruction does not influence function at 2years. Am J Sports Med. 2019; epub ahead of print.6364 656611

6768 6970 INCREASE STRENGTH AND ROMINCREASED INTENSITY 71 7212

7374 7576 77 7813

7980 8182 LIGHT FUNCTIONAL ACTIVITIESJOGGING, STEPPING, FOOTWORK AND AGILITY DRILLS REVEALS83STRENGTH ASSESSMENT75-80% 8414

85 86 8788 899015