Document Title: Shelbourne-EKLR-Ch07-2000.shtml
Article Title: Anterior Cruciate Ligament Reconstruction: Evolution of Rehabilitation
Author: K. Donald Shelbourne, MD, and Rocci V. Trumper, MD
Publication: Knee Ligament Rehabilitation, edited by Todd S. Ellenbecker. Philadelphia, Pennsylvania: Churchill Livingstone (Harcourt), 2000. (This book has 51 contributing authors and 465 pages.)
Pages: 106-116
Keywords: ACL reconstruction, rehabilitation, protocol, accelerated, delayed, exercises, ligamentization, graft incorporation, revascularization, reinnervation.

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Comments: Donald Shelbourne is a pioneer in ACL-reconstruction rehabilitation. This chapter describes how ACL-surgery rehabilitation has progressed from long immobilized periods and permanent stiffness (range-of-motion deficits) to the modern standard of immediate mobilization and (for first-time ACL reconstructions with no complicating factors such as multiple-ligament reconstructions or meniscal repair) prompt weight-bearing and accelerated ramping-up of activities. Shelbourne also discusses the evolution of ACL-reconstruction surgical procedures, and notes the close interrelationships between surgery and rehabilitation. Additionally, Shelbourne describes how he has learned from his experiences as a surgeon. He points out that the accelerated ACL-rehab protocol can be traced to patients who were noncompliant with the very restrictive original protocol. Shelbourne also notes the importance of early range-of-motion regainment, and the need for control of swelling. In practice, the measures taken for swelling control and range-of-motion regainment include the use of ice, compression, elevation, and CPM (continuous passive motion).

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Introduction

Rehabilitation following anterior cruciate ligament (ACL) reconstruction has changed dramatically over the past decade. Conventional postoperative management emphasizes early protection of the ACL graft by restricting knee motion, weight-bearing, and the rate of return to functional activities.1-4 The high rate of postoperative complications, most notably permanent knee stiffness, has brought about a number of changes in most postoperative rehabilitation protocols.5-11

This chapter examines the evolution of the perioperative rehabilitation that has occurred in our clinic over a 15-year period. We are limiting our presentation to the rehabilitation of patients with ACL-deficient knees reconstructed with an autogenous patellar tendon graft. Specifically, we focus on the decreased incidence of surgical morbidity and the increased patient success in returning safely to functional activities. By maintaining an extensive prospective database and retrospectively analyzing the results, our program has evolved in response to what we have learned from our patients. We emphasize, in our program and in this paper, the influence of the surgical technique and perioperative rehabilitation activities designed to optimize long-term knee stability.

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