The DOI matches its Crossref record; 57 of the 59 references it cites were found in a registry or an index.
How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II)
Open accessAbstract
Objectives: To summarise recommendations and appraise the quality of international clinical practice guidelines (CPGs) for rehabilitation after ACL reconstruction. Design: Systematic review of CPGs (PROSPERO number: CRD42017020407). Data sources: Pubmed, EMBASE, Cochrane, SPORTDiscus, PEDro and grey literature databases were searched up to 30 September 2018. Eligibility criteria: English-language CPGs on rehabilitation following ACL reconstruction that used systematic search of evidence to formulate recommendations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report the systematic review. Two appraisers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to report comprehensiveness, consistency and quality of CPGs. We summarised recommendations for rehabilitation after ACL reconstruction. Results: Six CPGs with an overall median AGREE II total score of 130 points (out of 168) and median overall quality of 63% were included. One CPG had an overall score below the 50% (poor quality score) and two CPGs scored above 80% (higher quality score). The lowest domain score was ‘applicability’ (can clinicians implement this in practice?) (29%) and the highest ‘scope and purpose’ (78%) and ‘clarity of presentation’ (75%). CPGs recommended immediate knee mobilisation and strength/neuromuscular training. Early full weight-bearing exercises, early open and closed kinetic-chain exercises, cryotherapy and neuromuscular electrostimulation may be used according individual circumstances. The CPGs recommend against continuous passive motion and functional bracing. Conclusion: The quality of the CPGs in ACL postoperative rehabilitation was good, but all CPGs showed poor applicability. Immediate knee mobilisation and strength/neuromuscular training should be used. Continuous passive motion and functional bracing should be eschewed.
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“Patellofemoral joint stress steadily increases from partial to medium depth squatting (0° to 90°).42”
From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [42]
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“This is important as quadriceps force contributes directly to patellofemoral joint reaction force and patellofemoral joint stress.42”
From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [42]
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“The increase in patellofemoral joint stress is the result of a steadily increasing patellofemoral joint reaction force that is more pronounced than the increase in contact area as the knee flexes.42”
From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [42]
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A quantitative study of China’s rehabilitation policies from the perspective of policy tools
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MethodAnterior Cruciate Ligament Injury: Non-operative Treatment and Post-operative Rehabilitation
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“32 Enhanced training for coaches on injury management and recovery could bridge the gap between generic physical therapy and the specific needs of Judokas.”
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“26 In line with this recommendation, most of the surveyed PTs (84.9”
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Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction
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Postoperative anterior cruciate ligament rehabilitation: A survey in Gauteng, South Africa
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“Andrade et al. (2020) and Shelbourne, Klootwyk and De Carlo (1992) demonstrated that accelerated rehabilitation, including early weight-bearing and progressive ROM exercises, yields superior results in strength, stability and functional recovery.”
InfluentialKhan, D., Ahmad, A., Karimi, H., Hanif, A., Almansour, A. M., Almansour, A., Aldahmash, B. A., Rady, A., & Almansour, M. I. (2025) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s528778 · Cited by 1
“17 The debate on the utilization of OKC and CKC in ACL rehabilitation and its associated specific disadvantages suggest the need for further research.”
Magnetic resonance imaging follow-up after anterior cruciate ligament reconstruction
Luo, H., Zhong, M., Feng, K., Li, Z., Wang, M., Weng, Y., & Liang, Z. (2025) · BMC Medical Imaging · doi:10.1186/s12880-025-01904-w · Cited by 1
Rehabilitation and Return to Sports of Knee Ligament Injuries
Compagnin, A., & Villa, F. D. (2025) · Springer eBooks · doi:10.1007/978-3-030-65430-6_65-1 · Cited by 1
Guo, Y., Gao, T., & Kong, B. (2026) · Sensors · doi:10.3390/s26020671 · Cited by 1
“Research indicates that NMES-augmented training effectively enhances muscle power, maximum strength, and muscle activation efficiency in both healthy athletes and patients [4].”
Maciel, D. G., do Nascimento, J. D. S., de França, I. M., de Barros, A. C. M., Santana, S. D. F., Cerqueira, M. S., & Vieira, W. H. D. B. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2633261 · Cited by 1
“Major clinical guidelines highlight resistance training as an essential component of rehabilitation programs, being incorporated across all phases of recovery [7,8].”
Huang, J., Chen, W., Zhang, J., Xu, H., Li, Y., Liu, Y., Lin, B., Li, R., Liang, M., Xu, X., et al. (2026) · Thyroid · doi:10.1177/10507256261427761 · Cited by 1
“5,9 Rehabilitation exercise is important for postoperative recovery, 18 – 20 yet post-thyroidectomy rehabilitation remains underutilized in clinical practice.”
Häner, M., Petersen, W. J., Praetorius, A., Mengis, N., Stoffels, T., Guenther, D., Pfeiffer, T. R., Mehl, J. T., Ellermann, A., Eberle, C., et al. (2026) · Journal of Experimental Orthopaedics · doi:10.1002/jeo2.70875 · Cited by 1
O’Shaughnessy, S. M., Dimagli, A., Kachulis, B., Rahouma, M., Demetres, M. R., Govea, N., & Rong, L. Q. (2022) · British Journal of Anaesthesia · doi:10.1016/j.bja.2022.09.008 · Cited by 1
“42,43 Domain 6, assessing conflicts of interest and sources of controversy in funding, has been suggested to possess equal importance to Domain 3.”
Kotsifaki, A., Korakakis, V., King, E. A., Barbosa, O., Maree, D., Pantouveris, M., Bjerregaard, A., Luomajoki, J., Wilhelmsen, J., & Whiteley, R. J. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-106679 · Cited by 1
Henning, M., Henning, R., & Dummett, J. F. (2023) · BMJ Open Quality · doi:10.1136/bmjoq-2023-002300 · Cited by 1
Quo vadis, Nachbehandlung? – Nachbehandlungsschemata kritisch betrachtet
Diemer, F. (2023) · physiopraxis · doi:10.1055/a-2130-3595 · Cited by 1
Cho, S. I., Yang, S.-J., Park, B. S., Kong, D. H., Lee, J. W., & Lee, D. W. (2024) · The Korean Journal of Sports Medicine · doi:10.5763/kjsm.2024.42.2.67 · Cited by 1
Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction
Yu, F., Xiao, L.-E., Wang, T., Hu, Y. S., & Xiao, J. F. (2024) · Orthopaedic Nursing · doi:10.1097/nor.0000000000001030 · Cited by 1
“Previous research findings have supported the notion that persistent muscle strength deficits after ACLR are primarily due to quadriceps activation failure and muscle atrophy (Andrade et al., 2020; Welling et al., 2019; Williams et al., 2005).”
BackgroundClinical Psychology in Rehabilitation After ACL Reconstruction
Piussi, R., Simonson, R., Högberg, J., Sundberg, A., Lindskog, J., & Senorski, E. H. (2024) · Springer eBooks · doi:10.1007/978-3-642-36801-1_505-1 · Cited by 1
Zeitpunkt der Rekonstruktion des vorderen Kreuzbandes – ist eine akute Versorgung obsolet?
Herbst, E., Glasbrenner, J., Kittl, C., Domnick, C., Raschke, M. C. E. J., Höher, J., & Patt, T. (2019) · Knie Journal · doi:10.1007/s43205-019-00018-y
Barrero-Santiago, L., Santiago‐Pescador, S., Santos‐Lozano, A., & Cousiño, L. A. J. (2020) · Sportis Scientific Journal of School Sport Physical Education and Psychomotricity · doi:10.17979/sportis.2020.6.3.5968
“Si se tiene en cuenta la revisión de Andrade et al. (2019), en la cual compara y analiza las guías clínicas más actuales sobre la rehabilitación del LCA, pone de manifiesto la necesidad de realizar en la primera semana postoperatoria los siguientes aspectos: movilización inmediata de la rodilla;…”
BackgroundPratiques postopératoires précoces après reconstruction du ligament croisé antérieur en France
Sezer, H. B., Noailles, T., Toanen, C., Lefèvre, N., Bohu, Y., Fayard, J., & Hardy, A. (2021) · Revue de Chirurgie Orthopédique et Traumatologique · doi:10.1016/j.rcot.2021.09.018
Montoya, L. E. L., Valadez, L. R. G., Montoya, Á. D. L., Sandoval, J., & Cabanillas, D. Y. L. (2021) · Journal of Advances in Medicine and Medical Research · doi:10.9734/jammr/2021/v33i2231161
Orthopädische und traumatologische Sporttherapie
Beinert, K., Freiwald, J., Kugler, A., Meier, H., Pohl, T., Roser, M., & Schweda, S. (2021) · Elsevier eBooks · doi:10.1016/b978-3-437-23461-3.00029-8
Reuter, S. (2020) · Springer eBooks · doi:10.1007/978-3-662-62052-6_3
Salvioli, S., Innocenti, T., Giardulli, B., & Testa, M. (2022) · MetArXiv (OSF Preprints) · doi:10.31222/osf.io/pwrjv
Return to Running After Anterior Cruciate Ligament Reconstruction
Compagnin, A., Gastaldo, M., & Villa, F. D. (2022) · Springer eBooks · doi:10.1007/978-3-662-65064-6_11
Häner, M., Petersen, W. J., Mason, J., Schneider, S., & Hollander, K. (2022) · Springer eBooks · doi:10.1007/978-3-662-65064-6_25
McSharry, L., Brady, R., Lawson, S., & Regan, J. (2022) · Advances in Communication and Swallowing · doi:10.3233/acs-210038
“It has allowed for feasible quality measurement and has informed practitioners about the relevance of CPG implementation across disciplines (Andrade et al., 2020; Boaden et al., 2020; Gillespie et al., 2018; Lin et al., 2020; Yang et al., 2018; Zafra-Tanaka et al., 2019).”
BackgroundKnee Disorder: Intra-Articular
Hoo, J. S., D’Onofrio, G., & Figueroa, G. (2022) · Springer eBooks · doi:10.1007/978-3-030-92042-5_43
Neto, F. A. C., Lemos, S. L., Neto, M. A., Lima, F. P. S., Licurci, M. D. G. B., Fagundes, A. D. A., Lima, M. O., & Nogueira, D. V. (2022) · Research Society and Development · doi:10.33448/rsd-v11i12.34425
de Sousa, R. R., Moura, A. D. J., de Oliveira, D. F. L., do Vale, T. S., Oliveira, A. D. S., Silva, T. M., & Júnior, P. H. D. H. V. (2022) · Brazilian Journal of Science · doi:10.14295/bjs.v1i11.164
Culvenor, A. G., Whittaker, J. L., Bricca, A., & Crossley, K. M. (2023) · doi:10.31219/osf.io/bryfh
Physiotherapy After Anterior Cruciate Ligament Reconstruction a Literature Review
Rutkowska-Kogut, K., Truszczyńska-Baszak, A., & Wrzesień, Z. (2023) · Rehabilitacja Medyczna · doi:10.5604/01.3001.0016.2374
Retour au sport après une lésion du ligament croisé antérieur
Rambaud, A. J. M., Néri, T., & Édouard, P. (2023) · Elsevier eBooks · doi:10.1016/b978-2-294-76665-7.00045-1
Gallen, M. (2023) · Kinésithérapie la Revue · doi:10.1016/j.kine.2022.12.139
Harput, G., Demirci, S., Nyland, J. A., Soylu, A. R., & Tunay, V. B. (2023) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-023-03571-5
Metadata
- Authors
- Andrade, R., Pereira, R., van Cingel, R., Staal, J. B., & Espregueira-Mendes, J.
- Affiliations
- Universidade do Porto (PT)
- Fernando Pessoa University (PT)
- HAN University of Applied Sciences (NL)
- Corresponding author
- Andrade, Renato
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2019-06-07
- Volume
- 54
- Issue
- 9
- Pages
- 512-519
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2948803383
- Cited by
- 264
- References
- 59
- Citations by year
- 2026: 32 · 2025: 64 · 2024: 43 · 2023: 45 · 2022: 36 · 2021: 30 · 2020: 12 · 2019: 2
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- anterior cruciate ligament reconstruction, postoperative rehabilitation, guideline quality assessment, AGREE II, resistance training, neuromuscular training, closed kinetic chain exercises, open kinetic chain exercises, cryotherapy, neuromuscular electrical stimulation, continuous passive motion, functional bracing, weight-bearing exercise
- MeSH terms
- Anterior Cruciate Ligament Injuries, Early Ambulation, Electric Stimulation Therapy, Exercise Therapy, Humans, Range of Motion, Articular, Practice Guidelines as Topic, Cryotherapy, Resistance Training, Anterior Cruciate Ligament Reconstruction
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