CoChat
Sign Up
Cited by 212Knee injuries and reconstruction techniquesSports injuries and preventionTendon Structure and Treatment

ACL Reconstruction rehabilitation: Clinical data, biologic healing, and criterion-based milestones to inform a return-to-sport guideline

Open access
Brinlee, Alexander W., Dickenson, Scott B., Hunter-Giordano, Airelle, Snyder-Mackler, Lynn·2022·Sports Health A Multidisciplinary Approach
DOI 10.1177/19417381211056873PMC PMC9460090
Open this paper in CoChat — free account

Abstract

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians’ current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. Evidence Acquisition: Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention. Study Design: Clinical review. Level of Evidence: Level 5. Results: Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey–Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. Conclusion: Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. Strength of Recommendation Taxonomy (SORT): B.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1177/19417381211056873

Cites

71 of 71 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Increased gluteus maximus activation can be achieved through the use of wider stance squats, as well as external band resistance around the thighs.

    “Increased gluteus maximus activation can be achieved through the use of wider stance squats,26–29 as well as external band resistance around the thighs.45,46”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [45]

    The citation range after “wider stance squats” attaches this source to that part of the sentence. Searches for wider stance squats and gluteus maximus activation found no passage addressing their relationship. The closest passages (indexed as Abstract; page unavailable) discuss quadriceps strengthening and ACL strain during squatting, not squat stance width or gluteus maximus activation. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

  • External band resistance around the thighs promotes gluteus maximus and gluteus medius activation.

    “Secondary considerations for hip bias squatting early in the recovery process include external band resistance around the thighs to promote gluteus maximus and gluteus medius activation45,46 and avoidance of deep squats (i.e., recommendations highlighted above for PFP).”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [45]

    The rehabilitation discussion (indexed as Abstract; page unavailable) addresses quadriceps loading and knee-extension exercises, but does not address bands around the thighs or gluteus maximus and medius activation. Searches for those muscles and for resistance-band squats found no passage establishing the claimed effect. (LLM, conf=0.70)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. [48]48. Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med. 2009;37:1434-1443. [DOI] [PubMed] [Google Scholar]
  2. [50]50. Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL. Am J Sports Med. 2015;42:1567-1573. [DOI] [PMC free article] [PubMed] [Google Scholar]

Cited by

Sorted by citations

Related

Authors
Brinlee, A. W., Dickenson, S. B., Hunter-Giordano, A., & Snyder-Mackler, L.
Affiliations
  • University of Delaware (US)
  • Department of Physical Therapy, University of Delaware, Newark, Delaware
Corresponding author
Hunter-Giordano, Airelle
Venue
Sports Health A Multidisciplinary Approach
Publisher
SAGE Publications
Published
2021-12-13
Volume
14
Issue
5
Pages
770-779
ISSN
  • 1941-0921 (ISSN-L)
  • 1941-7381
DOI
10.1177/19417381211056873
PMC
PMC9460090
OpenAlex
W4200440427
Cited by
212
References
71
Citations by year
2026: 53 · 2025: 59 · 2024: 58 · 2023: 36 · 2022: 6
FWCI
23.49
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Sports Health A Multidisciplinary Approach (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
Keywords
anterior cruciate ligament reconstruction, postoperative rehabilitation, return to sport, rehabilitation guidelines, clinical milestones, graft healing, open kinetic chain exercises, closed kinetic chain exercises, quadriceps strength, knee range of motion, knee effusion, secondary injury prevention, ACL injury prevention
MeSH terms
Return to Sport, Anterior Cruciate Ligament Injuries, Activities of Daily Living, Biological Products, Humans, Anterior Cruciate Ligament Reconstruction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review