{"id":10282,"date":"2022-11-14T06:00:38","date_gmt":"2022-11-14T05:00:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10282"},"modified":"2022-11-11T10:44:28","modified_gmt":"2022-11-11T09:44:28","slug":"acl-injury-rehabilitation-clinical-implications-from-an-optiknee-systematic-review","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2022\/11\/14\/acl-injury-rehabilitation-clinical-implications-from-an-optiknee-systematic-review\/","title":{"rendered":"ACL Injury rehabilitation: clinical implications from an OPTIKNEE systematic review"},"content":{"rendered":"

This blog is part of a series on work by OPTIKNEE Consensus<\/a>. This is an international consensus group focused on improving knee health and preventing osteoarthritis after a traumatic knee injury.<\/b><\/p>\n

Keywords: <\/b>Rehabilitation, Anterior cruciate ligament, OPTIKNEE<\/span><\/p>\n

Anterior cruciate ligament (ACL) tears are one of the most talked about injuries in sports medicine. Most people who tear their ACL will embark on a rehabilitation program (with or without ACL surgical reconstruction).\u00a0 The international OPTIKNEE consensus project aims to optimize knee health and prevent post-traumatic osteoarthritis (OA) following knee injuries like ACL tears. As part of this consensus, we recently published a systematic review of systematic reviews in BJSM<\/a> (OPEN ACCESS) examining the effectiveness of different rehabilitation interventions to improve symptomatic, functional, clinical, psychosocial and quality of life outcomes, and prevent re-injury after ACL (and\/or meniscal) injury (<\/span>1).<\/span> The summary of this study is outlined in this blog.\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

Why is this study important?<\/b><\/p>\n

ACL and meniscal injuries can be devastating (<\/span>2, 3). <\/span>Although many people successfully regain pre-injury function and return to sport after extensive rehabilitation and surgery, pain, psychological distress and reduced function are equally as common. They cannot return to pre-injury sport \u2013 an activity that brings them enjoyment with all the long-term health and wellbeing participation benefits (4). <\/span>There is little consensus about the optimal components of an ACL tear rehabilitation program to achieve pre-injury function, activity and quality of life, leading to significant variations in approaches. Systematic reviews of systematic reviews pull together the highest level of evidence as a one-stop shop to inform clinical practice.<\/span><\/p>\n

How did the study go about this?<\/b><\/p>\n

This study reviewed systematic reviews of randomised clinical trials that evaluated the effectiveness of any rehabilitation intervention following traumatic ACL and\/or meniscal injury (a common secondary injury) to improve symptomatic and\/or functional outcomes. We assessed outcomes relating to pain, symptoms, function, re-injury, psychosocial factors, quality of life and adverse events.<\/span><\/p>\n

What did the study find?<\/b><\/p>\n

We found 22 systematic reviews, including 142 randomised controlled trials of mostly men (56% – 95%), and almost all after ACL reconstruction (none following isolated meniscal injury). In general, there was a disappointingly low level of evidence for the effectiveness of rehabilitation interventions to improve symptomatic and functional outcomes after ACL injury.<\/span><\/p>\n

The strongest level of evidence (moderate certainty) was found for:<\/span><\/p>\n

    \n
  1. Neuromuscular electrical stimulation to improve quadriceps strength.<\/span><\/li>\n
  2. Open versus closed kinetic chain exercises to be similarly effective for quadriceps strength, self-reported function, and knee laxity.<\/span><\/li>\n
  3. Structured home-based rehabilitation to be similarly effective to structured in-person rehabilitation for quadriceps and hamstring strength, self-reported function, and knee laxity.<\/span><\/li>\n
  4. Postoperative knee bracing to provide no benefit to physical function and knee laxity.<\/span><\/li>\n<\/ol>\n

    Low certainty evidence was found for:<\/span><\/p>\n

      \n
    1. \n
        \n
      1. Pre-operative rehabilitation consisting of 3\u20136 weeks of muscle strengthening and neuromuscular (i.e., function and stability) control exercises to improve self-reported and physical function (e.g., hop performance) 3 months post-ACLR.<\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n