Exercises Following Anterior Cruciate Ligament Reconstructive Surgery: Biomechanical Considerations and Efficacy of Current Approaches

Figures & data

Table 1. Considerations in the Choice of Exercises to Foster Optimal Rehabilitation in People Undergoing Anterior Cruciate Ligament Reconstructive Surgery

• Duration after injury

• Duration after surgery

• Host characteristics

• Age

• Gender

• Health status

• Musculoskeletal status

• Prior injury history

• Weight

• Nature of the injury

• Nature of the surgery/surgical techniques

• Lifestyle needs

Figure 1. Conceptual model of the relationship among anterior cruciate ligament graft strength, fixation strength, and functional tension over the early rehabilitation period, depicting that the tension applied to the healing graft should be selected with the view that its strength is changing along with fixation strength over time. The specific amount of tension in light of surgery type remains to be determined, however.

Table 2. Summary of Randomized Controlled Studies of Closed Versus Open Chain Exercise Applications Following Anterior Cruciate Ligament Reconstructive Surgery

Authors	Sample	Study Design	Finding	Limitations
Bynum, Barrack, and Alexander (1995)	Patients with ACL reconstruction	2 grp comparison with tests at a min 1 yr	At 19 months, CKC grp had better stability, less pain, more satisfaction with outcome	Ex. dosage uncertain/unequal Baseline laxity status unknown No data on functional outcomes
Hooper, Hill, Drechsler, et al. (2002)	32 patients	2 grp comparison 2 and 6 wks postsurgery 2 grp comparison CKC vs CKC plus OKC	OKC and CKC resulted in similar isokinetic torque values	No other measures reportedUnclear exercise dosage
Mikkelson, Werner, and Eriksson (2000)	44 patients		CKC plus OKC yielded higher numbers of patients returning to prior sports, and returned 2 months earlier than those who carried out CKC only with no compromise in stability at 6 m	Not certain therapist/assessors were blinded
				Exercise dosage unclear/unequal
				No laxity measures in directions other than anterior laxity assessed
				Demographic data at baseline not clearly shown to demonstrate equivalency grps
Morrisey, Hudson, Drechsler, et al. (2000)	36 patients	Pts received OKC or CKC exs for 4 wks and were tested for knee laxity at 2 and 4 wks	OKC grp had 9% greater laxity, but this felt to reflect greater laxity in OKC grp	Short-term study Exercise dosage unclear
Morrissey, Drechsler, Morissey, et al. (2002)	43 patients	CKC and OKC exs were compared for pain effects	At 2 and 6 wks there were no differences in pain scores	No other measures reported
				All pts received PT
Perry, Morrissey, King, et al. (2005)	49 patients recovering from ACLR surgery received formal PT plus either OKC or CKC exercises 3x per wk	RCT with tests at 8 and 14 wks	No diff grps in knee laxity or function	–All had PT
				–Follow-up time limited
				–Bicycling included
				–Dosage exs not equitable
				–Proprioception exs included
Abbreviations: ACL=anterior cruciate ligament; ACLR: anterior cruciate ligament replacement; CKC=closed kinetic chain exercises; OKC=open kinetic chain exercises; PT=physical therapy; Pts=patients; RCT=randomized controlled trial; diff=differences; grps=groups; wks=weeks.

Bynum , EB , Barrack , RL and Alexander , AH . 1995 . Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. A prospective randomized study . American Journal of Sports Medicine , 23 : 401 – 406 .

 PubMed Web of Science ®Google Scholar

Hooper , DM , Hill , H , Drechsler , WI and Morrissey , MC . 2002 . Range of motion specificity resulting from closed and open kinetic chain resistance training after anterior cruciate ligament reconstruction . Journal of Strength and Conditioning Research , 16 : 409 – 415 .

 Google Scholar

Mikkelson , C , Werner , S and Eriksson , E . 2000 . Closed kinetic chain alone compared to open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: A prospective matched follow-up study . Knee Surgery Sports Traumatology Arthoscopy , 8 : 337 – 342 .

 Google Scholar

Morrissey , MC , Hudson , ZL , Drechsler , WI , Coutts , FJ , Knight , PR and King , JB . 2000 . Effects of open versus closed kinetic chain training on knee laxity in the early period after anterior cruciate ligament reconstruction . Knee Surgery Sports Traumatology Arthroscopy , 8 : 343 – 348 .

 Google Scholar

Perry , MC , Morrissey , MC , King , JB , Morrissey , D and Earnshaw , P . 2005 . Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction . Knee Surgery Sports Traumatology and Arthroscopy , 13 : 357 – 369 .

 PubMedGoogle Scholar