Accelerated vs. Conservative Rehabilitation After ACL Reconstruction (ACL-R)
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Presenter(s)
Riley Mauzer, Jennifer Russell, Dominic Noble-Henden
Abstract
Riley Mauzer, Jenny Russell, Dominic Noble-Henden Brandon Donahue, DAT, LAT, ATC, CES Focused Clinical Question: In individuals aged 18-60 post ACL reconstruction, what is the effect of an accelerated rehabilitation program compared to a conservative rehabilitation program on instability rates? Clinical Scenario: Anterior Cruciate Ligament Reconstruction (ACL-R) is a common procedure for individuals returning to high activity levels post injury. While accelerated rehabilitation may lead to faster recovery, concerns about increased knee laxity and re-injury persist. This critical appraisal aims to compare the effects of accelerated and conservative rehabilitation protocols on knee instability rates following ACL-R. Search Strategy: We aimed to identify peer-reviewed evidence relating to different forms of rehabilitation following ACL-R and their effects on knee instability. Searches were conducted in PubMed, National Library of Medicine, Journal of Clinical Medicine, ResearchGate, and Google Scholar. Search terms included: Accelerated vs Conservative ACL rehabilitation, ACL rehabilitation, Reconstruction, and ACL-R. Studies were included if they comprised patients with ACL reconstruction, utilized participants ages 18-60, used accelerated or conservative rehabilitation programs, and evaluated joint laxity and instability outcomes. Exclusion criteria included patients with multiple knee injuries and those using rehabilitation programs not considered accelerated or conservative. After reviewing several studies, nine met the inclusion criteria and were included in our final review. Evidence Quality Assessment: The quality of the nine articles was assessed using the PEDRO scale, with scores ranging from 5/10 to 10/10. The Oxford Level of Evidence resulted in primarily a Level 2b with one study scoring a Level 3b, meaning the review was comprised of lower quality randomized control trials and one cohort study. Results and Summary of Search: One study found a significant difference (p=0.039) in knee laxity after 12 months, with greater joint laxity resulting in the accelerated rehabilitation group. However, eight of nine studies reported no significant differences (p= .33-.98) between the two approaches over longer follow-up periods of 2 years. These findings suggest that early differences in knee laxity may exist but do not persist in the long term. Further research with larger sample sizes and longer follow-up is necessary to determine which rehabilitation protocol is more effective. Most studies show no significant difference in knee laxity between conservative and accelerated rehabilitation protocols over 24 months. While some studies report short-term differences, long-term outcomes do not support one approach as superior in reducing instability or preventing re-injury after ACL-R. A key limitation is that the available evidence is insufficient to definitively answer the clinical question. Further research with larger sample sizes and longer follow-up is necessary to determine which rehabilitation protocol is more effective. Clinical Bottom Line: Our research findings were inconclusive with no statistically significant difference in knee laxity over time between accelerated and conservative rehabilitation protocols for patients undergoing ACL-R. Based on the Strength of Recommendation Taxonomy (SORT), our findings fall under category B, indicating that recommendations would be based on inconsistent evidence. Implications: Our findings challenge the current understanding of ACL-R rehabilitation, showing no significant difference in laxity between accelerated and conservative approaches after 2 years. Further research is needed to determine the most effective rehabilitation method for preventing long-term instability and re-injury after ACL-R.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Brandon Donahue, DAT, LAT, ATC, CES
Second Advisor/Mentor
Nora Kraemer, PhD, LAT, ATC, CSCS
Start Date
4-24-2025 12:00 AM
End Date
4-24-2025 12:00 AM
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Metadata Creation Responsibility
Jennifer Russell
Accelerated vs. Conservative Rehabilitation After ACL Reconstruction (ACL-R)
Riley Mauzer, Jenny Russell, Dominic Noble-Henden Brandon Donahue, DAT, LAT, ATC, CES Focused Clinical Question: In individuals aged 18-60 post ACL reconstruction, what is the effect of an accelerated rehabilitation program compared to a conservative rehabilitation program on instability rates? Clinical Scenario: Anterior Cruciate Ligament Reconstruction (ACL-R) is a common procedure for individuals returning to high activity levels post injury. While accelerated rehabilitation may lead to faster recovery, concerns about increased knee laxity and re-injury persist. This critical appraisal aims to compare the effects of accelerated and conservative rehabilitation protocols on knee instability rates following ACL-R. Search Strategy: We aimed to identify peer-reviewed evidence relating to different forms of rehabilitation following ACL-R and their effects on knee instability. Searches were conducted in PubMed, National Library of Medicine, Journal of Clinical Medicine, ResearchGate, and Google Scholar. Search terms included: Accelerated vs Conservative ACL rehabilitation, ACL rehabilitation, Reconstruction, and ACL-R. Studies were included if they comprised patients with ACL reconstruction, utilized participants ages 18-60, used accelerated or conservative rehabilitation programs, and evaluated joint laxity and instability outcomes. Exclusion criteria included patients with multiple knee injuries and those using rehabilitation programs not considered accelerated or conservative. After reviewing several studies, nine met the inclusion criteria and were included in our final review. Evidence Quality Assessment: The quality of the nine articles was assessed using the PEDRO scale, with scores ranging from 5/10 to 10/10. The Oxford Level of Evidence resulted in primarily a Level 2b with one study scoring a Level 3b, meaning the review was comprised of lower quality randomized control trials and one cohort study. Results and Summary of Search: One study found a significant difference (p=0.039) in knee laxity after 12 months, with greater joint laxity resulting in the accelerated rehabilitation group. However, eight of nine studies reported no significant differences (p= .33-.98) between the two approaches over longer follow-up periods of 2 years. These findings suggest that early differences in knee laxity may exist but do not persist in the long term. Further research with larger sample sizes and longer follow-up is necessary to determine which rehabilitation protocol is more effective. Most studies show no significant difference in knee laxity between conservative and accelerated rehabilitation protocols over 24 months. While some studies report short-term differences, long-term outcomes do not support one approach as superior in reducing instability or preventing re-injury after ACL-R. A key limitation is that the available evidence is insufficient to definitively answer the clinical question. Further research with larger sample sizes and longer follow-up is necessary to determine which rehabilitation protocol is more effective. Clinical Bottom Line: Our research findings were inconclusive with no statistically significant difference in knee laxity over time between accelerated and conservative rehabilitation protocols for patients undergoing ACL-R. Based on the Strength of Recommendation Taxonomy (SORT), our findings fall under category B, indicating that recommendations would be based on inconsistent evidence. Implications: Our findings challenge the current understanding of ACL-R rehabilitation, showing no significant difference in laxity between accelerated and conservative approaches after 2 years. Further research is needed to determine the most effective rehabilitation method for preventing long-term instability and re-injury after ACL-R.
