The first anterior cruciate ligament (ACL) repair and replacement surgery was performed in 1903 and nowadays reconstruction of ACL is one of the best therapeutic options of ACL rupture management and most frequently performed orthopedic surgeries. ACL rupture is one of the most prevalent injuries among physically active and young people.
Usually treatment after rupture of ACL may be operative or conservative. For patients who do not perform highly demanding activities conservative treatment is usually advised. It consists of modifying activities, strengthening muscles of legs and appropriate physical exercises.
Meanwhile, athletes, who perform sports regularly or patients with recurrent giving way or knee instability and other ligament injuries in the same knee are recommended to have a surgical treatment. It is performed to restore knee kinematics, reducing the risks of subsequent injury and the progression of degenerative changes. The most important symptoms leading to surgery are recurrent episodes during daily activities affecting the quality of life of the patient. Despite restoration of knee joint stability, immediate and persistent muscular weakness continues to prevent the recovery from ACL surgery.
The success rate of ACL reconstruction and recovery is determined by many factors including the origin of the failure, surgeon practical skills, the preoperative laxity of the knee, menisci and articular cartilage.
The rehabilitation after ACL reconstruction is very important part of treatment and has a significant impact on the outcome of the knee surgery. Knee functional recovery also depends on human factors including the motivation of patient, conformity and willingness to complete the prescribed rehabilitation programme.
Rehabilitation after the ACL reconstruction should follow a logical progression from protected, simple exercises to complex, sport speciﬁc workout aimed at regaining neuromuscular control and returning the patient to full participation. The rehabilitation seeks to strengthen the knee in order to regain the normal knee joint stability and allow it to function effectively. The recovery period starts immediately after surgery and includes analgesics, ice compression, and elevation in order to decrease pain and swelling while restoring full motion in a timely manner.
First exercises begin with quadriceps contractions and straight leg rises attempting to lift the leg independently, ankle pumps, walking with crutches and other exercises. For the first two weeks after the surgery knee extension is very important. As a patient achieves estimated strength he can typically begin a heavier exercises involving stress on the knee in order to increase resistance. For example, jogging.
After four months, the difficulty of exercises further increases and if patient does not feel any discomfort, exercise such as running are possible without risk. Usually it takes 6 months for a patient to resume everyday activities after ACL reconstruction. Despite all efforts recovery varies from case to case, and sometimes takes a year or even longer.
However, some patients even after ACL reconstruction and completion of the prescribed rehabilitation are unable to resume their activities like before injury. This problem is most common among athletes where expectations and requirements are very high compared to less active regular people.
It is important to keep in mind that a lot of conditions may result in persistent complaints and an unsatisfactory outcome, such as a graft failure, which is the most common cause of failed ACL surgery. As a result many people may still feel abnormal functional activity with knee instability and strong pain, decreased range of motion, quadriceps strength deﬁcits, reduced functional performance, neuromuscular dysfunction, and biomechanical problems that may account for the very different outcomes. However, patient satisfaction in terms of rehabilitation or surgery results is complex issue which should be discussed with a patient.