Skip to main content

Advertisement

SpringerLink
Log in

Frühphase nach Rekonstruktion des vorderen Kreuzbandes

First phase of rehabilitation after anterior cruciate ligament reconstruction

  • Leitthema
  • Published:
Knie Journal Aims and scope

Zusammenfassung

Hintergrund

Die Verletzung des vorderen Kreuzbandes sowie deren operative Versorgung ist eine der häufigsten Sportverletzungen/-eingriffe und für die Patienten häufig ein einschneidendes Erlebnis. Eine strukturierte Rehabilitation nach Rekonstruktion des vorderen Kreuzbandes ist nach wie vor ein viel diskutiertes Thema, das eine komplexe interdisziplinäre Zusammenarbeit von Ärzten, Therapeuten und Patient benötigt. Ziel ist hierbei stets eine Rückkehr möglichst zur vollen Funktion mit Vermeidung einer erneuten Verletzung.

Ziel der Arbeit

Ziel dieses Artikels ist die strukturierte Darstellung der Frühphase der Rehabilitation nach Rekonstruktion des vorderen Kreuzbandes anhand evidenzbasierter Daten sowie die Beleuchtung derer Inhalte.

Material und Methoden

Es erfolgte eine strukturierte Literaturrecherche und Zusammenfassung über Medline zum Thema der Frühphase der Rehabilitation nach Rekonstruktion des vorderen Kreuzbandes und die Zusammenfassung zu einem praxisorientierten Übersichtartikel.

Ergebnisse und Diskussion

Eine gut strukturierte und überlegte Frühphase der Rehabilitation nach Rekonstruktion des vorderen Kreuzbandes ist die Grundvoraussetzung für eine Rückkehr in Alltag, Beruf und Sport. Hier erfolgt die langfristige Planung des Rehabilitationsverlaufes mit individueller Zielsetzung im Hinblick auf zeit- und funktionsbasierte Faktoren. Eine Gewährleistung der sicheren Wundheilung, Schmerz- und Schwellungsreduktion stehen primär im Vordergrund. Im Verlauf erfolgt ein schrittweiser Übergang zur Verbesserung der Kniegelenksfunktion und der gesamten Beinachsenstabilität. Maßnahmen zur gezielten Verbesserung der Schmerzsituation, Gelenksbeweglichkeit, abschwellende Maßnahmen und neuromuskulärer Funktionserhalt der Muskulatur stehen besonders im Vordergrund.

Abstract

Background

Anterior cruciate ligament (ACL) injuries and their surgical treatment afterwards are one of the most common athletic injuries and interventions, and for patients it is often a life-changing experience. Structured rehabilitation after surgical reconstruction of the ACL is still a highly discussed topic which requires intensive interdisciplinary teamwork between physicians, therapists, and patients. The goal throughout this is the return to full functionality while avoiding reinjury.

Objectives

The aim of this article is to give an evidence-based, structured presentation on early phase rehabilitation after ACL reconstruction, including a discussion of the current literature.

Materials and methods

Based on a structured literature search in MEDLINE, a practice-oriented review of ACL rehabilitation is presented.

Results and discussion

Well-structured and well thought out early phase rehabilitation after ACL reconstruction is prerequisite to achieve the return to everyday life, work, and sport. Long-term planning of the rehabilitation process includes setting of individual goals consisting of time- and function-based factors. Ensuring safe wound healing as well as reducing pain and swelling should be the primary focus in this phase. As rehabilitation progresses, there should be a gradual transition to improving knee function and leg axis stability. Measures for targeted improvement of pain, joint mobility, swelling, and neuromuscular function are also important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Rauch A, Meyer T (2017) Die Implementierung der ICF in das Rehabilitationsmanagement – ein Fallbeispiel. In: Crevenna R (Hrsg) Kompendium Physikalische Medizin und Rehabilitation: Diagnostische und therapeutische Konzepte. Springer, Berlin, Heidelberg, S 89–111

    Chapter  Google Scholar 

  2. Moretti L et al (2022) Graft intra-articular remodeling and bone incorporation in ACL reconstruction: the state of the art and clinical implications. J Clin Med 11(22):6704. https://doi.org/10.3390/jcm11226704

    Article  PubMed  PubMed Central  Google Scholar 

  3. Scheffler SU, Unterhauser FN, Weiler A (2008) Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16(9):834–842

    Article  CAS  PubMed  Google Scholar 

  4. Czamara A, Królikowska A (2018) Two-plane assessment of knee muscles isometric and Isokinetic torques after anterior cruciate ligament reconstruction. Med Sci Monit 24:4882–4893

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ithurburn MP et al (2015) Young athletes with quadriceps femoris strength asymmetry at return to sport after anterior cruciate ligament reconstruction demonstrate asymmetric single-leg drop-landing mechanics. Am J Sports Med 43(11):2727–2737

    Article  PubMed  Google Scholar 

  6. Schmitt LC et al (2015) Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sports Exerc 47(7):1426–1434

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nagelli C et al (2018) Biomechanical deficits at the hip in athletes with ACL reconstruction are ameliorated with neuromuscular training. Am J Sports Med 46(11):2772–2779

    Article  PubMed  PubMed Central  Google Scholar 

  8. Johnson AK, Palmieri-Smith RM, Lepley LK (2018) Contribution of neuromuscular factors to quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 53(4):347–354

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kuenze CM et al (2015) Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 50(3):303–312

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rauch A, Cieza A, Stucki G (2008) How to apply the international classification of functioning, disability and health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 44(3):329–342

    CAS  PubMed  Google Scholar 

  11. Buckthorpe M, Frizziero A, Roi GS (2019) Update on functional recovery process for the injured athlete: return to sport continuum redefined. Br J Sports Med 53(5):265–267

    Article  PubMed  Google Scholar 

  12. Nelson C et al (2021) Postoperative rehabilitation of anterior cruciate ligament reconstruction: a systematic review. Sports Med Arthrosc Rev 29(2):63–80

    Article  PubMed  Google Scholar 

  13. Martimbianco AL et al (2014) Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature. Phys Ther Sport 15(4):261–268

    Article  PubMed  Google Scholar 

  14. Chen MR, Dragoo JL (2013) The effect of nonsteroidal anti-inflammatory drugs on tissue healing. Knee Surg Sports Traumatol Arthrosc 21(3):540–549

    Article  PubMed  Google Scholar 

  15. Snyder-Mackler L et al (1994) Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction. Phys Ther 74(10):901–907

    Article  CAS  PubMed  Google Scholar 

  16. Jenkins SM et al (2022) Rehabilitation after anterior cruciate ligament injury: review of current literature and recommendations. Curr Rev Musculoskelet Med 15(3):170–179

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dhillon MS, Bali K, Prabhakar S (2012) Differences among mechanoreceptors in healthy and injured anterior cruciate ligaments and their clinical importance. Muscles Ligaments Tendons J 2(1):38–43

    PubMed  PubMed Central  Google Scholar 

  18. Benjaminse A, Otten E (2011) ACL injury prevention, more effective with a different way of motor learning? Knee Surg Sports Traumatol Arthrosc 19(4):622–627

    Article  PubMed  Google Scholar 

  19. van Melick N et al (2016) Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 50(24):1506–1515

    Article  PubMed  Google Scholar 

  20. Sturgill LP et al (2009) Interrater reliability of a clinical scale to assess knee joint effusion. J Orthop Sports Phys Ther 39(12):845–849

    Article  PubMed  Google Scholar 

  21. Lu Y et al (2020) Perioperative blood flow restriction rehabilitation in patients undergoing ACL reconstruction: a systematic review. Orthop J Sports Med 8(3):2325967120906822

    Article  PubMed  PubMed Central  Google Scholar 

  22. Spada JM, Paul RW, Tucker BS (2022) Blood flow restriction training preserves knee flexion and extension torque following anterior cruciate ligament reconstruction: a systematic review. J Orthop 34:233–239

    Article  PubMed  Google Scholar 

  23. Adams D et al (2012) Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther 42(7):601–614

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ageberg E et al (2008) Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup. Arthritis Rheum 59(12):1773–1779

    Article  PubMed  Google Scholar 

  25. De Carlo MS, McDivitt R (2006) Rehabilitation of patients following autogenic bone-patellar tendon-bone ACL reconstruction: a 20-year perspective. N Am J Sports Phys Ther 1(3):108–123

    PubMed  PubMed Central  Google Scholar 

  26. de Jong SN et al (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23(1):21–8–28.e1–3

    PubMed  Google Scholar 

  27. Eitzen I, Holm I, Risberg MA (2009) Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med 43(5):371–376

    Article  CAS  PubMed  Google Scholar 

  28. McHugh MP et al (1998) Preoperative indicators of motion loss and weakness following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 27(6):407–411

    Article  CAS  PubMed  Google Scholar 

  29. Meuffels DE et al (2012) Guideline on anterior cruciate ligament injury. Acta Orthop 83(4):379–386

    Article  PubMed  PubMed Central  Google Scholar 

  30. Millett PJ, Wickiewicz TL, Warren RF (2001) Motion loss after ligament injuries to the knee. Part II: prevention and treatment. Am J Sports Med 29(6):822–828

    Article  CAS  PubMed  Google Scholar 

  31. Noyes FR, Mangine RE, Barber SD (1992) The early treatment of motion complications after reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res 277:217–228

    Article  Google Scholar 

  32. Quelard B et al (2010) Preoperative factors correlating with prolonged range of motion deficit after anterior cruciate ligament reconstruction. Am J Sports Med 38(10):2034–2039

    Article  PubMed  Google Scholar 

  33. Risberg MA et al (2007) Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trial. Phys Ther 87(6):737–750

    Article  PubMed  Google Scholar 

  34. Shelbourne KD, Gray T (1997) Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. A two- to nine-year followup. Am J Sports Med 25(6):786–795

    Article  CAS  PubMed  Google Scholar 

  35. Shelbourne KD et al (2012) Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med 40(1):108–113

    Article  PubMed  Google Scholar 

  36. Shelbourne KD et al (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 19(4):332–336

    Article  CAS  PubMed  Google Scholar 

  37. van Grinsven S et al (2010) Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18(8):1128–1144

    Article  PubMed  Google Scholar 

  38. Meredith SJ et al (2021) Return to sport after anterior cruciate ligament injury: panther symposium ACL injury return to sport consensus group. J ISAKOS 6(3):138–146

    Article  PubMed  Google Scholar 

  39. Murgier J, Cassard X (2014) Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction. Preliminary study. Orthop Traumatol Surg Res 100(3):309–312

    Article  CAS  PubMed  Google Scholar 

  40. Glattke KE, Tummala SV, Chhabra A (2022) Anterior cruciate ligament reconstruction recovery and rehabilitation: a systematic review. J Bone Joint Surg Am 104(8):739–754

    Article  PubMed  Google Scholar 

  41. Bednarski P, Kiwerski J (2019) Evaluation of local cryotherapy after anterior cruciate ligament reconstruction. Critical review of the literature. Ortop Traumatol Rehabil 21(5):319–328

    Article  PubMed  Google Scholar 

  42. Tornatore L et al (2020) Effects of combining manual lymphatic drainage and Kinesiotaping on pain, edema, and range of motion in patients with total knee replacement: a randomized clinical trial. Int J Rehabil Res 43(3):240–246

    Article  PubMed  Google Scholar 

  43. Pichonnaz C et al (2016) Effect of manual lymphatic drainage after total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil 97(5):674–682

    Article  PubMed  Google Scholar 

  44. Brinlee AW et al (2022) ACL reconstruction rehabilitation: clinical data, biologic healing, and criterion-based milestones to inform a return-to-sport guideline. Sports Health 14(5):770–779

    Article  PubMed  Google Scholar 

  45. Bolia IK et al (2021) Managing perioperative pain after anterior cruciate ligament (ACL) reconstruction: perspectives from a sports medicine surgeon. Open Access J Sports Med 12:129–138

    Article  PubMed  PubMed Central  Google Scholar 

  46. Wright RW et al (2008) A systematic review of anterior cruciate ligament reconstruction rehabilitation: part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. J Knee Surg 21(3):217–224

    Article  PubMed  PubMed Central  Google Scholar 

  47. Escamilla RF et al (2012) Anterior cruciate ligament strain and tensile forces for weight-bearing and non-weight-bearing exercises: a guide to exercise selection. J Orthop Sports Phys Ther 42(3):208–220

    Article  PubMed  Google Scholar 

  48. Bordes P et al (2017) No beneficial effect of bracing after anterior cruciate ligament reconstruction in a cohort of 969 athletes followed in rehabilitation. Ann Phys Rehabil Med 60(4):230–236

    Article  CAS  PubMed  Google Scholar 

  49. Shelburne KB, Pandy MG (1998) Determinants of cruciate-ligament loading during rehabilitation exercise. Clin Biomech (Bristol, Avon) 13(6):403–413

    Article  PubMed  Google Scholar 

  50. Kernozek T et al (2013) From the gait laboratory to the rehabilitation clinic: translation of motion analysis and modeling data to interventions that impact anterior cruciate ligament loads in gait and drop landing. Crit Rev Biomed Eng 41(3):243–258

    Article  PubMed  Google Scholar 

  51. Jewiss D, Ostman C, Smart N (2017) Open versus closed kinetic chain exercises following an anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Sports Med (Hindawi Publ Corp) 2017:4721548

    PubMed  Google Scholar 

  52. Perriman A, Leahy E, Semciw AI (2018) The effect of open- versus closed-kinetic-chain exercises on anterior tibial laxity, strength, and function following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Sports Phys Ther 48(7):552–566

    Article  PubMed  Google Scholar 

  53. Noehren B, Snyder-Mackler L (2020) Who’s afraid of the big bad wolf? Open-chain exercises after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 50(9):473–475

    Article  PubMed  Google Scholar 

  54. Cerqueira MS et al (2020) Effects of blood flow restriction without additional exercise on strength reductions and muscular atrophy following immobilization: a systematic review. J Sport Health Sci 9(2):152–159

    Article  PubMed  Google Scholar 

  55. Nitzsche N et al (2021) The effectiveness of blood-flow restricted resistance training in the musculoskeletal rehabilitation of patients with lower limb disorders: a systematic review and meta-analysis. Clin Rehabil 35(9):1221–1234

    Article  PubMed  Google Scholar 

  56. Minniti MC et al (2020) The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders: a systematic review. Am J Sports Med 48(7):1773–1785

    Article  PubMed  Google Scholar 

  57. Van Cant J et al (2020) Quadriceps strengthening with blood flow restriction for the rehabilitation of patients with knee conditions: a systematic review with meta-analysis. J Back Musculoskelet Rehabil 33(4):529–544

    Article  PubMed  Google Scholar 

  58. Prill R et al (2022) Physiotherapy after reconstruction of the anterior cruciate ligament—an investigation within the framework of the CAMOPED-study

    Google Scholar 

  59. https://www.icf-research-branch.org/icf-core-sets-projects. Zugegriffen: 20.12.2022

  60. Winstein C et al (2014) Infusing motor learning research into neurorehabilitation practice: a historical perspective with case exemplar from the accelerated skill acquisition program. J Neurol Phys Ther 38(3):190–200

    Article  PubMed  PubMed Central  Google Scholar 

  61. Elwyn G et al (2012) Shared decision making: a model for clinical practice. J Gen Intern Med 27(10):1361–1367

    Article  PubMed  PubMed Central  Google Scholar 

  62. Tang C, Wang A, Yan J (2022) Exploring motivations and resistances for implementing shared decision-making in clinical practice: a systematic review based on a structure-process-outcome model. Health Expect 25(4):1254–1268

    Article  PubMed  PubMed Central  Google Scholar 

  63. Gokeler A et al (2022) Return to sports after ACL injury 5 years from now: 10 things we must do. J Exp Orthop 9(1):73

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Therapiezentrum Albo, München, Deutschland

    Welf Leopold Albrecht

  2. Bernau am Chiemsee, Deutschland

    Christina Valle

  3. Athletikum Rhein Ruhr, BG-Klinikum Duisburg – Klinik für Arthroskopische Chirurgie, Sporttraumatologie & Sportmedizin, Großenbaumer Allee 250, 47259, Duisburg, Deutschland

    Arthur Praetorius

Authors
  1. Welf Leopold Albrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Valle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arthur Praetorius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arthur Praetorius.

Ethics declarations

Interessenkonflikt

Die Autoren W.L. Albrecht, C. Valle und A. Praetorius erklären, dass keine finanziellen, nichtfinanziellen oder persönlichen Interessenskonflikte bei der Anfertigung des Artikels bestehen.

Dieser Artikel beinhaltet keine Daten aus Studien an Tieren oder Menschen.

Additional information

Redaktion

Arthur Praetorius, Duisburg

Christina Valle, Bernau

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albrecht, W.L., Valle, C. & Praetorius, A. Frühphase nach Rekonstruktion des vorderen Kreuzbandes. Knie J. 5, 12–21 (2023). https://doi.org/10.1007/s43205-023-00195-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43205-023-00195-x

Schlüsselwörter

Keywords

Search

Navigation