[Biological, biomechanical and clinical concepts of after-care following knee ligament surgery].

Rehabilitation of the anterior cruciate ligament (ACL) continues to be a topic of intense interest among surgeons and therapists. Numerous experimental studies have demonstrated that motion and a certain amount of stress are necessary for ligament healing. In experimental and clinical studies closed kinetic chain exercises have been proven to be safe already in the early phase of rehabilitation. Since 1987, over 2900 patients who have undergone ACL reconstruction using the central one-third of the bone patellar tendon bone graft have followed our accelerated rehabilitation protocol. Follow-up of the patients reveals early return to athletic activity and maintenance of long-term stability. Our 1987 accelerated rehabilitation program continues to be modified, with less constraints placed on the postoperative patient in our present rehabilitation protocol. Past patient non-compliance to previously established protocols still yielded excellent results that demanded further investigation. Gradually we developed a four-phase rehabilitation protocol. The initial phase encompasses the preoperative period with the goal of resolving swelling and regaining full motion. The second phase involves the initial two weeks post ACL reconstruction and focuses primarily on wound healing, full extension, control of swelling, and leg control. The third phase (two to five weeks) involves increasing flexion, developing a functional gait, and resuming activities of daily living. The fourth phase (> five weeks) identifies a safe return to competitive athletics. With this accelerated rehabilitation protocol a decreased postoperative morbidity was noted without jeopardizing the long term stability of the ACL reconstructed knee.