Anterior Cruciate Ligament

B. Significance

The anterior cruciate ligament (ACL) is one of four major ligaments of the knee joint: anterior (front) cruciate ligament, posterior (back) cruciate ligament (PCL), medial (inside) collateral ligament (MCL), and lateral (outside) collateral ligament (LCL). The ACL primarily works to coordinate function, promote overall stability of the knee, and prevent any unnecessary forward movement of the tibia. Many studies have attempted to determine why the ACL is associated with a high incidence of tears. There are nearly 200,000 annual cases of knee injury, with roughly 100,000 of these knees reconstructed (9). According to the Journal of Sports Medicine Orthopedic Surgery, injury to the ACL is most predominant in populations aged

Since ACL damage frequently occurs, and can cause numerous complications even after receiving surgical treatment, many studies have been conducted on ACL damage related surgery and the most efficient rehabilitation exercises. Unfortunately, ACL tears rarely heal by themselves (10). The loss of this ligament causes the knee to be highly unstable, and drastically increases the chance of the knee slipping out of place. Usually, this will occur while attempting sudden changes in direction or lateral pivoting motions. As the incidence rates continue to grow, both surgical and therapeutic measures must be taken in order to improve the lives of this population. Post-operative rehabilitation is the most important determinant for a successful outcome of ACL reconstruction, one of the most common procedures used to date (3,6). Patients with an ACL deficiency, whom are not suitable for reconstructive surgery, should focus on regaining full range of motion (ROM) and strength; this will reduce the chance of encountering post-operative issues, while using an accelerated rehabilitation physical therapy program. Ultimately, this study will be very significant; the contribution of the proposed research is expected to be favorably beneficial for populations aged 15-45 years, who are recovering from reconstructive surgery of the anterior

Not only were the operations highly unsuccessful, but also these patients were no better than those whom were left untreated (12). After numerous refinements and tweaks to the surgical technique, as well as pre-operative and post-operative rehabilitation, surgeons were eventually able to find a procedure that was low risk and highly dependable. An autografting procedure (taking tissue from another part of the body) is performed to substitute the torn ACL. Typically, the most common grafts are the patella tendon from the injured knee or a hamstring graft (12). Both grafts have their advantages and disadvantages, but more importantly, they have both shown to lead to a successful recovery when paired with accelerated rehabilitation. Dr. Donald Shelbourne, from the Methodist Sports Medicine Center in Indianapolis, developed a rehabilitation protocol that emphasizes complete knee extension on the first postoperative day, as well as immediate weight bearing exercises, appropriate for the patient’s tolerance. Of 800 patients who experienced ACL patella tendon-bone graft reconstructive surgery (performed by one surgeon), 450 followed the accelerated program schedule, and 73 were contacted after a two-year follow up. This was compared against a control, with patients who used a non-accelerated program. The follow up included frequent clinical