Physiotherapeutic rehabilitation in the postoperative period of anterior cruciate ligament: an integrative review of current evidence
DOI:
https://doi.org/10.71248/hpk9b062Keywords:
Anterior Cruciate Ligament, Exercise Therapy, Physical Therapy Modalities, Rehabilitation.Abstract
This study aimed to analyze the main physiotherapeutic approaches used in postoperative rehabilitation of the ACL, based on literature. This is a qualitative integrative literature review conducted in PubMed, SciELO, and PEDro databases, including studies published in the last five years in Portuguese and English. Ten randomized clinical trials were selected after applying eligibility criteria and the PRISMA flowchart. Results show that early and active intervention, such as early weight-bearing, improve range of motion, function, and reduce muscle atrophy without compromising graft integrity. Closed kinetic chain exercises and unilateral protocols demonstrated greater effectiveness in functional recovery and muscle symmetry. Neuromuscular training, eccentric exercises, and aquatic therapy showed relevant benefits in proprioception, strength, and joint stability. Complementary resources, such as virtual reality and mirror therapy, mainly improved subjective outcomes, including pain and functional perception. It is concluded that ACL rehabilitation should be based on multifactorial, individualized, progressive, and evidence-based approaches to optimize recovery and prevent reinjury.
References
Araújo, A. G. S.; Pinheiro, I. (2015). Protocolos de tratamento fisioterápico nas lesões de ligamento cruzado anterior após ligamentoplastia: uma revisão. Cinergis, v. 16, n. 1, p. 61–65. DOI: 10.17058/cinergis.v16i1.5619
Cederström, N., Nilsson, G., Dahan, R., Granér, S., & Ageberg, E. (2024). Using an integrated motor imagery and physical training intervention after knee injury: an interim analysis of the MOTIFS randomised controlled trial. BMJ open sport & exercise medicine, 10(4).
Chen, J., Wu, T., & Guo, Y. (2023). Nordic hamstring exercises in functional knee rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomised, controlled study. Scientific Reports, 13(1), 19039
Domnick C, Raschke MJ, Herbort M. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques. World J Orthop. 2016 Feb 18;7(2):82-93. doi: 10.5312/wjo.v7.i2.82. PMID: 26925379; PMCID: PMC4757662.
Evans, J.; Nielson, J. L.; Mabrouk, A. (2023). Anterior cruciate ligament (ACL) knee injuries. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK499848/. Acesso em: 8 abr. 2026.
Figueira, A.; Junior, J. (2022) A importância da fisioterapia imediata no pós-operatório do ligamento cruzado anterior. Research, Society and Development, v. 11, n. 1, e52111125450, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i1.254.
Ghaderi, M., Letafatkar, A., Thomas, A. C., & Keyhani, S. (2021). Effects of a neuromuscular training program using external focus attention cues in male athletes with anterior cruciate ligament reconstruction: a randomized clinical trial. BMC Sports Science, Medicine and Rehabilitation, 13(1), 49.
Gsangaya, M. R., Htwe, O., Naicker, A. S., Yusoff, B. A. H. M., Mohammad, N., Soh, E. Z. F., & Silvaraju, M. (2023). Comparison between the effect of immersive virtual reality training versus conventional rehabilitation on limb loading and functional outcomes in patients after anterior cruciate ligament reconstruction: a prospective randomized controlled trial. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 34, 28-37.
Hajouj, E., Hadian, M. R., Mir, S. M., Talebian, S., & Ghazi, S. (2021). Effects of innovative aquatic proprioceptive training on knee proprioception in athletes with anterior cruciate ligament reconstruction: a randomized controlled trial. Archives of Bone and Joint Surgery, 9(5), 519.
Högberg J, Piussi R, Lövgren J, Wernbom M, Simonsson R, Samuelsson K, Hamrin Senorski E. (2024). Restoring Knee Flexor Strength Symmetry Requires 2 Years After ACL Reconstruction, But Does It Matter for Second ACL Injuries? A Systematic Review and Meta-analysis. Sports Med Open. 10(1):2. DOI: 10.1186/s40798-023-00666-5. PMID: 38180584; PMCID: PMC10769975.
Kochman, M.; Kasprzak, M.; Kielar, A. (2022). ACL reconstruction: which additional physiotherapy interventions improve early-stage rehabilitation? A systematic review. International Journal of Environmental Research and Public Health, v. 19, n. 23, p. 15893. DOI: 10.3390/ijerph192315893.
Kumar, M., & Madaan, V. (2024). A comparison between open kinetic and closed kinetic chain exercises along with conservative treatment in grade-I ACL injury in sprinters: a randomized controlled trail. Indian J Physi Other Occup Ther, 18(3), 59-66.
Lucena, H. A. et al. (2023). Tratamento da lesão do ligamento cruzado anterior. Revista Interdisciplinar em Saúde, v. 10, n. único, p. 755–76. DOI:10.35621/23587490.v10.n1.p755-765.
Luzo, M. V. M. et al. Ligamento cruzado anterior – Artigo de atualização. Revista Brasileira de Ortopedia, v. 51, n. 4, p. 385–395, jul. 2016. DOI: 10.1016/j.rbo.2015.07.008
Ogrodzka-Ciechanowicz, K., Głąb, G., Ślusarski, J., & Gądek, A. (2021). Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial. BMC Musculoskeletal Disorders, 22(1), 975.
Oliveira, G. R. R. de; Raimundo, R. J. de S.; Lima, K. O. de. (2024). Abordagens fisioterapêuticas no tratamento de lesões do ligamento cruzado anterior. Revista JRG de Estudos Acadêmicos, São Paulo, v. 7, n. 15, p. e151547, 2024. DOI: 10.55892/jrg.v7i15.1547. Disponível em: https://revistajrg.com/index.php/jrg/article/view/1547. Acesso em: 8 abr. 2026.
Oliveira, M., Júnior, P. L., Imoto, A. M., Santos, T., Borges, J. H. S., Nunes, P., ... & Peccin, M. S. (2022). Unilateral versus bilateral resistance exercise in postoperative rehabilitation after ACL reconstruction with bone–patellar tendon–bone graft: a randomized controlled trial. Orthopaedic journal of sports medicine, 10(4), 23259671221088830.
Pastora-Bernal, J.M.; Estebanez-Pérez, M.J.; Lucena-Anton, D.; García-López, F.J.; Bort-Carballo, A.; Martín-Valero, R. (2021). The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review. J. Clin. Med. DOI: https://doi.org/10.3390/jcm10030428
Toshniwal, P., Wani, S., & Mungikar, S. (2022). Effectiveness of mirror therapy in adjunct to conventional physiotherapy on pain, instability, joint mobility and proprioception in patients with post anterior cruciate ligament reconstruction surgery: A randomized controlled Trial.[J]. Neuro Quantology, 20(9), 5954-60.
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. British Journal of Sports Medicine, v. 50, n. 24, p. 1506–1515.
Yang, X., Li, Y., He, C., Jin, T., & Huang, Y. (2024). Early versus delayed start of weight-bearing after arthroscopic anterior cruciate ligament reconstruction with hamstring tendons. The Journal of Sports Medicine and Physical Fitness, 65(2), 230-237.
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