Background
The use of quadriceps tendon (QT) autografts for anterior cruciate ligament reconstruction (ACLR) has become increasingly popular due to their strong biomechanical properties and positive clinical outcomes. Despite these advantages, standardized postoperative rehabilitation protocols specifically tailored for QT-ACLR remain undeveloped, unlike the more traditional grafts from patellar tendon (PT) and hamstring tendon (HT).
Objective
This study aimed to conduct a systematic review of publicly available postoperative rehabilitation protocols for QT-ACLR from accredited orthopedic programs to outline prevalent practices and highlight the need for further research.
Methods
A comprehensive review of rehabilitation protocols from accredited orthopedic surgery programs in North America was performed, focusing on those specifically designed for QT autografts. The inclusion criteria were public availability and specificity to QT autografts without concurrent procedures like meniscal repair. We categorized and analyzed key components of rehabilitation such as range of motion (ROM), weight-bearing, strengthening exercises, and guidelines for return to sport.
Results
From a total of 219 programs, 16 protocols qualified for our study. These protocols revealed a wide range of recommendations across various rehabilitation aspects. Only three protocols included preoperative guidelines that stressed the importance of ROM exercises and lower extremity strengthening. Almost all protocols (93.75%) suggested adjunct therapies like bracing, icing, and neuromuscular electrical stimulation (NMES), with bracing being the most commonly recommended therapy, endorsed by 86.7% of protocols primarily for use in full extension during early ambulation. Every protocol emphasized ROM exercises, with directives for achieving full knee extension and flexion ranging from 2 to 16 weeks post-surgery. Immediate weight-bearing was allowed by 81.25% of protocols, often with the support of crutches, and the progression timelines to full weight-bearing varied significantly. Strength training was recommended in 93.75% of protocols, incorporating a variety of exercises from isometrics to dynamic closed and open chain exercises initiated at different stages postoperatively. All protocols advised balance and proprioceptive training, though the specific exercises and timing varied considerably. More than two-thirds of the protocols recommended functional tests like single-hop and isokinetic strength assessments starting from nine weeks postoperatively as part of the criteria for return to sport, which typically began at six months with a focus on achieving specific functional benchmarks.
Conclusion
The review of QT-ACLR rehabilitation protocols across highly ranked orthopedic programs highlights a substantial variation in recommended practices, especially regarding the timing and intensity of exercises and the utilization of adjunct therapies. The absence of consensus highlights the urgent need for high-quality research to develop evidence-based guidelines that can optimize recovery outcomes and ensure a safe return to sport for patients undergoing ACLR with QT autografts. This study underlines the essential areas for future investigations to establish standardized and effective rehabilitation protocols.
Keywords: ACL reconstruction, quadriceps tendon autograft, postoperative rehabilitation, orthopedic surgery, return to sport.