Background Rehabilitation after anterior cruciate ligament reconstruction is a significant process which may decisively influence patient capacity to return to usual activity levels. Physiotherapy has a favourable influence on improving stability in the ACL deficient knee by using physical exercise and manual contact, the most affordable methods that can be used to improve quality of life. A combination of proprioceptive neuromuscular facilitation (PNF) tehniques and hydrotherapy is a treatment that can prevent stability loss and serve as an adjunct to conventional therapy.

Purpose To compare the effect of adding a combination of PNF tehniques and hydrotherapy (research group) to a standard postoperative rehabilitation program (control group).

Methods A total of fourty patients completed a standard rehabilitation program and in addition, twenty of them underwent 10-minute sessions of PNF tehniques and 15-minute sessions of hydrotherapy (34–36°C) each day, five days a week, for four weeks. Outcome measures including knee range of motion (ROM), manual muscle testing of flexors and extensors of the knee, functional assessment using Modified Cincinnati Knee Rating System (MCKRS), were assessed at baseline (initial assessment) and at four weeks (final assessment).

Results The research group achieved significantly better results at the end of rehabilitation program compared with the control group. ROM of the reaserch group increased by 52.8° for flexion and 3.2° for extension, between the initial and final measurements in the injured knee. The corresponding changes for control group were 44° for flexion and 2° for extension.

Extensor strength of the reaserch group increased by 40% and 22% for flexors, between the initial and final measurements in the injured knee, comparative to the control group where the increase was by 30% for extensors and 20% for flexors.

The functional score with respect to the MCKRS, for the research group, improved by 36.4% between the initial and final measurements, whereas the corresponding changes for the control group were 25.8%.

Conclusion PNF tehniques and hydrotherapy combined with standard rehabilitation program is effective at accelerating recovery after anterior cruciate ligament reconstruction.