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Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus
  1. Nicky van Melick1,2,
  2. Robert E H van Cingel3,4,
  3. Frans Brooijmans5,
  4. Camille Neeter6,
  5. Tony van Tienen7,
  6. Wim Hullegie8,
  7. Maria W G Nijhuis-van der Sanden1
  1. 1Funqtio, Steyl, The Netherlands
  2. 2Radboud University Medical Center, Research Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
  3. 3Sport Medisch Centrum Papendal, Arnhem, The Netherlands
  4. 4Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
  5. 5B&sis, Eindhoven, The Netherlands
  6. 6Neeter Fysiotherapie, Amsterdam, The Netherlands
  7. 7Kliniek ViaSana, Mill, The Netherlands
  8. 8FysioGym Topsport, Enschede, The Netherlands
  1. Correspondence to Nicky van Melick, Funqtio, Triangelstraat 1F, Steyl 5935 AG, The Netherlands; nicky{at}


Aim The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction.

Design Clinical practice guideline underpinned by systematic review and expert consensus.

Data sources A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015.

Eligibility criteria for selecting studies Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury.

Summary Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9–12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.

  • Anterior cruciate ligament
  • Rehabilitation

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  • Funding The realisation of the KNGF evidence statement was funded by the KNGF.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.