Objective Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes.
Design Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence.
Data sources MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library.
Eligibility criteria Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults.
Results We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion.
Conclusion The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.
- anterior cruciate ligament
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Twitter @agculvenor, @m_girdwood, @Knee_Howells, @melhabphysio, @jwhittak_physio, @ewa_roos
Contributors AGC, JLW, EMR and KMC designed the systematic review and were involved in priority theme setting. AGC, BP and MH completed all searches and study selection (including inclusion and exclusion of abstracts). AGC and MG completed all data extraction and risk of bias assessment. AGC and CBJ planned the analyses, and all authors interpreted the data. MG prepared all figures. AGC wrote the initial draft. All authors critically revised the manuscript for important intellectual content and approved the final version of the manuscript.
Funding This review is part of the OPTIKNEE consensus (https://bit.ly/OPTIKNEE) which has received funding from the Canadian Institutes of Health Research (OPTIKNEE principal investigator JLW #161821). Initial priority theme setting was supported by a La Trobe University Research Focus Area Collaboration Grant (OPTIKNEE principal investigator AGC). AGC is a recipient of a National Health and Medical Research Council (NHMRC) of Australia Investigator Grant (GNT2008523). MG is a recipient of a NHMRC of Australia PhD Scholarship (GNT1190882). The funders had no role in any part of the study or in any decision about publication
Competing interests AGC, BP and JLW are Associate Editors of BJSM. KMC is a senior advisor of BJSM. All other authors declare no competing interests.
Provenance and peer review Not commissioned; externally peer reviewed.
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