Postoperative Rehabilitation

  • Craig J. Edson


Rehabilitation of the multiple ligament injured knee presents several challenges to the rehabilitation specialist. A thorough understanding of the surgical procedure, the biomechanics of the knee, and the manner in which exercises and daily activities affect the involved structures is imperative. This chapter outlines the exercise protocols currently in place at our facility, as well as the scientific rationale behind the exercises that comprise these postoperative regimens.


Anterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Knee Flexion Posterior Cruciate Ligament Patellofemoral Joint 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bach BR, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Kahn NH. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five-to nine-year follow-up evaluation. Am J Sports Med 1998; 26: 20–29.PubMedGoogle Scholar
  2. 2.
    Beynnon BD, Johnson RJ. Anterior cruciate ligament injury rehabilitation in athletes. Biomechanical considerations. Sports Med 1996; 22: 54–64.PubMedCrossRefGoogle Scholar
  3. 3.
    Bynum BD, et al. Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. A prospective randomized study. Am J Sports Med 1997; 25: 823–829.CrossRefGoogle Scholar
  4. 4.
    Fitzgerald GK. Open versus closed kinetic chain exercise: issues in rehabilitation after anterior cruciate ligament reconstructive surgery. Phys Ther 1997; 77: 1747–1754.PubMedGoogle Scholar
  5. 5.
    Frndak PA, Berasi CC. Rehabilitation concerns following anterior cruciate ligament reconstruction. Sports Med 1991; 12: 338–346.PubMedCrossRefGoogle Scholar
  6. 6.
    Hooper DM, Morissey MC, Dreschler W, Morissey D, King J. Open and closed kinetic chain exercises in the early period after anterior cruciate ligament reconstruction. Am J Sports Med 2001; 29: 167–174.PubMedGoogle Scholar
  7. 7.
    Noyes FR, Barber-Westin SD. Reconstruction of the anterior cruciate ligament with human allograft. Comparison of early and late results. J Bone Joint Surg Am 1996; 78: 524–537.PubMedGoogle Scholar
  8. 8.
    Parker MG. Biomechanical and histological concepts in the rehabilitation of patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 1994; 20: 44–50.PubMedGoogle Scholar
  9. 9.
    Shelbourne KD, Klootwyk TE, Wilkens JH, Carlos MS. Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in an accelerated rehabilitation program. Am J Sports Med 1995; 23: 575–579.PubMedCrossRefGoogle Scholar
  10. 10.
    Steindler A. Kinesiology of the Human Body Under Normal and Pathological Conditions. Springfield, IL: Charles C Thomas; 1970.Google Scholar
  11. 11.
    Irrgang JJ. Rehabilitation for non-operative and operative management of knee injuries. In: Fu FA, Harner CD, Vince KD, eds. Knee Surgery. Baltimore, MD: Williams, and Wilkins; 1994: 485–502.Google Scholar
  12. 12.
    Lutz GE, Palmitier RA, An KN, Chao YS. Comparison of tibiofemoral joint forces during open–kinetic–chain and closed-kinetic-chain exercises. J Bone Joint Surg Am 1993; 75: 732–739.PubMedGoogle Scholar
  13. 13.
    Wilk KE, Escamilla RF, Fleisig GS, Barrentine SW, Andrews JR, Boyd ML. A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Am J Sports Med 1996; 24: 518–527.PubMedCrossRefGoogle Scholar
  14. 14.
    Snyder-Mackler L. Scientific rationale and physiological basis for the use of closed kinetic chain exercises in the lower extremity. J Sports Rehabil 1996; 5: 2–12.Google Scholar
  15. 15.
    Arms SW, Pope MH, Johnson RJ, Fisher RA, Arvidsson I, Eriksson E. The bio–mechanics of anterior cruciate ligament rehabilitation and reconstruction. Am J Sports Med 1984; 12: 8–18.PubMedCrossRefGoogle Scholar
  16. 16.
    Grood ES, Suntay WJ, Noyes FR, Butler DL. Biomechanics of the knee–extension exercise: effect of cutting the anterior cruciate ligament. J Bone Joint Surg Am 1984; 66: 725–734.PubMedGoogle Scholar
  17. 17.
    Renstrom P, Arms SW, Stanwyck TS, Johnson RJ, Pope MH. Strain within the anterior cruciate ligament during hamstring and quadriceps activity. Am J Sports Med 1986; 14: 83–87.PubMedCrossRefGoogle Scholar
  18. 18.
    Daniel DM, Stone ML, Barrett P, Sachs R. Use of the quadriceps active test to diagnose posterior cruciate ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg Am 1988; 70: 387–391.Google Scholar
  19. 19.
    Hungerford DS, Barry M. Biomechanics of the patellofemoral joint. Clin Orthop 1979; 144: 9–15.PubMedGoogle Scholar
  20. 20.
    Cohen ZA, Roglic H, Grelsamer RP, Henry JH, Levine WN, Mow VC, Ateshian GA. Patellofemoral stresses during open and closed kinetic chain exercises: an analysis using computer simulation. Am J Sports Med 2001; 29: 480–487.PubMedGoogle Scholar
  21. 21.
    Ohkoshi Y, Yasuda K, Kaneda K, Wada T, Yamanaka M. Biomechanical analysis of rehabilitation in the standing position. Am J Sports Med 1991; 19: 605–611.PubMedCrossRefGoogle Scholar
  22. 22.
    Dahlkuits NJ, Mago P, Seedholm BB. Forces during squatting and rising from a deep squat. Eng Med 1982; 11: 69–76.CrossRefGoogle Scholar
  23. 23.
    Wilk KE. Rehabilitation of isolated and combined posterior cruciate ligament injuries. Clin Sports Med 1994; 13: 649–677.PubMedGoogle Scholar
  24. 24.
    Kvist J, Gillquist J. Sagittal plane knee translation and electromyographic activity during closed and open kinetic chain exercises in anterior cruciate ligament–deficient patients and control subjects. Am J Sports Med 2001; 29: 72–82.PubMedGoogle Scholar
  25. 25.
    Ericson MO, Nisell R. Tibiofemoral joint forces during ergometer cycling. Am J Sports Med 1986; 14: 285–290.PubMedCrossRefGoogle Scholar
  26. 26.
    Morrison JB. The biomechanics of the knee joint in relation to normal walking. J Biomech 1970; 3: 51–60.PubMedCrossRefGoogle Scholar
  27. 27.
    Morrison JB. Function of the knee joint in various activities. Biomech Eng 1969; 4: 573–580.Google Scholar
  28. 28.
    Smidt GL. Biomechanical analysis of knee extension and flexion. J Biomech 1973; 6: 79–92.PubMedCrossRefGoogle Scholar
  29. 29.
    Beynnon BD, Fleming BC, Johnson RJ. The strain behavior of the anterior cruciate ligament during squatting and active flexion–extension exercise. A comparison of an open and closed kinetic chain exercise. Am J Sports Med 1997; 25: 823–829.PubMedCrossRefGoogle Scholar
  30. 30.
    Lysholm M, Messner K. Sagittal plane translation of the tibia in anterior cruciate ligament–deficient knees during commonly used rehabilitation exercises. Scand J Med Sci Sports 1995; 5: 49–56.PubMedCrossRefGoogle Scholar
  31. 31.
    Vergis A, Hindriks M, Gillquist J. Sagittal plane translations of the knee in anterior cruciate deficient subjects and controls. Med Sci Sports Exerc 1994; 29: 1561–1566.Google Scholar
  32. 32.
    Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy 1996; 12: 521–530.PubMedCrossRefGoogle Scholar
  33. 33.
    Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy 1996; 12: 5–14.PubMedCrossRefGoogle Scholar
  34. 34.
    Noyes FR, Barber–Westin SD. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation: use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 1997; 25: 769–778.PubMedCrossRefGoogle Scholar
  35. 35.
    Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med 1995; 23: 580–587.PubMedCrossRefGoogle Scholar
  36. 36.
    Ogata K, McCarthy JA. Measurements of length and tension patterns during reconstruction of the posterior cruciate ligament. Am J Sports Med 1992; 20: 351–355.PubMedCrossRefGoogle Scholar
  37. 37.
    Kaufman KR, An K-N, Litchey WJ, Morrey BF, Chao EYS. Dynamic joint forces during knee isokinetic exercise. Am J Sports Med 1991; 19: 305–315.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Craig J. Edson

There are no affiliations available

Personalised recommendations