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Long Term Effects after ACL Surgery

If you had an anterior cruciate ligament (ACL) reconstruction 20 years ago, your leg would have been immobilized for six weeks or more after surgery. Today patients begin moving the knee and putting weight on the leg right away. But how much movement can be allowed without stretching out the repair graft or damaging the knee cartilage? That's
the topic of this study.

Researchers in the United States, Canada, and Sweden worked together to complete this study. Two groups of patients were included. All had an ACL repair using the same kind of tendon graft. Everyone exercised under the supervision of a licensed physical therapist three times a week. A home program was done on other days. Both groups followed the same exercise program.

The main difference between the two groups was how fast the patients progressed. In the first (accelerated) group, patients went through the whole program in 19 weeks. There was more strain on the healing ACL graft with this exercise program. The second
(nonaccelerated) group completed the program in 32 weeks. Exercises that strained the healing graft weren't started until later in the second group.

Results were measured using joint laxity, patient satisfaction, and function. Patients were evaluated before surgery and again three, six, 12, and 24 months after surgery. Synovial fluid from the joint was also tested for biomarkers of cartilage metabolism.

The authors report no difference in results between the two groups. This was true early on after the surgery and as much as two years later. The most surprising discovery was that the joint cartilage showed signs of healing even two years after the repair. Researchers aren't sure what to make of this finding. It means that the joint is still remodeling after patients have returned to full activities.

References: Bruce D. Beynnon, PhD, et al. Rehabilitation After Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. March 2005. Vol. 33. No. 3. Pp. 347-359.

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