Anterior cruciate ligament reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes
OBJECTIVE: To investigate the clinical outcomes after hamstring tendon autograft ACL reconstruction with accelerated, brace-free rehabilitation.
DESIGN: Systematic review according to PRISMA guidelines.
DATA SOURCES: Embase, Medline Ovid, Web of science, Cochrane CENTRAL and Google scholar from 1-1-1974 till 31-1-2017.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Study designs reporting outcomes in adults after arthroscopic, primary ACL reconstruction with hamstring autograft and accelerated, brace-free rehabilitation.
RESULTS: Twenty-four studies were included in the review. After hamstring tendon autograft ACL reconstruction with accelerated brace-free rehabilitation: (a) Early start of open kinetic exercises at 4 weeks in a limited range of motion (90°-45°) and progressive concentric and eccentric exercises from 12 weeks did not alter outcomes; (b) Gender and age did not influence clinical outcomes; (c) Anatomic reconstructions showed better results than non-anatomic reconstructions; (d) There was no difference between single- and double-bundle reconstructions; (e) Femoral and tibial tunnel widening occurred; (f) Hamstring tendons regenerated after harvest and (h) Biological knowledge did not support return to sports at 4-6 months.
CONCLUSIONS: After hamstring tendon autograft ACLR with accelerated brace-free rehabilitation, clinical outcome is similar after single- and double-bundle ACLR. Early start of open kinetic exercises at 4 weeks in a limited range of motion (90°-45°) and progressive concentric and eccentric exercises from 12 weeks post surgery do not alter clinical outcome. Further research should focus on achievement of best balance between graft loading and graft healing in the various rehabilitation phases after ACLR as well as validated, criterion-based assessments for safe return to sports.
LEVEL OF EVIDENCE: 2b; therapeutic outcome studies
KEYWORDS: hamstring autograft, ACL reconstruction, accelerated rehabilitation, clinical outcomes, graft remodelling