weight-bearing-standing training for lower limb recovery after anterior cruciate ligament reconstruction

ACLR 患者的康复治疗计划

Enhanced Recovery after Surgery (ERAS) is a concept that promotes the early initiation of postsurgery rehabilitation care units, particularly after orthopedic operations, when conditions are appropriate1. This approach seeks to shift the clinical focus from treating the disease to functional rehabilitation promptly with the goal of reducing hospital stays, minimizing postoperative complications, improving patient prognosis and satisfaction, and enhancing overall rehabilitation outcomes. Since the introduction of ERAS, Chinese orthopedic rehabilitation specialist, Zhou Mouwang, has advocated for the active application of accelerated recovery protocols to further progress perioperative rehabilitation practices within the realm of Chinese orthopedics2. Internationally recognized consensus guidelines have also been established to facilitate enhanced surgical recovery for orthopedic conditions such as joint replacement and spine surgery3. Nonetheless, while considerable advancements have been made in implementing ERAS in recent years, the primary application has been in major operations, such as joint replacement surgeries4. As a result, there is a pressing need to further investigate and expand the application of ERAS within the rehabilitation of other orthopedic conditions.
The anterior cruciate ligament (ACL) plays a pivotal role in maintaining knee joint stability. ACL injuries are among the most prevalent sports-related injuries, with approximately 2 million cases occurring worldwide annually5. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment approach, aiming to restore normal knee anatomy and stability, prevent secondary injuries, and enable patients' return to sport. Rehabilitation following ACL injury has been an active research area. It is widely accepted that post ACLR rehabilitation is integral for optimizing surgical outcomes and facilitating patients' recovery of sports-related function6,7. However, early weight-bearing (EWB) rehabilitation protocols after ACLR remain understudied, leading to a lack of consensus among clinicians.
The latest research in 2021 supports allowing immediate weight-bearing and full knee range of motion within tolerance after ACL autograft reconstruction surgery7. However, a consensus has not yet been reached in clinical practice. The authoritative British Journal of Sports Medicine published in 2016 also advocates for immediate weight-bearing post ACLR, finding it does not increase knee joint laxity. If gait is proper without increased pain or effusion during/after walking, immediate weight-bearing is considered acceptable6. In contrast, a review in 2022 summarizes that accelerated weight-bearing rehabilitation following ACLR may increase risks of knee joint laxity and bone tunnel widening compared to delayed weight-bearing protocols, advising cautious selection of postoperative regimens8. Additional concerns with EWB include knee pain, swelling, effusion, wound healing, and fall risks after ACLR. Although substantial literature endorses EWB after ACLR, clinical practices still vary. A study in 20209 found that surgeon experience influences post ACLR weight-bearing timelines in France; more experienced surgeons were more likely to favor EWB rehabilitation.
Under the guidance of the ERAS concept, EWB is an important factor affecting patient function and quality of life. However, whether the EWB program could impair wound healing, increase pain and swelling, or impact knee stability remains a key concern for orthopedic and rehabilitation clinicians. In view of the current dilemma of clinicians and inconsistent research results, this study aims to explore the safety and feasibility of EWB after ACLR.

作者聚焦：在前交叉韧带重建术后康复中实施加速恢复术后概念

前交叉韧带重建后早期负重康复方案

Our group conducted a clinical study of early weightbearing rehabilitation after cruciate ligament reconstruction. The aim of this study is to explore the possibility of implementing the ERAS concept in the early rehabilitation of this disease. We developed a standardized and early weightbearing rehabilitation program, and observed its feasibility and effectiveness.There is no concern on the early weightbearing rehabilitation project after anterior cruciate ligament reconstruction. However, the early weightbearing rehabilitation can accelerate patients waiting to decide and improve their satisfaction, which is in line with the contemporary concept of enhanced recovery after surgery. The early weightbearing rehabilitation program of our team is safe, effective, and feasible.The program can improve the daily activity of daily living and patient satisfaction. We found no adverse effects of the protocol on the old and needs stability of the patients. Our findings provide us a theoretical basis for accelerated recovery of the anterior reconstruction, physical can carry out the early weightbearing rehabilitation for the patients to improve their self, their ability, and reduce dependence and the medical costs.

前交叉韧带重建术后下肢恢复的负重站立训练

指导员]进行前交叉韧带重建后，告知患者康复过程。将受影响的下肢抬高至与水平线成 30 度角。将冰袋敷在患膝上，每次 20 分钟，每日 3 次。清醒时，每小时进行五分钟的踝关节泵锻炼。让治疗师向四个方向活动髌骨，按摩股四头肌和腘绳肌，以松弛髌骨和周围组织。进行股四头肌等长收缩训练，每天 10 组，每次 10 次。然后伸展和弯曲膝关节。指导患者在有或没有助行器的情况下站立。然后要求患者站立，双脚分开与肩同宽。让治疗师站在患者患侧，并给予他们口头指导。对着镜子观察身体姿势，独立调整姿势或在治疗师的指导下调整姿势。将患腿放在电子体重仪上，逐渐将患腿的负重强度增加到体重的25%50%75%和100%。

weight-bearing-standing-training-for-lower-limb-recovery-after

Research

JoVE Journal

Medicine

Weight-Bearing-Standing Training for Lower Limb Recovery After Anterior Cruciate Ligament Reconstruction

42 次观看.  Shanghai Second Rehabilitation Hospital. 指导员]进行前交叉韧带重建后，告知患者康复过程。将受影响的下肢抬高至与水平线成 30 度角。将冰袋敷在患膝上，每次 20 分钟，每日 3 次。清醒时，每小时进行五分钟的踝关节泵锻炼。让治疗师向四个方向活动髌骨，按摩股四头肌和腘绳肌，以松弛髌骨和周围组织。进行股四头肌等长收缩训练，每天 10 组，每次 10 次。然后伸展和弯曲膝关节。指导患者在有或?...

视频: 前交叉韧带重建术后下肢恢复的负重站立训练

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment for ACL injury, aiming to regain normal anatomical structure and stability of the knee joint and promote the patient's return to sports. Under the guidance of the concept of enhanced recovery after surgery, early weight-bearing rehabilitation (EWB) is an important factor affecting patient function and quality of life. However, there is no consensus on whether EWB rehabilitation can be performed after ACL surgery. 
This study aims to explore the safety and feasibility of EWB after ACL surgery. The study implemented a gradual EWB rehabilitation program in the experimental group, including weight-shifting training, balance training, and gait training on the affected lower limb, and assessed wound healing and stability of the knee joint. The study found that EWB after ACLR is safe and feasible. EWB rehabilitation not only does not pose a negative effect on the patient's knee pain, swelling, wound healing, and stability, but also helps to improve knee active flexion and quality of life faster and better. The EWB program in this study is simple, safe, and effective, and it provides strong theoretical guidance and practical demonstration for accelerated rehabilitation after ACLR.

Based on the safety and feasibility, this article presents an early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction. The protocol is clear and easy to operate, which is helpful to promote its use in clinical practice and accelerate the functional recovery of patients.

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment ...