Several studies demonstrate that accelerated rehabilitation emphasising immediate full range of motion, early full weight bearing, strength training, and an early introduction to closed chain exercises, allows a prompt resumption of activities of daily living and sport. The exercises employed in 'accelerated' rehabilitation programmes are known to produce the least strain in the graft(17,18). Such programmes follow graduated protocols which are tailored to the patient's needs and progress. The immediate return to full hyperextension and early functional activity have not been shown to be detrimental to the long-term stability of the knee joint(19,20) and avoid joint stiffness.
The length of time off work will depend on the patient's occupation. A return to sedentary tasks is possible within a fortnight, particularly if the patient is able to get to work using crutches. More manual occupations will require at least three months off work. A significant amount of time off work is necessary in any case to allow for the intensive rehabilitation necessary in these cases.
Usually a patient returns to activities of normal daily living within a few weeks and sports by six months post surgery. Once the patient has regained power greater than 75% of the unaffected leg, strength training is intensified and he/she may begin activities such as straight-line jogging and more sports-specific type training at low intensity.
It is not until patients have regained complete quadriceps and hamstring strength equal to or greater than the other leg, that they are allowed to return to higher intensity sports specific training.
There appears to be no significant benefit in terms of patient recovery for overprotection with plasters/braces or restriction of movement. There is also very little evidence for the use of continuous passive motion (CPM) machines or cryotherapy (which we nevertheless find most patients like).