title: WITHDRAWN: Exercise for treating isolated anterior cruciate ligament injuries in adults.
abstract: BACKGROUND
  The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. Injury causes pain, effusion and inflammation leading to the inability to fully activate the thigh muscles. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation.
  
  
  OBJECTIVE
  To present the best evidence for effectiveness of exercise used in the rehabilitation of isolated ACL injuries in adults, on return to work and pre-injury levels of activity.
  
  
  METHODS
  We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Feb 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1996 to March 2005), EMBASE (1980 to March 2005), other databases and reference lists of articles.
  
  
  METHODS
  Randomised controlled trials and quasi-randomised trials testing exercise programmes designed to rehabilitate adults with isolated ACL injuries. Trials where participants were randomised to receive any combination of the following: no care, usual care, a single-exercise intervention, and multiple-exercise interventions, were included. The primary outcome measures of interest were returning to work and return to pre-injury level of activity post treatment, at six months and one year.
  
  
  METHODS
  Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials.
  
  
  RESULTS
  Nine trials involving 391 participants were included. Only two trials, involving 76 participants, reported conservative rehabilitation and seven trials, involving 315 participants, evaluated rehabilitation following ACL reconstruction. Methodological quality scores varied considerably across the trials, with the nature of participant and assessor blinding poorly reported. Trial comparisons fell into six categories. Pooling of data was rarely possible due to lack of appropriate data as well as the wide variety in outcome measures and time points reported. Insufficient evidence was found to support the efficacy of one exercise intervention over another.
  
  
  CONCLUSIONS
  This review has demonstrated an absence of evidence to support one form of exercise intervention against another and the use of supplementary exercises in the management of isolated ACL injuries. Further research in the form of large scale well designed randomised controlled trials with suitable outcome measures and surveillance periods, using standardised reporting should be considered.
authors.affiliation: Centre for Rehabilitation Sciences, University of Teesside, School of Health and Social Care, Middlesbrough, Tees Valley, UK, TS1 3BA.
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Trees
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Howe
authors.forename: John
authors.initials: J
authors.lastname: Dixon
authors.forename: Lisa
authors.initials: L
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D005081:Exercise Therapy; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function