title: Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction.
abstract: To assess the quality and variability found across anterior cruciate ligament (ACL) rehabilitation protocols published online by academic orthopaedic programs.
  
  
  
  Web-based ACL physical therapy protocols from United States academic orthopaedic programs available online were included for review. Main exclusion criteria included concomitant meniscus repair, protocols aimed at pediatric patients, and failure to provide time points for the commencement or recommended completion of any protocol components. A comprehensive, custom scoring rubric was created that was used to assess each protocol for the presence or absence of various rehabilitation components, as well as when those activities were allowed to be initiated in each protocol.
  
  
  
  Forty-two protocols were included for review from 155 U.S. academic orthopaedic programs. Only 13 protocols (31%) recommended a prehabilitation program. Five protocols (12%) recommended continuous passive motion postoperatively. Eleven protocols (26%) recommended routine partial or non-weight bearing immediately postoperatively. Ten protocols (24%) mentioned utilization of a secondary/functional brace. There was considerable variation in range of desired full-weight-bearing initiation (9 weeks), as well as in the types of strength and proprioception exercises specifically recommended. Only 8 different protocols (19%) recommended return to sport after achieving certain strength and activity criteria.
  
  
  
  Many ACL rehabilitation protocols recommend treatment modalities not supported by current reports. Moreover, high variability in the composition and time ranges of rehabilitation components may lead to confusion among patients and therapists.
  
  
  
  Level II.
authors.affiliation: Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: ericmakhnimd@gmail.com.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Makhni
authors.affiliation: Department of Orthopaedics, Naval Medical Center San Diego, San Diego, California, U.S.A.
authors.forename: Erica K
authors.initials: EK
authors.lastname: Crump
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Steinhaus
authors.affiliation: Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
authors.affiliation: Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Section of Sports Medicine, Sports Medicine Fellowship Program Director, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods / Q000534:rehabilitation*; D001915:Braces; D002985:Clinical Protocols; D004434:Early Ambulation; D005081:Exercise Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D053580:Muscle Strength / Q000502:physiology; D009862:Online Systems; D019990:Perioperative Care / Q000379:methods; D026741:Physical Therapy Modalities / Q000592:standards*; D015397:Program Evaluation; D011434:Proprioception / Q000502:physiology; D011787:Quality of Health Care; D016059:Range of Motion, Articular; D016474:Weight-Bearing / Q000502:physiology