No evidence for the most appropriate postoperative rehabilitation protocol following anterior cruciate ligament reconstruction with concomitant articular cartilage lesions: a systematic review

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The purpose of this study was to systematically review the literature to investigate the recommended rehabilitation protocol for patients undergoing ACLR with concomitant articular cartilage injury with a view to develop guidelines on the most appropriate treatment.


The primary outcome was specific rehabilitation protocols including

  • weight-bearing status,
  • immobilisation,
  • continuous passive motion (CPM)
  • return to play criteria.
  • Secondary outcomes included patient-reported outcomes. A best evidence synthesis was performed

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No consensus was found on weight-bearing status, postoperative immobilisation, the use of CPM, or return to play criteria. Given the quality of the papers, there was no evidence to recommend any specific rehabilitation regime in the postoperative management of concomitant ACLR and articular cartilage lesions


Despite associated articular cartilage injury is a frequent finding in patients undergoing ACL reconstruction (ACLR), with some studies suggesting the presence of severe chondral damage in up to 46% of cases.

From a clinical perspective, decisions on postoperative rehabilitation for patients undergoing ACLR and treatment of articular cartilage lesions should be made on a case-by-case basis with criteria-based progression until more robust evidence becomes available.

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