Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 3 Issue 5

Rehabilitation Program after Post-Traumatic Reconstruction of the Anterior Cruciate Ligament (With a Clinical Case Report)

Ivet Koleva1,2* and Borislav Yoshinov 3,4

1Lower Limb Deformity Unit, Al-Razi Orthopaedic Hospital, Kuwait
2Department of Physical and Rehabilitation Medicine, Hospital “Serdika”, Sofia, Bulgaria
3Medical Faculty of Sofia University, Bulgaria
4University of Telecommunications, Sofia, Bulgaria

*Corresponding Author: Ivet Koleva, Professor, Medical University of Sofia, Bulgaria.

Received: March 23, 2020; Published: April 21, 2020



 The Anterior Cruciate Ligament (ACL) is an important stabilizer of the knee, providing almost 85% of the joint stability to forward force (especially in some aggressive twisting and jumping sports, as skiing and basketball). The common orthopedic surgical intervention is the reconstruction, performed as soon as possible after the traumatic injury. After the orthopedic surgery, a period of rehabilitation must begin and the consultation with a medical doctor - specialist in Physical and Rehabilitation Medicine (PRM) is required. The goal of current article is to suggest a complex PRM-algorithm of care of these patients, based on detailed literature review and on our own clinical practice. In all traumatic knee conditions with a knee surgery, the PRM Algorithm traditionally includes functional evaluation of the knee mobility and stability and a complex PRM programme of care, including natural and preformed physical modalities. The pre-defined PRM protocol includes only physiotherapy (analytic exercises) combined with cryotherapy. Authors consider that the traditions of some rehabilitation schools (e.g. Bulgarian) can be used. We suggest a detailed complex PRM-algorithm, including physiotherapy, cryotherapy, hydro or balneotherapy; and many preformed physical factors: functional electrical stimulations of the quadriceps femoris muscle (accentuating on the heads m.vastus lateralis and m. vastus medialis, especially on m.vastus medialis obliquus); interferential currents; Deep Oscillation; low intensity low frequency magnetic field; ultrasound or ultra-phonophoresis with non-steroidal anti-inflammatory drugs. We propose a practical schema for a patient after ACL reconstruction, through a clinical case presentation: a male patient after reconstruction of the right ACL, after traumatic rupture of the ACL. Immediately after the orthopedic surgery, the patient was treated as inpatient in the PRM Clinic of a Bulgarian University hospital and after - as outpatient in the PRM-Department of an ambulatory Medical Center. We expose the detailed PRM-program and the obtained results in this patient. In conclusion, we emphasize the impact of the complex PRM-programme in case of ACL-reconstruction and the efficacy for: pain relief; enhancement of the range of motion of the knee; enrichment of the functional capacity; amelioration of the neuro-muscular coordination; stabilization of the gait; improvement of the quality of life.

Keywords: Rehabilitation; Anterior Cruciate Ligament; Physical Medicine; Electrotherapy; Magnetic Field; Deep Oscillation; Laser



  1. Shankman G. “Fundamental Orthopedic Management for the Physical Therapist Assistant”. St. Louis: Mosby Year Book (1997).
  2. American Academy of Physical Medicine and Rehabilitation Task Force on Medical Inpatient Rehabilitation Criteria (JL Melvin Chair). Standards for Assessing Medical Appropriateness Criteria for Admitting Patients to Rehabilitation Hospitals or Units (2006).
  3. Bethoux F and Calmels P. “Guide de mesure et d’évaluation en médecine physique et de réadaptation”. Paris: Roche (2003).
  4. Cyriax J and Russell G. “Textbook of orthopedic Medicine”. London: Chirchill-Livingstone (1981).
  5. Daniels L and Worthingham C. “Evaluation de la fonction musculaire”. Le TESTING - techniques de l’examen manuel. Paris: Maloine (1973): 88-90.
  6. DeLisa JA. “Physical Medicine and Rehabilitation - principles and practice”. 4th Philadelphia: Lippincott, Williams and Wilkins (2005).
  7. Floyd RT. “Manual of structural kinesiology”. 16th New York: Mc Graw-Hill (2007).
  8. Grasp and gait rehabilitation (bases). Monograph. (In English). Edited by prof. Ivet Koleva, and prof. Elena Avramescu. Authors: I Koleva, RD Yoshinov, M Zheleva, Y Zhelev, B Yoshinov, RR Yoshinov; ET Avramescu, D Kamal, C Kamal, MR Trăistaru. - Sofia: ‘SIMEL PRESS (2017): 396.
  9. Haig AJ. “Practice of physical medicine and rehabilitation on both sides of the Atlantic: differences and the factors that drive them”. European Journal of Physical and Rehabilitation Medicine2 (2008): 111-115.
  10. Knee Arthroscopy Physical Therapy Protocol (2016).
  11. Koleva I., et al. “Rehabilitation guidelines of operational standard procedures in rehabilitation after lower limb orthopedic surgery”. In: Education and New Developments, Edited by Mafalda Carmo, Lisbon (2017): 594-598.
  12. Koleva I., et al. “Functional assessment in orthopedical and traumatological rehabilitation: impact of International Classification of Functioning”. Evolutio-Medicine 2 (2016): 22-29.
  13. Koleva I., et al. “Efficacy of hydro-, balneo- and peloidotherapy in the pain management and quality of life of patients with socially-important diseases and conditions of the locomotory and nervous system: Bulgarian experience”. Balnea 10 (2015).
  14. Koleva I., et al. “Physical Analgesia. Edited by prof. Ivet Koleva. - Saint-Denis (France): Connaissances et Savoirs”. Sciences Sante (2018):146.
  15. Melvin JL. “Physical and rehabilitation medicine: comments related to the White book on physical and rehabilitation medicine in Europe”. European Journal of Physical and Rehabilitation Medicine2 (2008): 117-119.
  16. Physical Therapy Protocols (2016).
  17. Physical Therapy Post-operative Rehabilitation Protocols (2016).
  18. Stucki G., et al. “Value and application of the ICF in rehabilitation medicine”. Disability and Rehabilitation 24 (2002): 932-938.
  19. White Book on Physical and Rehabilitation Medicine in Europe. Produced by the Section of Physical and Rehabilitation Medicine, Union Europeenne des Medecins Specialistes (UEMS), the European Board of Physical and Rehabilitation Medicine and l’Academie Europeenne de Medicine de Readaptation in conjunction with the European Society of Physical and Rehabilitation Medicine (ESPRM). C Gutenbrunner, AB Ward, MA Chamberlain Editors. Journal of Rehabilitation Medicine45 (2007): 1-48.
  20. World Health organization. “International Classification of Functioning, Disability and Health (ICF)”. Geneva, WHO (2001).


Citation: Ivet Koleva and Borislav Yoshinov. “Rehabilitation Program after Post-Traumatic Reconstruction of the Anterior Cruciate Ligament (With a Clinical Case Report)". Acta Scientific Orthopaedics 3.5 (2020): 26-32.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US