A Cochrane review [Abstract] 1 [withdrawn from publication] included 9 studies evaluating the effectiveness of exercise in the rehabilitation of isolated anterior cruciate ligament (ACL) injuries in adults, with a total of 391 subjects. There were six comparisons: supplementary proprioceptive or perturbation training versus traditional regime as part of conservative management (2 trials; n=76), and home based versus supervised rehabilitation, closed kinetic chain versus closed and/or open kinetic chain rehabilitation and land based versus water based rehabilitation exercises following surgical reconstruction (7 trials, n=315). 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.
Another Cochrane review 2 (abstract , review [Abstract]) [withdrawn from publication] considering exercise in the treatment of ACL injuries in combination with collateral ligament and meniscal damage to the knee in adults included 5 trials (n=243) evaluating exercise programmes following ACL reconstruction and one trial (n=100) comparing supervised with self-monitored exercises as part of conservative treatment. No study compared the effect of exercise versus no exercise. Age range of the predominantly male participants was 15 to 49 years. Length of follow up varied from 6 weeks to 24 months. Included trials compared muscle strengthening in weight bearing and non-weight bearing positions; exercise at home or under supervision; early rehabilitation and delayed rehabilitation and adding balance and proprioception exercises to a standard rehabilitation programme. Insufficient evidence was found to support the efficacy of one exercise intervention over another.
Comment: The quality of evidence is downgraded by imprecise data (limited study size for each comparison), inconsistency (heterogeneity in interventions and outcomes) and serious limitations in study quality with poor reporting.
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