anterior cruciate ligament


Concept Accelerated Rehabilitation


Shelbourne 1995

- noticed patients noncompliant with their rehab protocol were doing much better

- looked at what noncompliant patients were doing

- what they were doing was advancing activities as tolerated


Reviewed results of accelerated rehabilitation

- fewer ruptures with better ROM


Major recommendations


Management Options



Natural History of ACL deficient knee is variable

- functional instability 15% - 90%

- progression to OA is variable


Depends on level of patient demands / activity


1.  Late meniscal injury in ACL deficient knee




2.  Function


Daniels Am J Sports Med 1994

- 292 ACL defecients knees



ACL Normal ArthroscopyACL Normal Arthroscopy




Developmental Anatomy


Knee joint first appears as a mesenchymal cleft at 8 weeks gestation

- ACL and PCL separate entities by week 10