Åhlén et al⁵⁴

19

10 to 9

Operated versus contralateral leg

8.5 (6–11) years

Significant increase in Tegner, Lysholm and hop test postoperative versus preoperative ST and G regenerated in, respectively, 89% and 95% of patients with almost normal insertion pes anserinus. Regenerated tendons had similar cross-sectional area compared with contralateral leg. Strength deficit in deep flexion but not in internal rotation.

Ali et al⁵¹

78

69 to 5

NA

64 (48–84) months

Detachment of tibia insertion is unnecessary and an accelerated rehab. can be followed without brace use.

Baltaci et al³²

30

All males

Wii Fit (15) versus conv rehab. (15)

12 weeks

Both rehab. programme have same effect on muscle strength, dynamic balance and functional performance. Practice of Wii Fit activities could address physical therapy goals.

Christensen et al¹²

36

53% male (aggressive rehab.) versus 88% male non-aggressive rehab.

Aggressive (19) versus non-aggressive rehab. (!17)

24 weeks

No difference between aggressive and non-aggressive rehabilitation in AP laxity, subjective IKDC scores, ROM and muscle strength.

Clark et al⁵²

82

27 to 14 in each group

41 ACLR versus 41 controls

12 months

Significant increases in asymmetry in ACLR group for all outcome measures except symmetry index relative to operated limb. Weight-bearing asymmetry can be assessed with Wii Fit balance board.

Czamara et al⁴²

30

All males

SB ACLR (15) versus DB ACLR (15)

24 weeks

No differences between SB versus DB ACLR in AP laxity, pivot shift test, ROM, joint circumference, pain scores, peak torque muscles tibial rotation and run test.

Czaplicki et al⁴⁶

29

All males

NA

12 months

1 year after ACLR may be too early to return to full physical fitness for males who are physically active.

Fukuda et al¹⁰

49

Early start 16 to 7) versus late start (13 to 9)

Early start (25) versus late start (24)

17 (13–24) months

Faster recovery quadriceps strength in early group. No difference between early and late start of open kinetic chain exercises in pain and functional improvement.

Howell et al²¹

41

28 to 13

NA

26 (24–32) months

Absent pivot shift in 82% patients and 88% <3 mm laxity difference with KT-1000. Stability, girth of thigh, Lysholm and Gillquist scores were identical at 4 months and 2 years.

Janssen et al⁹

67

6–12 ms (9 to 6), 1–2 years (10 to 6), >2 years post-ACLR (7 to 10)

Group 1 (15), group 2 (16), group 3 (11)

117 months

Human hamstring autografts remain viable after ACLR and showed three typical stages of graft remodelling. Remodelling in humans takes longer compared with animal studies and is not complete up to 2 years after ACLR.

Janssen et a ref 44

22

17 to 5

MRI operated and contralateral leg

12 months

Gracilis regenerated in all patients, ST in 14/21 patients. There was no relation between isokinetic flexion strength and tendon regeneration.

Jenny et al⁴⁷

72

57 to 15

NA

4.3 years

Patient-based decision to return to work and sport was possible without compromising functional outcome. The postoperative restrictions implemented by orthopaedic surgeons following ACLRs may be relaxed and more patient based.

Karikis et al⁴⁸

94

DB (32 to 13) versus SB (31 to 18)

DB (45) versus SB (49) ACLR

26 (22–34) months

Anatomical DB ACLR did not result in better rotational or AP stability compared with anatomical SB ACLR.

Kinikli et al³³

33

33 to 2

Study group (16) versus control (17)

16 weeks

Adding progressive eccentric and concentric exercises may improve the functional results after ACLR with autograft hamstring tendons.

Królikowska et al⁵³

40

All males

ST group (20) versus ST-G group (20)

6 months

Generally, no difference between ST and ST-G groups. There is an influence of gracilis tendon harvest on internal shin rotation isometric torque at deep internal rotation angle.

Koutras et al^{36 49}

42

39 to 3

NA

9 months

Measuring knee flexion strength in prone demonstrates higher deficits than in conventional seated position.

Salmon et al³⁸

200

100 to 100

Men versus women

7 years

Significant greater laxity in women compared with men without effect on activity level, graft failure, subjective and functional assessments.

Sastre et al³⁴

40

DB (70% male) versus SB (70% male) ACLR

DB (20) versus SB (20) ACLR

2 years

No significant differences in DB versus SB ACLR in IKDC objective and subjective results.

Srinivas et al⁵⁰

63

58 to 5

Various fiaxtion systems femur and tibia

1 year

Femoral and tibial tunnel widening varies with different methods and was maximum with suture disc method compared with others after ACLR with hamstring autograft.

Toanen et al⁵⁶

12

5 to 7

NA

49.6 (24) months

Older patients (>60 years) and active patients with non-arthritic ACL-deficient knees showed good results on functional recovery without risk of midterm OA.

Trojani et al⁵⁵

18

6 to 12

NA

30 (12–59) months

Age >50 years is not a contraindication to select hamstring tendon autograft for ACLR. ACLR restores knee stability but does not modify pain in case of previous medial meniscectomy.

Vadalà et al³⁵

45

33 to 12

Acc rehab (20) versus conv rehab. (25)

10 (9–11) months

Bone tunnel enlargement can be increased by accelerated rehab. after ACLR with hamstring tendon autografts.

Zaffagnini et al⁴⁵

21

All males

NA

48.1 (46–50)

Return to sports was 95% after 1 year and 64% after 4 years in professional soccer players after non-anatomical quadruple hamstring tendon autograft ACLR. 71% still played competitive soccer at final follow-up. Clinical scores were restored after 6 months.