Hydrotherapy in ACL Rehabilitation
Original Editor - Falcone Tseng
Introduction[edit | edit source]
Anterior Cruciate Ligament (ACL) injuries are a common orthopedic condition, especially among athletes and young people, which can have long term physical and lifestyle impacts. This may include post traumatic arthritis, meniscus or cartilage injuries, knee instability, as well as impaired quality of life and not returning to sport. At present, recommended treatment options are surgical reconstruction, or conservative management, with both these approaches requiring rehabilitation . Research continues to investigate how to optimize ACL rehabilitation, including utilizing hydrotherapy. Hydrotherapy is the delivery of physiotherapy treatment in an aquatic environment, utilizing the properties of water (density, buoyancy, hydrostatic pressure and viscosity).
Outcome Measures of ACL Rehabilitation[edit | edit source]
- Instability episodes 
- Pain 
- Passive range of motion (knee flexion & extension)
- Muscle strength
- Thigh circumference (thigh girth, thigh muscle mass, knee joint swelling) 
- Active range of motion (knee flexion & extension) 
- Issues with:
- Measures of knee function:
- Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) 
- International Knee Documentation Committee (IKDC) form, Lysholm and Tegner scores
- Knee Injury and Osteoarthritis Outcome Score (KOOS4) 
- Graft rupture post-ACL reconstruction 
- Contralateral ACL injury 
- Lachman and pivot-shift tests 
- 6 minute walk test (6MWT) 
Advantages of Hydrotherapy in ACL and ACL Reconstruction Rehabilitation[edit | edit source]
- Reduce pain and swelling
- Early weightbearing 
- Posture, gait and motor pattern retraining in a supported environment 
- Water resistance induced muscular conditioning 
- Cardiovascular exercise
- Early plyometrics
- In later stages of rehabilitation can support the between session recovery and optimal load management
Evidence[edit | edit source]
A study of 67 amateur or professional athletes post-ACL reconstruction, found patients who underwent 3 weeks of combined hydrotherapy with conventional rehabilitation, had superior outcomes in proprioception, walking and muscle strength in the short and medium term, compared to participants exclusively in conventional rehabilitation program . In addition, another study found patients who received innovative aquatic proprioceptive training alongside conventional rehabilitation had improved proprioception efficiency compared with those receiving only conventional treatment.
Another trial found that ACL reconstruction patients placed through 9 weeks of aquatic rehabilitation immediately post-surgery had better clinical parameters in muscle strength and mass circumference, pain, swelling, and range of motion compared to those on land rehabilitation .
A smaller case study of 3 subjects demonstrated no risk of harm in utilizing hydrotherapy to accelerate rehabilitation of ACL reconstruction .
One study compared water-based treadmill walking training with land-based treadmill walking training via a randomized, single blind trial with 60 patients post anterior ACL reconstruction. They found the ratio of peak torque to body weight ratio for the knee extensor muscles, passive position sense and Lysholm scores showed significantly greater improvement in the water-based group than in the land based group.
Further research is needed, including among non-athlete populations. For example, a 2022 systematic review for the OPTIKNEE consensus did not include hydrotherapy due to its inclusion in only 1 of the 142 randomized control trials reviewed.
Considerations for ACL hydrotherapy rehabilitation design[edit | edit source]
For ACL injury or reconstruction rehabilitation, the hydrotherapy program can include:
- Gait training
- Quadriceps and hamstring strengthening (closed and open kinetic chain exercises)
- Strength and endurance training (running and cycling)
- Hip and calf maintenance and strengthening
- Balance and proprioception exercises
- Plyometric training
- Sport-specific rehabilitation
Resources[edit | edit source]
References:[edit | edit source]
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