Main principles of postoperative rehabilitation after primary isolated anterior cruciate ligament reconstruction in young physically active patients

Purpose of the study: to develop a consensus statement, based on the Delphi protocol methodology, regarding the key principles of postoperative rehabilitation for physically active individuals from the general population following primary isolated ACL reconstruction.

Materials and methods: A two‑round Delphi study was conducted to develop the consensus statement. The working group formulated a list of questions divided into three categories: core rehabilitation principles, criteria for return to activity, and paramedical aspects of care. Twenty‑three rehabilitation experts participated, meeting strict criteria: higher medical or pedagogical education, at least 10 years of professional experience, and management of at least 100 patients after ACL reconstruction within the five years preceding the study. Consensus was defined as 70 % agreement among experts.

Results: Consensus was achieved on all 42 items. Key findings include the necessity of early rehabilitation initiation (within the first week), emphasis on therapeutic exercise, a staged approach to recovery, and clear criteria for return to physical activity. Experts noted that instrumental physiotherapy, intra‑articular injections, and frequent online consultations are not mandatory. The optimal duration of rehabilitation is 6–9 months with 5–6 training sessions per week. Critical success factors include patient motivation, continuity between surgeon and rehabilitation specialist, and accessibility of the rehabilitation plan.

Conclusion: This consensus statement represents the first document of its kind within the Russian professional rehabilitation community. It provides orthopedic surgeons and specialists in physical and rehabilitation medicine with an opportunity to optimize management of patients with isolated ACL ruptures. Optimization can be achieved by improving continuity and applying unified approaches at different stages of the rehabilitation process, which will reduce complication risks, accelerate return to an active lifestyle, and improve quality of life after ACL reconstruction.

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