ACL Rehab, Open vs. closed kinetic chain!

Believe it or not, after several years of research and decades of clinical experience, the optimal rehab program after ACL reconstruction is still open to debate.

It has been generally thought that open kinetic chain (OKC) exercises (i.e. knee extensions in sitting) are NOT APPROPRIATE early in the rehab program, in order to avoid biomechanical stresses on the graft.

On the contrary closed kinetic chain (CKC) exercises (i.e. squatting) have been recommended and thought to be superior since:

1) CKC exercises minimize the sheer forces that act on the tibia relative to the femur

2) CKC exercises increase tibio-femoral compressive forces

3) CKC exercises enhance hamstrings contraction

4) CKC exercises are more functional

5) CKC exercises may lessen the stress on the patello-femoral joint and potential pain

This 2005 review paper surprisingly concludes that:

Open-kinetic chain and closed-kinetic chain exercises may NOT be different in their effects on the healing response of the ACL-reconstructed knee. Also recent biomechanical studies have shown that the peak strains produced on an ACL graft are similar. Clinical studies suggest that BOTH forms of exercises can be beneficial in the early rehab of the reconstructed knee.

Posted on: March 12, 2006

Categories: Knee

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