REHABILITATION OF PATIENTS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING INTERNAL BRACE TECHNIQUE
Abstract
Introduction and Purpose: Anterior cruciate ligament (ACL) injuries are among the most common and functionally limiting conditions in physically active individuals. Although traditional ACL reconstruction techniques are effective in restoring knee stability, they are associated with prolonged rehabilitation, potential graft failure, and psychological barriers to returning to sport. The Internal Brace Ligament Augmentation (IBLA) technique has emerged as a biomechanically enhanced alternative that may overcome some of these limitations.
Materials and Methods: This narrative review is based on a literature search conducted in PubMed, Web of Science, and Google Scholar using the keywords: ACL reconstruction, Internal Brace, rehabilitation, and return to sport. Studies were included if they addressed ACL reconstruction using the IBLA technique, with a focus on rehabilitation protocols, functional outcomes, and comparisons with standard ACL reconstruction methods.
Results: Current evidence suggests that the Internal Brace technique provides improved graft stability and reduces elongation during early loading phases. These advantages may support faster mobilization and progression through rehabilitation. Clinical data indicate the potential for earlier return to sport with functional outcomes comparable or superior to traditional techniques. Nonetheless, standardized rehabilitation protocols specific to IBLA remain underdeveloped, and long-term outcome data are still limited.
Conclusions: Internal Brace Ligament Augmentation represents a promising innovation in ACL reconstruction, offering mechanical support that may enable accelerated and safer rehabilitation. While preliminary findings are encouraging, further high-quality research is needed to confirm long-term efficacy and establish evidence-based rehabilitation guidelines. The integration of biomechanical and clinical insights may improve functional recovery and return-to-sport success in active populations.
References
Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):33-47. doi: 10.1016/j.berh.2019.01.018.
Wilson WT, Hopper GP, Banger MS, Blyth MJG, Riches PE, MacKay GM. Anterior cruciate ligament repair with internal brace augmentation: A systematic review. Knee. 2022 Mar;35:192-200. doi: 10.1016/j.knee.2022.03.009.
Lu W, Deng Z, Essien AE, Arthur Vithran DT, Opoku M, Li Y, Xiao W. Clinical Research Progress of Internal Brace Ligament Augmentation Technique in Knee Ligament Injury Repair and Reconstruction: A Narrative Review. J Clin Med. 2023 Mar 2;12(5):1999. doi: 10.3390/jcm12051999.
Kiapour AM, Quatman CE, Goel VK, Hewett TE, Demetropoulos CK, Wordeman SC. Biomechanical properties of internal brace-augmented ACL reconstruction: An in vitro and finite element study. Am J Sports Med. 2021;49(3):642–650. doi:10.1177/0363546520985092.
Monk AP, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database Syst Rev. 2016 Apr 3;4(4):CD011166. doi: 10.1002/14651858.CD011166.pub2.
Carter HM, Lewis GN, Smith BE. Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review. BMC Musculoskelet Disord. 2023 Jun 9;24(1):471. doi: 10.1186/s12891-023-06489-5.
Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med. 2023 May;57(9):500-514. doi: 10.1136/bjsports-2022-106158.
Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord. 2020 Oct 3;21(1):647. doi: 10.1186/s12891-020-03676-6.
Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports Health. 2022 Sep-Oct;14(5):770-779. doi: 10.1177/19417381211056873.
Manoharan A, Fithian A, Xie V, Hartman K, Schairer W, Khan N. Return to Sports After Anterior Cruciate Ligament Reconstruction. Perm J. 2024 Jun 14;28(2):102-108. doi: 10.7812/TPP/23.132.
García-Rodríguez P, Pecci J, Vázquez-González S, Pareja-Galeano H. Acute and Chronic Effects of Blood Flow Restriction Training in Physically Active Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health. 2024 Sep-Oct;16(5):820-828. doi: 10.1177/19417381231208636.
Kochman M, Kasprzak M, Kielar A. ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? A Systematic Review. Int J Environ Res Public Health. 2022 Nov 29;19(23):15893. doi: 10.3390/ijerph192315893.
Erickson LN, Lucas KCH, Davis KA, Jacobs CA, Thompson KL, Hardy PA, Andersen AH, Fry CS, Noehren BW. Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial. Phys Ther. 2019 Aug 1;99(8):1010-1019. doi: 10.1093/ptj/pzz062.
Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016 Feb 24;7:21-32. doi: 10.2147/OAJSM.S72332.
Wu J, Kator JL, Zarro M, Leong NL. Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair. Sports Health. 2022 May-Jun;14(3):424-432. doi: 10.1177/19417381211032949.
Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair - past, present and future. J Exp Orthop. 2018 Jun 15;5(1):20. doi: 10.1186/s40634-018-0136-6.
Buckthorpe M, West A, Grieve R, et al. Optimising the early-stage rehabilitation process post-ACL reconstruction: A clinical perspective. Sports Med. 2024 Jan;54(1):49–72. doi:10.1007/s40279-023-01934-w.
Pipino G, Tomasi E, Mardones R, et al. Rehabilitation after ACL reconstruction: Dry land vs aquatic therapy. Muscles Ligaments Tendons J. 2023;13(3):421–429. doi:10.32098/mltj.03.2023.10.
Giai Via A, Tomasi E, Borghi R, et al. Comparative outcomes of aquatic versus land-based rehabilitation after ACL reconstruction. Muscles Ligaments Tendons J. 2023;13(3):421–429. doi:10.32098/mltj.03.2023.10.
Davies GJ, McCarty E, Provencher MT, Manske RC. ACL return-to-sport guidelines and criteria. Curr Rev Musculoskelet Med. 2017 Sep;10(3):301–311. doi:10.1007/s12178-017-9446-5.
Gokeler A, Dingenen B, Hewett TE. Rehabilitation and return-to-sport testing after ACL reconstruction: where are we in 2022? Arthrosc Sports Med Rehabil. 2022;4(Suppl 1):S15–S28.
Wong SE, Feeley BT, Pandya NK. Complications after pediatric ACL reconstruction: a meta-analysis. J Pediatr Orthop. 2019 Sep;39(7):e466–e474. doi:10.1097/BPO.0000000000001385.
Brewer BW, Cornelius AE, Van Raalte JL, et al. Rehabilitation adherence and anterior cruciate ligament reconstruction outcome. Psychol Health Med. 2004;9(2):163–175. doi:10.1080/13548500410001670690
Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-reported fear predicts functional performance and second ACL injury after ACL reconstruction. Sports Health. 2018 May-Jun;10(3):228–234. doi:10.1177/1941738117745806.
Hatamzadeh M, Sharifnezhad A, Hassannejad R, Zory R. Discriminative sEMG-based features for muscle evaluation in ACLR athletes. arXiv preprint. 2023 Mar;abs/2303.06954.
Harris-Hayes M, Ertl JP, Hill M, Stahl R, Klingenstein G. Sex differences in biomechanics and neuromuscular function after ACL reconstruction: Implications for return-to-sport criteria. Phys Ther Sport. 2021 Feb;49:192–199. doi:10.1016/j.ptsp.2021.05.003.
Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016 Jan;50(15):946–951. doi:10.1136/bjsports-2015-095908.
de Sire A, Coccia G, Ferrillo M, et al. Effects of proprioceptive exercise on neuromuscular control and re-injury risk following ACL reconstruction: A systematic review and meta-analysis. J Funct Morphol Kinesiol. 2022 Mar;7(1):6. doi:10.3390/jfmk7010006.
Reiman MP, Lorenz DS, Walker JC, Phillips D, Goerger BM. Closed-kinetic chain rehabilitation following ACL reconstruction: effects on outcomes at six months and one year. Phys Ther Sport. 2017 Nov;26:26–32. doi:10.1016/j.ptsp.2016.10.001.
Stephens TF, Myer GD, Kissenberth MJ, et al. A randomized controlled trial of early neuromuscular training for female athletes after ACL reconstruction: 12-month outcomes. Clin J Sport Med. 2021 Sep;31(5):e367–e374. doi:10.1097/JSM.0000000000000875.
Itoh Y, Sugaya H, Toh S, Akimoto T. Long-term follow-up of ACL reconstruction using hamstring tendon autografts with early accelerated versus conventional rehabilitation protocols. Int Orthop. 2023 Apr;47(4):723–731. doi:10.1007/s00264-022-05662-w.
Views:
110
Downloads:
24
Copyright (c) 2025 Klaudia Bilińska, Anna Szot, Joanna Węgrzecka, Kazimierz Czajka
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
