Objective
To compare the outcomes of a 6-month-long accelerated rehabilitation with a 12-month-long rehabilitation. There is no consensus on the optimal duration of rehabilitation after anterior cruciate ligament reconstruction (ACLR). Trends in the past decades have shifted towards accelerated programs, often resulting in a return to play (RTP) at 4–6 months, postoperatively. However, longer rehabilitation cycles have recently experienced renaissance due to a greater understanding of graft remodeling.
Methods
Adult athletes who underwent ACLR between 2015 and 2018 by the same surgeon were included and followed-up prospectively for 24 months. Participants were allocated into two groups based on their RTP (6 months vs. 12 months) and compared with graft elongation, reoperation rate, and sports career (quit or continue) outcomes.
Results
Fifty-four patients underwent accelerated rehabilitation and 92 completed conventional rehabilitation. The accelerated rehabilitation was significantly associated with graft elongation—the accelerated rehabilitation group (n=9) and the conventional rehabilitation group (n=0), p<0.001—and need for reoperation—the accelerated rehabilitation group (n=5) and the conventional rehabilitation group (n=1), p=0.026. Although the relationship between rehabilitation time and quitting competitive sports did not reach significance at 0.05 level (p=0.063), it was significant when p<0.1, thereby showing a clear trend.
Conclusion
Accelerated rehabilitation increased graft elongation risk. Knee laxity ≥3 mm measured at 6 months after ACLR should be accompanied by RTP time frame re-evaluation. Arthrometry checkups or routine magnetic resonance imaging shortly after RTP may be considered in cases of accelerated rehabilitation.

Citations

• Movement Assessments as Predictors for Initial Anterior Cruciate Ligament Injury: A Critically Appraised Topic
  Destinee Johnson, Rebecca Maldonado, Erin Lally
  Journal of Sport Rehabilitation.2025; 34(7): 767.     CrossRef
• Global Variations in Surgical Techniques for Primary Anterior Cruciate Ligament Reconstruction at Minimum 2-Year Follow-up: A Systematic Review of Randomized Clinical Trials
  Sina Tartibi, Derrick M. Knapik, S. Ryan Pierson, Christopher K. Bozorgmehr, Daniel C. Touhey, Matthew J. Matava, Matthew V. Smith, Robert H. Brophy
  Orthopaedic Journal of Sports Medicine.2025;[Epub]     CrossRef
• Return to Sport and Risk of Second Anterior Cruciate Ligament (ACL) Injury in Elite Male Footballers: 10-Year Experience From a Single Center
  Alberto Grassi, Tommaso Bonanzinga, Federico Maria Adravanti, Gian Andrea Lucidi, Emanuele Altovino, Stefano Zaffagnini, Maurilio Marcacci
  Orthopaedic Journal of Sports Medicine.2025;[Epub]     CrossRef
• Anterior cruciate ligament reconstruction in the elderly: 5-Year follow-up study
  Takayuki Kurokawa, Károly Csete, Péter Jávor, Lilla Sándor, Bálint Baráth, Helga Holovic, László Török, Petra Hartmann
  Injury.2024; 55: 111529.     CrossRef
• Blood Flow Restriction Training and Its Use in Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis
  Jamaal Butt, Zubair Ahmed
  Journal of Clinical Medicine.2024; 13(20): 6265.     CrossRef
• Reasons for the Variability of Rehabilitation Programs and the Perspective of the Standardized Guidelines Development for Patients after Anterior Cruciate Ligament Reconstruction
  V.V. Kotiuk, O.O. Kostrub, I.A. Zasadniuk, D.O. Smirnov, V.A. Podik, R.I. Blonskyi
  TERRA ORTHOPAEDICA.2023; (3(118)): 64.     CrossRef