The impact of early weight-bearing on results following anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) ruptures are common injuries that typically affect young, physically active individuals and may require surgical reconstruction. Studies have shown that the long time success of ACL reconstruction depends on the surgical technique and the postoperative rehabilitation strategy. However, there is still no consensus on the content of rehabilitation programs. Hence, additional research is required to elucidate the significance of early weight-bearing in the rehabilitation process following ACL reconstruction. The aim of this article is to examine the impact of weight-bearing on the clinical results of ACL reconstruction. We retrospectively reviewed patient records who had undergone arthroscopic reconstruction using a semitendinosus-gracilis tendon graft for anterior cruciate ligament rupture between January 2018 and December 2020. The study included the data of 110 patients. The patients were split into two groups: Group 1 underwent early weight-bearing, while Group 2 followed a non-weight-bearing regimen for three weeks. We assessed the patients using the anterior drawer test, Lachman test, range of motion, Lysholm knee scale, Cincinnati scale, Tegner scale, International Knee Documentation Committee (IKDC) form and clinical records. Analytical tests were conducted to compare the results. The complication rates did not show a significant difference between the groups. Group 1 had higher frequencies of positive anterior drawer and Lachman tests. The Lysholm and Cincinnati knee scores of patients in Group 1 were notably lower than those of patients in Group 2. Additionally, the Tegner activity scores and IKDC scores of patients in Group 1 were also meaningfully lower than those of patients in Group 2. In Group 1 patients, there was no notable relationship observed between body mass index (BMI) and the results of the anterior drawer test (ADT) or Lachman test. However, patients with a BMI of 25 or higher in Group 1 showed a decrease in postoperative IKDC scores. In Group 2 patients, no significant relationship was identified between BMI and either the ADT or the Lachman test outcome. Based on current literature and current rehabilitation guidelines following ACL reconstruction, the decision to initiate early weight-bearing is based on a limited number of studies with low levels of evidence. In our study, we found that patients who followed a non-weight-bearing regimen for 3 weeks after surgery had better mid-term results than those who were allowed to bear weight early. It appears that further prospective studies on this topic are needed to update rehabilitation guidelines in the next.