Commentary and historical perspective of anterior cruciate ligament rehabilitation

This article serves as the introduction and historical perspective of anterior cruciate ligament surgery and rehabilitation. Several physician- therapist teams have been invited to share their 'state of the art' techniques and to contrast their programs to that espoused by Shelbourne and Nitz in 1990. Our commentary/review of 'Accelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction' (Shelbourne KD, Nitz P, Am J Sports Med 18:292-299, 1990) is provided to contextualize the reader to what most clinicians would recognize as an extremely aggressive rehabilitation approach that is being popularized in the 1990s. A comparison is then presented of the rehabilitation sequence used in the MacIntosh procedures, demonstrating how early motion/functional rehabilitation was the hallmark of this type of extraarticular rehabilitation sequence and how today's pattern has evolved to follow that philosophy. Each of the teamed authors has attempted to present his surgery and rehabilitation/techniques and highlight differences between his program and that of Shelbourne and Nitz. We hope that the readers find this glimpse of the past and present helpful in formulating their rehabilitation sequences and that the future will be predicated on excellent basic science and clinical judgment.