Rehabilitation guidelines after autograft anterior cruciate ligament reconstruction need more graft-specific exercise recommendations—A scoping review

Purpose: Autografts for anterior cruciate ligament reconstruction (ACLR) are primarily harvested from the quadriceps, patellar, and semitendinosus tendons. The purpose of this scoping review was to describe available recommendations for exercise-based rehabilitation following primary ACLR with a quadriceps tendon (QT), semitendinosus tendon (ST), or bone-patellar-tendon-bone (BPTB) autograft and determine whether these recommendations included graft-specific clinical practice guidelines (CPGs). Methods: A search was conducted via three electronic databases, using variations of three main strings: ‘anterior cruciate ligament reconstruction’, ‘rehabilitation’ and ‘guideline’. To be considered eligible, publications had to be published between 2014 and 2024, target patients 16 or older, and include exercise-based recommendations for rehabilitation after primary ACLR using QT, BPTB or ST autografts. Identified papers were screened for title, abstract and full text in accordance with a pre-registered protocol, with specific inclusion and exclusion criteria. Charting of data found within eligible publications was done according to their overall exercise-based content, as well as any graft-specific considerations. Results: A total of 1083 publications were imported for screening, but after the removal of duplicates and subsequent screening of titles, abstracts and 98 full texts, 17 remained for inclusion. The timeline and implementation of different exercise modalities involving knee joint loading varied during the earliest phases of rehabilitation. Sixteen papers included one or more graft-specific considerations, the majority of which focused on protecting the graft and/or considerations relating to the BPTB harvest site. Few focused on the ST or QT harvest sites, and only one publication provided guidelines that considered all three autografts. Conclusion: CPGs providing exercise recommendations and post-surgical considerations for all three autograft types are needed. These would provide a comprehensive and valuable resource for clinicians to plan rehabilitation for patients who have undergone ACLR, mindful of graft choice and surgical procedure. Level of Evidence: Level V.