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Objectives and questions: Rupture of the anterior cruciate ligament (ACL) in the knee has neurophysiological consequences. Surgery is recommended to restore stability. Treatment in physical medicine and rehabilitation (PMR) can be lengthy. Our choice of comparison (conventional protocol versus accelerated protocol) is based on new findings in the field of brain plasticity. The main objective of our work is to determine the impact of early physical medicine and rehabilitation treatment following ACL reconstruction surgery on functional outcomes and return to sports activities.

Material and methods: Our study (descriptive and comparative foresight) covers a series of 178 patients with anterior knee instability who underwent Kenneth Jones (KJ) ligamentoplasty. The study population was divided into two groups: 104 patients who underwent surgery and received a conventional PRM treatment protocol, and 74 patients who underwent surgery and received an accelerated protocol. The measurement tools used were the CLAS system of the ARPEGE classification and the Lysholm scale. Statistical analysis was performed using Statistical Package for Social Sciences version 20.

Results: Functional results at 12 months according to the Lysholm scale: statistically highly significant difference (P < 0.000) between patients in the two protocols; accelerated protocol, 0% poor functional results, 2.7% good results, and 97.3% excellent results. Knee flexion stiffness affected 32.3% of patients in the conventional protocol versus 2.7% of patients in the accelerated protocol, with a highly significant statistical difference (p < 0.000). Extension stiffness was noted in 4.5% of patients, all of whom belonged to the conventional protocol group, with a statistically significant difference (p < 0.02). Previous sporting activity was resumed in 58.1% of cases in the accelerated protocol group, which is significantly (p < 0.000) higher than in the conventional protocol group (32.9%).

Discussion and conclusions: The functional results found in patients in the accelerated protocol group, according to the Lysholm scale, are consistent with those reported in the literature. However, the results for patients undergoing the conventional protocol are significantly lower than those for the accelerated protocol group and the literature. This can be explained by the high incidence of complications in patients undergoing the conventional protocol. These complications have a direct and indirect impact on the items included in the Lysholm scale and therefore on the final results. In this study, we opted for the accelerated physical therapy program after ACL reconstruction based on the favorable results compared to those of the conventional protocol. The priority is to prevent the development of negative or maladaptive plasticity, which leads to strategies of non-use and deconditioning.