Postoperative Rehabilitation of Multiligament Knee Reconstruction: A Systematic Review

Background: Multiple ligament knee injuries (MLKIs) are significant and often debilitating conditions, particularly common among young athletes. These injuries typically involve damage to multiple ligaments, resulting in joint instability and prolonging the healing process. Historically, returning to sports (RTS) after an MLKI has been deemed unlikely due to the severity of the injuries. However, advancements in surgical techniques and rehabilitation protocols have improved outcomes and created higher expectations for recovery and RTS. Despite these advancements, there is a lack of comprehensive literature that outlines objective outcomes and standardized rehabilitation protocols, complicating the recovery process. Methods: This systematic review presents postoperative rehabilitation protocols following multiple ligament reconstruction of the knee from ۲۰۱۱ to ۲۰۲۱, emphasizing the importance of early intervention, with rehabilitation starting on the first day after surgery to enhance outcomes. This review integrates available data on rehabilitation stages, focusing on criterion-based progression to monitor improvement through objective measures such as range of motion (ROM), strength, and overall function. It also examines various rehabilitation methods, including neuromuscular electrical stimulation and blood flow restriction techniques, used to reduce muscle atrophy and enhance recovery. Results: Findings indicate that effective postoperative rehabilitation can lead to successful recovery outcomes, with most patients able to resume running within ۶ to ۱۲ months and return to competitive sports within ۸ to ۱۲ months post-surgery. The rehabilitation process is divided into several phases: the initial phase focuses on protecting the limb and managing symptoms while recovering ROM, the intermediate phase emphasizes strength and functional restoration, and the final phase involves reintegration into specific sporting activities. Objective measures play a crucial role in guiding rehabilitation decisions throughout these phases. Notably, patients participating in structured rehabilitation protocols show significant improvements in strength and functional performance compared to those who do not follow such guidelines. Conclusion: Findings indicate that effective postoperative rehabilitation can lead to successful recovery outcomes, with most patients able to resume running within ۶ to ۱۲ months and return to competitive sports within ۸ to ۱۲ months post-surgery. The rehabilitation process is divided into several phases: the initial phase focuses on protecting the limb and managing symptoms while recovering ROM, the intermediate phase emphasizes strength and functional restoration, and the final phase involves reintegration into specific sporting activities. Objective measures play a crucial role in guiding rehabilitation decisions throughout these phases. Notably, patients participating in structured