Integrated versus traditional rehabilitation program after anterior cruciate ligament (ACL) reconstruction in high level athletes

INTERVENTION: Neurophysiological and metabolic capacities that underpin sport practiced by each subject, the parameters of frequency, intensity, recovery, etc. with which each neurophysiological and metabolic capacity will be administered to each subject will be calibrated on the basis of the results of the evaluation tests carried out for each neurophysiological and metabolic capacity and modulated in relation to the residual functional capacities of each subject in each specific period of rehabilitation program. The correct development of an integrated post Anterior Cruciate Ligament Reconstruction (ACL‐R) rehabilitation program requires an assessment of the functional requirements imposed by the sport practiced by the athlete who will be rehabilitated, as well as a knowledge of the training principles applied in his/her specific sport. This requires a close collaboration between physician, physiotherapist and athletic trainer. In addition, a periodic re‐evaluation of the athlete is necessary during the rehabilitation program in order to acquire the information necessary to manipulate the various variables (load intensity, repetitions, recovery time, etc.) to achieve the desired objectives, always keeping considering what are the functional requirements of the sport practiced. Traditional rehabilitation after an injury still follows predetermined blocks in a fixed timeline, the integrated rehabilitation program followed by group 2 consider both physical (strength and aerobic parameters) and neuromuscular capacities from the early rehabilitation stage; only dosage changes in time. Moreover, in the integrated rehabilitation program neurophysiological parameters of the sport practiced must be taken into consideration. Generally: integrated rehabilitation program will be di CONDITION: Anterior cruciate ligament reconstruction; ; Anterior cruciate ligament reconstruction Musculoskeletal ‐ Other muscular and skeletal disorders Physical Medicine / Rehabilitation ‐ Other physical medicine / rehabilitation Surgery ‐ Other surgery PRIMARY OUTCOME: The primary outcome will be a composite of the limb symmetry index (%) of the maximum voluntary isometric force (MVCi) and the rate of force development (RFD) of the lower limbs, measured with the horizontal leg press. The MVIC and the RFD were calculated using a system for muscle performance measurement (MuscleLab 4000; BoscosystemLab SpA, Rieti, Italy). The apparatus was used to set the knee angle during the horizontal leg‐press test with an electronic goniometer (BoscosystemLab SpA) and to record the force‐time curve with a strain gauge load cell set (ET‐STG‐02; BoscosystemLab SpA) that collected data at a sampling rate of 100 Hz.[before starting rehabilitation programs and 3‐6‐9‐12 (primary endpoint) months post‐intervention commencement; ] SECONDARY OUTCOME: Fatigue index (or measure of the anaerobic endurance) ; ; The subject will run up to a 5 meter mark (then 10 and then 20) and back to the start each time; for a total of 70 meters shuttle run). The time taken to complete each 7o‐m shuttle run was recorded. ; The Fatigue Index will be derived from six 70‐m shuttle runs as follow: ; ; Average time of 6 shuttle runs x (slowest shuttle run‐ fastest shuttle run) x 6 / shuttle runs completed INCLUSION CRITERIA: High‐level athletes that underwent ACL‐R ; [At 3, 6, 9, and 12 months post‐intervention commencement] Self‐reported knee function assessed using a composite of the International Knee Documentation Committee (IKDC) evaluation system, and the Tegner score[before starting rehabilitation programs and 3‐6‐9‐12 months post‐intervention commencement] Short version of Tampa Scale for Kinesiophobia (TSK‐11)[before starting rehabilitation programs and 3‐6‐9‐12 months post‐intervention commencement]