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Figure A
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Figure B
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Figure C
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Figure D
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Open chain exercises place increased stress on the graft and are typically avoided early after ACL reconstruction. Open chain exercises are those in which the distal limb segment is not fixed. In closed chain exercises, the foot remains fixed to the ground or a base plate. Co-contraction of hamstring and quadriceps is easier to achieve in closed chain exercise, resulting in a more balanced application of force across the knee. Kruse et al. performed a systematic review of ACL rehabilitation studies. They concluded that in the early postoperative period, immediate weight-bearing, range of motion from 0-90 degrees flexion and closed-chain kinetic exercises were safe. Andersson et al. performed a systematic review of randomized controlled trials of ACL reconstruction. They concluded that after a patellar tendon ACL reconstruction, closed chain exercise resulted in less laxity, less pain and better subjective outcomes. Figure A shows a vertical squat. Figure B shows stationary bicycling. Figure C shows leg press. Figure D shows seated leg extension. Figure E shows a stair climbing machine. Incorrect answers: Answers 1-3, 5. These are all closed chain exercises which are considered safer than open chain after ACL reconstruction.
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