Table 4.

Details of the included studies

Rehabilitation	N	Gender (M to F)	Participant groups	Follow-up	Outcomes
Åhlén et al54	19	10 to 9	Operated versus contralateral leg	8.5 (6–11) years	Significant increase in Tegner, Lysholm and hop test postoperative versus preoperative ST and G regenerated in, respectively, 89% and 95% of patients with almost normal insertion pes anserinus. Regenerated tendons had similar cross-sectional area compared with contralateral leg. Strength deficit in deep flexion but not in internal rotation.
Ali et al51	78	69 to 5	NA	64 (48–84) months	Detachment of tibia insertion is unnecessary and an accelerated rehab. can be followed without brace use.
Baltaci et al32	30	All males	Wii Fit (15) versus conv rehab. (15)	12 weeks	Both rehab. programme have same effect on muscle strength, dynamic balance and functional performance. Practice of Wii Fit activities could address physical therapy goals.
Christensen et al12	36	53% male (aggressive rehab.) versus 88% male non-aggressive rehab.	Aggressive (19) versus non-aggressive rehab. (!17)	24 weeks	No difference between aggressive and non-aggressive rehabilitation in AP laxity, subjective IKDC scores, ROM and muscle strength.
Clark et al52	82	27 to 14 in each group	41 ACLR versus 41 controls	12 months	Significant increases in asymmetry in ACLR group for all outcome measures except symmetry index relative to operated limb. Weight-bearing asymmetry can be assessed with Wii Fit balance board.
Czamara et al42	30	All males	SB ACLR (15) versus DB ACLR (15)	24 weeks	No differences between SB versus DB ACLR in AP laxity, pivot shift test, ROM, joint circumference, pain scores, peak torque muscles tibial rotation and run test.
Czaplicki et al46	29	All males	NA	12 months	1 year after ACLR may be too early to return to full physical fitness for males who are physically active.
Fukuda et al10	49	Early start 16 to 7) versus late start (13 to 9)	Early start (25) versus late start (24)	17 (13–24) months	Faster recovery quadriceps strength in early group. No difference between early and late start of open kinetic chain exercises in pain and functional improvement.
Howell et al21	41	28 to 13	NA	26 (24–32) months	Absent pivot shift in 82% patients and 88% <3 mm laxity difference with KT-1000. Stability, girth of thigh, Lysholm and Gillquist scores were identical at 4 months and 2 years.
Janssen et al9	67	6–12 ms (9 to 6), 1–2 years (10 to 6), >2 years post-ACLR (7 to 10)	Group 1 (15), group 2 (16), group 3 (11)	117 months	Human hamstring autografts remain viable after ACLR and showed three typical stages of graft remodelling. Remodelling in humans takes longer compared with animal studies and is not complete up to 2 years after ACLR.
Janssen et a ref 44	22	17 to 5	MRI operated and contralateral leg	12 months	Gracilis regenerated in all patients, ST in 14/21 patients. There was no relation between isokinetic flexion strength and tendon regeneration.
Jenny et al47	72	57 to 15	NA	4.3 years	Patient-based decision to return to work and sport was possible without compromising functional outcome. The postoperative restrictions implemented by orthopaedic surgeons following ACLRs may be relaxed and more patient based.
Karikis et al48	94	DB (32 to 13) versus SB (31 to 18)	DB (45) versus SB (49) ACLR	26 (22–34) months	Anatomical DB ACLR did not result in better rotational or AP stability compared with anatomical SB ACLR.
Kinikli et al33	33	33 to 2	Study group (16) versus control (17)	16 weeks	Adding progressive eccentric and concentric exercises may improve the functional results after ACLR with autograft hamstring tendons.
Królikowska et al53	40	All males	ST group (20) versus ST-G group (20)	6 months	Generally, no difference between ST and ST-G groups. There is an influence of gracilis tendon harvest on internal shin rotation isometric torque at deep internal rotation angle.
Koutras et al36 49	42	39 to 3	NA	9 months	Measuring knee flexion strength in prone demonstrates higher deficits than in conventional seated position.
Salmon et al38	200	100 to 100	Men versus women	7 years	Significant greater laxity in women compared with men without effect on activity level, graft failure, subjective and functional assessments.
Sastre et al34	40	DB (70% male) versus SB (70% male) ACLR	DB (20) versus SB (20) ACLR	2 years	No significant differences in DB versus SB ACLR in IKDC objective and subjective results.
Srinivas et al50	63	58 to 5	Various fiaxtion systems femur and tibia	1 year	Femoral and tibial tunnel widening varies with different methods and was maximum with suture disc method compared with others after ACLR with hamstring autograft.
Toanen et al56	12	5 to 7	NA	49.6 (24) months	Older patients (>60 years) and active patients with non-arthritic ACL-deficient knees showed good results on functional recovery without risk of midterm OA.
Trojani et al55	18	6 to 12	NA	30 (12–59) months	Age >50 years is not a contraindication to select hamstring tendon autograft for ACLR. ACLR restores knee stability but does not modify pain in case of previous medial meniscectomy.
Vadalà et al35	45	33 to 12	Acc rehab (20) versus conv rehab. (25)	10 (9–11) months	Bone tunnel enlargement can be increased by accelerated rehab. after ACLR with hamstring tendon autografts.
Zaffagnini et al45	21	All males	NA	48.1 (46–50)	Return to sports was 95% after 1 year and 64% after 4 years in professional soccer players after non-anatomical quadruple hamstring tendon autograft ACLR. 71% still played competitive soccer at final follow-up. Clinical scores were restored after 6 months.

ACLR, ACL reconstruction; AP, anterioposterior; conv, conventional; DB, double bundle; F, female; G, gracilis tendon; IKDC, International Knee Documentation Committee; M, male; NA, not applicable; OA, osteoarthritis; rehab., rehabilitation; ROM, range of motion; SB, single-bundle; ST, semitendinosus tendon; ST-G, semitendinosus/gracilis.