Accelerated Brace-Free Rehabilitation and Functional Outcome of Anterior Cruciate Ligament (ACL) Reconstruction with a Semitendinosus–Gracilis (STG) Graft: A Prospective Observational Study

Abstract

Background: Anterior cruciate ligament (ACL) rupture commonly causes marked functional impairment. Reconstruction with a semitendinosus–gracilis (STG) graft is well accepted, and rehabilitation has shifted towards accelerated, brace-free protocols. Objectives: To evaluate the functional outcome and safety of an accelerated, brace-free rehabilitation protocol after ACL reconstruction with an STG graft. Methods: In this prospective observational study (2022–2024), 33 patients aged 18–60 years underwent single-bundle arthroscopic ACL reconstruction with a quadrupled STG autograft, all by one surgeon using anteromedial-portal femoral drilling with cortical suspensory femoral and interference-screw tibial fixation. A four-phase brace-free protocol permitted weight-bearing as tolerated and 0–90° motion from day 1. The Tegner–Lysholm score was recorded preoperatively and at 1, 3, 6 and 9 months by an independent blinded assessor, and predefined complications were recorded prospectively. Results: Mean age was 34.3 ± 10.6 years; injuries followed road traffic accidents (42.4%) and sport (36.4%). The mean Lysholm score rose from 54.2 ± 7.5 preoperatively to 63.5 ± 3.3, 70.8 ± 4.2, 84.2 ± 3.0 and 84.5 ± 3.0 at 1, 3, 6 and 9 months (p < 0.001 to 6 months; p = 0.72 for 6 versus 9 months). There were no graft failures, deep infections, stiffness, instability, deep-vein thromboses or re-injuries; 2 patients (6.1%) had persistent anterior knee pain and 1 (3.0%) an effusion. Follow-up was complete. Conclusions: Accelerated brace-free rehabilitation produced substantial functional gains that plateaued by 6 months, with no graft failure or instability at 9 months. Proprioception was not measured. Larger comparative studies with longer follow-up are needed before generalizing to other grafts, techniques or populations.