Background: Anterior cruciate ligament (ACL) injuries are common. A goal of rehabilitation is to restore functional capacity. Currently, there are contrary opinions regarding the effectiveness of using either closed or open kinetic chain exercises (CKC, OKC) only, or a combination of both, following ACL injury, to obtain the most effective outcome. The debate also reflects the approach which places the least force on the ACL itself. Objective: To identify the evidence of effectiveness of closed versus open kinetic chain exercises, or a combination of both, in anterior cruciate ligament rehabilitation. Methods: A systematic review was undertaken of experimental studies published since 1990. Included studies were on humans with ACL injury. The ACL ligament could be healthy, ruptured, deficient or reconstructed. Studies on animals and cadavers were excluded. The methodological quality of included studies was appraised with the PEDro tool. Studies were graded according to hierarchy level, methodological quality, statistical significance, effect size, and clinical relevance. Recommendations were made on the strength of the body of evidence. The outcome measure of interest was force on the ACL during exercise. Results: 23 eligible studies were included. The majority of studies reflected lower level experimental designs with moderate methodological quality. Three studies showed a significant difference in ACL force comparing CKC and OKC exercises, 11 demonstrated trends towards significant differences in outcome and nine showed no significant differences. Conclusion: There is moderate evidence to recommend CKC exercises or a combination of CKC and OKC exercises, rather than OKC exercises alone, for ACL rehabilitation when considering forces on the ACL.




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