Comparative Study on Outcome of Early Aggressive and Standard Rehabilitation after Anterior Cruciate Ligament Reconstruction

  • Tantuway V Department of Orthopedics, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India
  • Mustafa Johar S. A. Department of Orthopedics, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India
  • Banerjee T Department of Orthopedics, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India
  • Narware S Department of Orthopedics, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India
  • Prajapati A Department of Orthopedics, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India
Keywords: ACL, ACL-R, Rehabilitation

Abstract

Background: Anterior cruciate ligament rupture is one of the most common debilitating knee injuries that can result in significant functional impairment. Although ACL reconstruction (ACL-R) is a commonly practiced surgical intervention, controversy still lingers with regard to graft selection and rehabilitation protocol, both of which are largely influenced by surgeon preference. The post-operative restrictions are largely based on the theory of graft and fixation vulnerability, with concerns related to compromising the biological healing process of the reconstructed graft during the first 12 weeks postoperatively. To date, controversy still lingers in evaluating the effects that aggressive rehabilitation has on clinical outcomes with semitendinosus graft. The aim of this study was to investigate whether immediate full weight bearing combined with aggressive rehabilitation in ACL-R significantly altered postoperative outcome over one year, relative to a program that included partial weight bearing and standard rehabilitation protocol in the immediate post-operative period.

Methods: The study was a prospective randomized clinical trial, with all patients being recruited by a single senior orthopedic surgeon at our institute after a confirmed diagnosis of an isolated ACL rupture by clinical examination and magnetic resonance imaging. Seventy patients were enrolled in the study from June 2015 to August 2017. Informed consent was taken. Clearance from ethical committee of the institute was taken. Patients were evaluated pre operatively and post operatively at the end of 1, 3, 6 months and 1 year for outcomes.

Results: In this prospective study conducted with seventy patients, we found better results in group 2 (full weight bearing) as compared to group 2 ( partial weight bearing) in terms of IKDC scoring, range of motion (ROM), ROM difference from opposite knee and fixed flexion deformity. The results were statistically significant.

Conclusion: We conclude that aggressive rehabilitation to be superior to standard rehabilitation after isolated ACL-R using STG

Downloads

Download data is not yet available.

References

1. Baquie P and Brukner P (1997): Injuries presenting to an Australian sports medicine centre: A 12–month study. Clinical Journal of Sports Medicine 7: 28–31.

2. Miyasaka KC, Daniel DM, Stone ML and Hirshman P (1991): The incidence of knee ligament injuries in the general population. The American Journal of Knee Surgery 4: 3–8.

3. Seward H, Orchard J, Hazard H and Collinson D (1993): Football injuries in Australia at the elite level. Medical Journal of Australia 159: 298–301.

4. Barrack RL, Bruckner JD, Kneisl J, Inman WS and Alexander AH (1990): The outcome of nonoperatively treated complete tears of the anterior cruciate ligament in active young adults. Clinical Orthopaedics and Related Research 259: 192–199.

5. Fetto JF and Marshall JL (1980): The natural history and diagnosis of anterior cruciate ligament insufficiency. Clinical Orthopaedics and Related Research 147: 29–38.

6. Frank CB and Jackson DW (1997): The science of reconstruction of the anterior cruciate ligament. Journal of Bone and Joint Surgery 79A: 1556–1576.

7. Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am. 2010;41(2):249–262.

8. Heijne A, Werner S. A 2-year follow-up of rehabilitation after ACL reconstruction using patellar tendon or hamstring tendon grafts: a prospective randomised outcome study. Knee Surg Sports Traumatol Arthrosc. 2010;18(6):805–813.

9. Isberg J, Faxen E, Brandsson S, Eriksson BI, Karrholm J, Karlsson J. Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1108–1115.

10. Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K. Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon. Int Orthop. 1998;22(6):352–356.

11. Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel: a biomechanical and histological study in the dog. J Bone Joint Surg Am. 1993;75(12):1795–1803.

12. Ekdahl M, Wang JH, Ronga M, Fu FH. Graft healing in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008;16(10):935–947.

13. Shelbourne KD, Gray T. Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med. 2009;37(3):471–480.

14. Wright RW, Preston E, Fleming BC, et al. A systematic review of anterior cruciate ligament reconstruction rehabilitation: part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. J Knee Surg. 2008;21(3):217–224.

15. Shelbourne KD, Klootwyk TE, Wilckens JH, De Carlo MS. Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program. Am J Sports Med. 1995;23(5):575–579.

16. Holm I, Oiestad BE, Risberg MA, Aune AK. No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year followup. Am J Sports Med. 2010;38(3):448–454.

17. Poolman RW, Farrokhyar F, Bhandari M. Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop. 2007;78(3):350–354.

18. Biggs A, Jenkins WL, Urch SE, Shelbourne KD. Rehabilitation for patients following ACL reconstruction: a knee symmetry model. N Am J Sports Phys Ther. 2009;4(1):2–12.

19. Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29(5):600–613.

20. Brosseau L, Balmer S, Tousignant M, et al. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil. 2001;82(3):396–402.

21. Shelbourne KD, Urch SE, Gray T, Freeman H. Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med. 2012;40(1):108–113.

22. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(12):1697–1705.

23. Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate ligament reconstruction:criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther. 2006;36(6):385–402.

24. Paterno MV, Ford KR, Myer GD, Heyl R, Hewett TE. Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clin J Sport Med. 2007;17(4):258–262
Published
2018-06-30
How to Cite
1.
Tantuway V, Mustafa Johar S. A., Banerjee T, Narware S, Prajapati A. Comparative Study on Outcome of Early Aggressive and Standard Rehabilitation after Anterior Cruciate Ligament Reconstruction. ojmpc [Internet]. 2018Jun.30 [cited 2020May31];24(1):25-. Available from: https://ojmpc.com/index.php/ojmpc/article/view/65
Section
Original Article