A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury

Abstract

STUDY DESIGN Prospective cohort study without a control group. OBJECTIVES Firstly, to present our 5-week progressive exercise therapy program in the early stage after anterior cruciate ligament (ACL) injury. Secondly, to evaluate changes in knee function after completion of the program for patients with ACL injury in general and also when classified as potential copers or noncopers, and, finally, to examine potential adverse events. BACKGROUND Few studies concerning early-stage ACL rehabilitation protocols exist. Consequently, little is known about the tolerance for, and outcomes from, short-term exercise therapy programs in the early stage after injury. METHODS One-hundred patients were included in a 5-week progressive exercise therapy program, within 3 months after injury. Knee function before and after completion of the program was evaluated from isokinetic quadriceps and hamstrings muscle strength tests, 4 single-leg hop tests, 2 different self-assessment questionnaires, and a global rating of knee function. A 2-way mixed-model analysis of variance was conducted to evaluate changes from pretest to posttest for the limb symmetry index for muscle strength and single-leg hop tests, and the change in scores for the patient-reported questionnaires. In addition, absolute values and the standardized response mean for muscle strength and single-leg hop tests were calculated at pretest and posttest for the injured and uninjured limb. Adverse events during the 5-week period were recorded. RESULTS The progressive 5-week exercise therapy program led to significant improvements (P<.05) in knee function from pretest to posttest both for patients classified as potential copers and noncopers. Standardized response mean values for changes in muscle strength and single-leg hop performance from pretest to posttest for the injured limb were moderate to strong (0.49–0.84), indicating the observed improvements to be clinically relevant. Adverse events occurred in 3.9% of the patients. CONCLUSION Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation, either to improve knee function before ACL reconstruction or as a first step in further nonoperative management.

Assessment of knee joint range of motion and the level of pain in patients after arthroscopic ACL reconstruction in the selected physiotherapy model

“…The selected results obtained in a postsurgical period led to a conclusion that implementing physiotherapy prior to the ACL reconstruction is a beneficial procedure in a complex therapy programme [28]. It is also confirmed by several other authors [38][39][40]. The study by Swank et al is one of the works in which the authors revealed a significant value of prehabilitation for the treatment of knee joint diseases [39].…”

“…Badania oceniające rolę rehabilitacji przedoperacyjnej chorych z dysfunkcjami stawu kolanowego (w tym z całkowitym uszkodzeniem ACL), które przeprowadzili Shaarani [38], Swank [39] i Eitzen [40] oraz dotychczasowe doświadczenia autora pracy [22] wskazują na konieczność poszukiwania dowodów na potwierdzenie tezy, iż fizjoterapia w tym okresie jest równie ważna, jak po operacji.…”

“…W badaniu własnym wybrane i uzyskane wyniki w okresie pooperacyjnym pozwalają na stwierdzenie, iż włączenie leczenia fizjoterapeutycznego przed zabiegiem rekonstrukcji ACL jest korzystnym działaniem w programie kompleksowego postępo-wania terapeutycznego [28]. Potwierdzają to rów-nież inni, choć nieliczni badacze tematu [38][39][40]. Jedną z prac, w której autorzy wykazali istotną wartość rehabilitacji przedoperacyjnej w leczeniu schorzeń i chorób stawu kolanowego, jest badanie Swanka i wsp.…”

“…The studies assessing the role of prehabilitation of patients with knee joint dysfunctions (including a complete ACL tear) carried out by Shaarani [38], Swank [39] and Eitzen [40] as well as our previous experiences [22] indicate the necessity to search for evidence to the thesis that physiotherapy in this period is as significant as physiotherapy after the surgery.…”

Physical therapy in the conservative treatment for anterior cruciate ligament rupture followed by contralateral rupture: case report

“…In this phase, we also initiated core stabilization exercises with dorsal, lateral and ventral bridges 15 and sensorimotor training recommended by the University of Delaware [16][17][18] . This phase consisted of 10 gradually progressed sessions and at the end the patient had no pain and effusion, did not report any episode of giving way and reached maximum muscle function (5/5) for flexion and knee extension.…”