Current Australian trends in rehabilitation following anterior cruciate ligament reconstruction

Feller, Julian A.; Cooper, Randall; Webster, Kate E.

doi:10.1016/s0968-0160(02)00009-1

Cited by 30 publications

(18 citation statements)

References 20 publications

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“…Some authors recommended patients need 4 to 6 months of rehabilitation before returning to sport activities after ACL reconstruction surgery and 6 to 9 months before returning to vigorous cutting and pivoting activities [5,12,15]. Although the majority of injured athletes are able to return to preinjury competition levels after rehabilitation, their performances may be adversely affected [7].…”

Section: Introductionmentioning

confidence: 99%

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Stanley

Creighton

Gross

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Patients have high reinjury rates after ACL reconstruction. Small knee flexion angles and large peak posterior ground reaction forces in landing tasks increase ACL loading. Questions/purposes We determined the effects of a knee extension constraint brace on knee flexion angle, peak posterior ground reaction force, and movement speed in functional activities of patients after ACL reconstruction. Patients and Methods Six male and six female patients 3.5 to 6.5 months after ACL reconstruction participated in the study. Three-dimensional videographic and force plate data were collected while patients performed level walking, jogging, and stair descent wearing a knee extension constraint brace, wearing a nonconstraint brace, and not wearing a knee brace. Knee flexion angle at initial foot contact with the ground, peak posterior ground reaction force, and movement speed were compared across brace conditions and between genders. Results Wearing the knee extension constraint brace increased the knee flexion angle at initial foot contact for each activity when compared with the other two brace conditions. Wearing the knee extension constraint brace also decreased peak posterior ground reaction force during walking but not during jogging and stair descent. Conclusions Although the knee extension constraint brace did not consistently reduce the peak posterior ground reaction force in all functional activities, it consistently increased knee flexion angle and should reduce ACL loading as suggested by previous studies. These results suggest the knee extension constraint brace has potential as a rehabilitation tool to alter lower extremity movement patterns of patients after ACL reconstruction to address high reinjury rates. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Stanley

Creighton

Gross

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…4,5 However, the use of quadruple strand semitendinosus (4ST) or double strand semitendinosus-gracilis (2ST-2G) grafts in ACL reconstructive surgery is becoming increasingly common. 6 This is primarily in an effort to combat post-operative anterior knee pain and persistent quadriceps weakness. 7,8 …”

Section: Introductionmentioning

confidence: 99%

Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review

Ardern

Webster

2009

Orthop Rev

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The hamstring tendons are an increasingly popular graft choice for anterior cruciate ligament reconstruction due to preservation of quadriceps function and the absence of anterior knee pain post-operatively. Two commonly used hamstring grafts are a quadruple strand semitendinosus graft (4ST) and a double strand semitendinosus-double strand gracilis graft (2ST-2G). It has been suggested that concurrent harvest of the semitendinsous and gracilis tendons may result in sub-optimal hamstring strength recovery as the gracilis may play a role in reinforcing the semitendinosus particularly in deep knee flexion angles. The objective of this systematic review was to synthesize the findings of available literature and determine whether semitendinosus and gracilis harvest lead to post-operative hamstring strength deficits when compared to semitendinosus harvest alone. Seven studies were identified which compared hamstring strength outcomes between the common hamstring graft types. The methodological quality of each paper was assessed, and where possible effect sizes were calculated to allow comparison of results across studies. No differences were reported between the groups in isokinetic hamstring strength. Deficits in hamstring strength were reported in the 2ST-2G groups when compared to the 4ST groups in isometric strength testing at knee flexion angles ≥70°, and in the standing knee flexion angle. Preliminary evidence exists to support the hypothesis that harvesting the semitendinosus tendon alone is preferable to harvesting in combination with the gracilis tendon for minimizing post-operative hamstring strength deficits at knee flexion angles greater than 70°. However, due to the paucity of research comparing strength outcomes between the common hamstring graft types, further investigation is warranted to fully elucidate the implications for graft harvest.

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“…In nine identified studies, response rate ranged from 36% to 80% with a mean (SD) of 55.6%(14.8) (Brattwall, Jacobson, Forssblad, & Jakobsson, 2010;Erickson et al, 2014;Feller, Cooper, & Webster, 2002;Hiemstra, Veale, & Sasyniuk, 2006;Kapoor et al, 2004;Marx et al, 2003;McRae et al, 2011;Mirza et al, 2000;Petersen & Zantop, 2013 (2011) reported 81.6% of Canadian orthopaedic surgeons used MT; similar to the findings of this study. In contrast, most Canadian respondents applied tension at 30 degrees knee flexion compared to near full extension based on an Australian sample.…”

Section: Discussionsupporting

confidence: 80%

Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

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BackgroundAnterior cruciate ligament reconstruction (ACLR) is an effective procedure for restoring stability and function. Being a technically demanding procedure, patient outcomes are highly dependent on numerous surgical factors, which are critical for success. The application of tension to the graft prior to tibial fixation is one such factor and is considered essential for the restoration of joint stability, normal knee biomechanics, graft revascularisation and patient function. In applying tension, a key factor is the amount of force applied to the graft. However, the method of applying the tension, position of the knee during tensioning, properties of the graft material, tunnel placement and graft fixation device can all influence the effect that graft tension has on outcomes. Despite the reported importance of graft tension there has been limited empirical evidence defining the best tensioning practice for restoring patient outcome post ACLR. AimsThe goal of this program of research was to explore the effect that different aspects of graft tensioning has on patient function post ACLR. To address the aims of the thesis, three studies were conducted. The first study was a systematic review aimed at examining if a particular amount of tension results in better functional outcomes post ACLR. The second study aimed to compare the effect of two methods of applying graft tension on patient function post ACLR. The study used a prospective randomised controlled trial to compare manual tensioning with the use of a tensioning device. The third study aimed to define current graft tensioning practices and explore the factors that influence surgical decision making. A national survey of Australian orthopaedic surgeons was conducted to achieve the aims of the study. ResultsThe systematic review (study one) revealed that a medium graft tension of 79N to 90N produced the least side-to-side difference (STSD) in anterior posterior (AP) tibial translation as measured by a KT-1000 when compared to tensions <79 or >90N. However, the heterogeneous use of functional outcomes inhibited the ability to draw conclusions on other patient specific functional outcomes.Furthermore, the review highlighted the lack of high quality studies, which also failed to discuss other aspects of graft tension such as the method of applying tension.iii Building on the findings of study one, the second study undertook a RCT to compare the functional outcomes of applying 80N of force with a tensioning device (TD) (n=10) to a manual tensioning method (MT) (n=13) using an estimated force described as a sustained maximum one handed pull.Patients were assessed at pre-surgery and two weeks, three months, six months and 12 months post Based on the findings of study one, tensioning between 79N and 90N appeared to improve the restoration of joint stability, when compared to higher and lower tensions. However, no effect on patient function within 24 months post surgery was apparent. Furthermore, study two observed that tension did not appear to have an...

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Current Australian trends in rehabilitation following anterior cruciate ligament reconstruction

Cited by 30 publications

References 20 publications

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review

Graft tensioning in anterior cruciate ligament reconstruction

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