Evidence-based rehabilitation following anterior cruciate ligament reconstruction

Abstract

Following a bone-patellar tendon-bone autograft (BPTB) or four-stranded semitendinosus/gracilis tendons autograft (ST/G) anterior cruciate ligament (ACL) reconstruction, the speed and safety with which an athlete returns to sports (or regains the pre-injury level of function) depends on the rehabilitation protocol. Considering the large differences in clinical and outpatient protocols, there is no consensus regarding the content of such a rehabilitation program. Therefore, we conducted a systematic review to develop an optimal evidence-based rehabilitation protocol to enable unambiguous, practical and useful treatment after ACL reconstruction. The systematic literature search identified 1,096 citations published between January 1995 and December 2006. Thirty-two soundly based rehabilitation programs, randomized clinical trials (RCT's) and reviews were included in which common physical therapy modalities (instruction, bracing, cryotherapy, joint mobility training, muscle-strength training, gait re-education, training of neuromuscular function/balance and proprioception) or rehabilitation programs were evaluated following ACL reconstruction with a BPTB or ST/G graft. Two reviews were excluded because of poor quality. Finally, the extracted data were combined with information from background literature to develop an optimal evidence-based rehabilitation protocol. The results clearly indicated that an accelerated protocol without postoperative bracing, in which reduction of pain, swelling and inflammation, regaining range of motion, strength and neuromuscular control are the most important aims, has important advantages and does not lead to stability problems. Preclinical sessions, clear starting times and control of the rehabilitation aims with objective and subjective tests facilitate an uncomplicated rehabilitation course. Consensus about this evidence-based accelerated protocol will not only enhance the speed and safety with which an athlete returns to sports, but a standardized method of outcome measurement and reporting will also increase the evidential value of future articles.

Early compensatory and anticipatory postural adjustments following anterior cruciate ligament reconstruction

“…Appropriate surgical reconstruction of the ligament has been shown to restore mechanical stability of the knee joint (Cascio et al 2004;Van Grinsven et al 2010), although neuromuscular control of the lower limb may be undermined for years after surgery (Konishi et al 2002). Persistent weakness of the muscles acting on the knee joint has been shown to arise from a reduced rate of voluntary activation Lorentzon et al 1989;Snyder-Mackler et al 1995;Urbach et al 2001), perhaps via impaired gamma drive (Konishi et al 2002).…”

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

“…Oś przyrządu pomiarowego ustawiona była w okolicy głowy kości strzałkowej, zgodnie z osią poprzeczną stawu. Ruch czynnego zgięcia i wyprostu w stawie kolanowym odbywał się z asekuracją badającego fizjoterapeuty [25,34,35]. Do oceny dolegliwości operowanego stawu kolanowego użyto wizualno--analogowej skal bólu (ang.…”

“…The centre of the measuring device was placed at the head of fibula in line with the transverse axis of the joint. A movement of active flexion and extension in the knee joint was performed under the supervision of the physiotherapist [25,34,35]. In order to assess pain in the operated knee joint, Visual Analogue Scale (VAS) was applied.…”

“…Osiągnięcie tego celu stanowi podstawę do realizacji następnych, a więc powrotu chorego do pełnienia wszystkich ról społecznych i zawodowych oraz aktywności rekreacyjnych lub sportowych sprzed całkowitego zerwania ACL. Zadaniem kompleksowej rehabilitacji jest również zapobieganie wtórnym urazom i przeciążeniom innych czę-ści ciała, które kompensują niewydolność kolana w łańcuchu kinematycznym podczas różnorodnej aktywności [24,25]. Celem pracy jest ocena zakresu ruchu stawu kolanowego oraz poziomu dolegliwości bólowych u pacjentów po artroskopowej jednopęczkowej rekonstrukcji więzadła krzyżowe-go przedniego w wybranym modelu usprawniania leczniczego.…”

“…the return of patients to all their social and professional roles and to recreational and sports activity from before the complete ACL tear. Another aim of complex rehabilitation is to prevent secondary injuries and overloads in other parts of the body which compensate for a knee malfunction in a kinematic chain during various forms of activity [24,25]. The aim of the study is to assess the range of motion (ROM) in the knee joint and the level of pain in patients after single-bundle arthroscopic ACL reconstruction in the selected model of rehabilitation.…”