Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics

Abstract

A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (P < 0.05). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (P = 0.002) and 15° (P = 0.012). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise.

Standards in der Nachbehandlung nach vorderem Kreuzbandersatz im deutschsprachigen Raum

“…Das deckt sich auch mit den aktuellen Empfehlungen in der Literatur. In mehreren Arbeiten zeigten Übungen in der geschlossenen Kette im Vergleich zu Trainingseinheiten in offener Kette deutlich weniger Last auf dem vordere Kreuzband [3,4,12,22,27]. Früher freigegeben werden vorsichtige Übungen mit wenig Gewicht in der offenen Kette und/oder Quadricepsübungen mit kurzem Hebel in der offenen Kette, vor allem bei größeren Winkelgraden [36,41].…”

“…Muskelaufbau effektiver zu sein als konzentrisches Training. Ebenso sollte ein neuromuskuläres Training stets in den Trainingsablauf eingeschlossen werden [14,27,28,41]. Kraftdefizite mit Dysbalancen zwischen Beugern und Streckern, Einschränkungen der Hüftabduktion wie auch funktionelle Störungen der neuromuskulären Kontrolle können häufig zu pathologischen Bewegungsmustern führen und sind ein wesentlicher Risikofaktor für eine Folgeverletzung oder Reruptur [16,18,29,31].…”

Outcomes Following Arthroscopic Single and Double Bundle Anterior Cruciate Ligament (ACL) Reconstruction Supported by the Comprehensive Early Rehabilitation Program (CERP)

“…Physiotherapy was implemented in both groups from the first day after the operation and it included exercises strengthening the muscles of the knee joint in closed kinetic chains and exercises improving ROM [37]. Norouzi et al suggested doing exercises in a closed kinetic chain would be better than in an open kinetic chain in patients following ACLR to provide functional stability for the knee joint [38]. Yabroudi and Irrgang suggested that rehabilitation after ACLR should include control of postoperative pain and edema, protection of the healing graft, restoration of full ROM symmetrical to the other knee, strengthening of the knee, hip and trunk stabilizers, strengthening of neuromuscular control, and gradual transition to activities needed to do sports again [39].…”

Protocolos De Tratamento Fisioterápico Nas Lesões De Ligamento Cruzado Anterior Após Ligamentoplastia – Uma Revisão

“…Essa lesão promove instabilidade articular, levando a uma limitação das atividades; o individuo pode referir dor, edema e perda da função do membro. A maioria tentará compensar o membro devido à estabilidade, fazendo-se necessário o uso da musculatura periarticular [12][13][14][15][16][17] . Ela acomete principalmente em homens, em que o mecanismo de lesão acontece por um estresse no ligamento suficiente para causar uma ruptura.…”