The effect of physiotherapy on knee joint extensor and flexor muscle strength after anterior cruciate ligament reconstruction using hamstring tendon

Abstract

SummaryBackgroundThe aim of this paper is to present the physiotherapeutic program employed at the Rehabilitation Centre for the College of Physiotherapy in Wrocław, Poland and its effectiveness by demonstrating the increase in strength of knee joint extensor and flexor muscles of patients after anterior cruciate ligament (ACL) reconstruction.Material/MethodsThirty-seven males participated in the physiotherapeutic program from the first week up to 8 months postoperatively. Each patient underwent an individual therapeutic program. Endoscopic reconstruction of a completely ruptured ACL was performed using Mitek’s method (graft harvesting from flexor muscles). All patients previously underwent orthopedic and functional examinations, including measurements of the range of movement, knee and thigh circumference and strength of flexor and extensor muscles of the involved and uninvolved leg using a Biodex 3 System in both static and isokinetic modes.ResultsThe outcome of the physiotherapeutic procedure, which is detailed in the paper, revealed a favorable effect of physiotherapy 6 months after ACL reconstruction. The observed 9% deficit in extensor muscle strength measured under isokinetic conditions of the involved knees compared with the uninvolved knees led us to conclude that the period of physiotherapy should be extended beyond 6 months for some patients.Conclusions1. Six months of physiotherapy following ACL reconstruction in males favorably affected muscle strength values of the involved and uninvolved knees under static and isokinetic conditions. 2. The application of individual loads during the sixth month of physiotherapy resulted in similar values of extensor and flexor muscle strength measured under static conditions, and flexor muscle strength measured under isokinetic conditions in involved and uninvolved knees.

An evaluation of the strategic approach to the rehabilitation of traumatic brain injury (TBI) patients

“…Existing, standard programs of rehabilitation for people with various brain defects are not adapted to the individual needs of the patient after brain injury and regardless of the possible improvement achieved on specific parameters (especially mobility) do not allow us to enhance the quality of life. This is because the patient is a passive subject of the physiotherapist’s interactions and is devoid of a voice in the process of their treatment, which has an effect on the assessment of the quality of their life, something equally stressed by other authors [1,7,40–43]. Controlled by the strategic plan aimed at the implementation of a program of rehabilitation for individually designed purposes, with the cooperation of the patient, is more effective in improving the quality of life, because the patient himself is responsible for the implementation of the individually designed objectives.…”

Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR)

“…During the exercise involving hamstrings, we tried to rotate the foot and lower leg internally, alternating with neutral rotation. In addition, concentric-eccentric exercises with an increased load were gradually introduced [15]. …”

“…These results were affected by the time of initiating the first measurements under isokinetic conditions (16 th postoperative week) compared to the results obtained during the 13 th week after reconstruction, performed under static conditions. It should be stressed that during the 13 th week after ACLR a subsequent third stage of rehabilitation was started, involving exercise with increased load, intensity and difficulty [15]. The PT values and their increments, obtained under isokinetic conditions in ACLR patients between the first and second test for angular velocity of 180°/s, were lower compared to higher increments in this biomechanic parameter for angular velocities of 60°/s, and even lower values were obtained with 180°/s, compared to the results obtained under static conditions.…”

“…The studies dealing with the analysis of IT and relative strength moments (RSM) obtained from knee extensor and flexor muscles after ACL reconstruction under static and isokinetic conditions are numerous [22–25]. Not only the relative values, but also the IT ratios for particular muscle groups and the correlations between the results obtained under static and isokinetic conditions, are essential in restoring strength in muscles affecting the operated joint [15,26]. Additionally, apart from isokinetic measurements, electromyography was performed in ACLR patients [27].…”

“…Graft stabilization was performed by the Regidfix method. The first group of subjects underwent a 4-stage physiotherapeutic procedure [15]. Group II consisted of 20 males with no lower limb injuries.…”