Rehabilitation nach operativem Ersatz des vorderen Kreuzbandes

[Rupture of the anterior cruciate ligament. Diagnostics and therapy]

Rupture of the anterior cruciate ligament (ACL) is the most common ligamentous knee injury. The knee is stabilized by the cruciate ligaments and the collateral ligaments. The ACL originates from the inner surface of the lateral condyle of the femur, runs in an anterior medial direction and inserts at the tibial plateau in the intercondyle area. The most common injury is an indirect knee trauma, typically a joint torsion in sports. Patients often describe a snapping noise followed by hemarthrosis. Concomitant injuries are lesions of the medial collateral ligament, the medial meniscus (unhappy triad) and chondral fractures. The age peak is between 15 and 30 years with a higher incidence in females. The cardinal symptom of the ACL rupture is the giving way phenomenon. The clinical diagnosis is provided by a positive Lachman test, a positive pivot shift test and the anterior drawer test. Fractures can be excluded by X-ray examination. Magnetic resonance imaging (MRI) allows the evaluation of the internal knee structures. ACL repair is carried out by arthroscopically assisted bone-tendon-bone or semitendinosus grafting techniques. Early rehabilitation is important for a good functional outcome.

Rehabilitation results following anterior cruciate ligament reconstruction using a hard brace compared to a fluid-filled soft brace

The purpose of this study was to compare the clinical outcomes of rehabilitation after ACL reconstruction using a water-filled soft brace to those using a hard brace. The method used in this study was a prospective randomised clinical trial including 36 patients wearing a hard brace and 37 patients wearing a water-filled soft brace for 6 weeks after surgery. Preoperative and postoperative (seven examinations) clinical evaluation within a follow-up period of 1 year including effusion status, swelling and range of motion (ROM), IKDC 2000, KT1000 Arthrometer, Lysholm knee scoring scale and Tegner activity score. Mean values are presented with standard deviations. Data was analysed using descriptive statistics and Student's t-test for unpaired samples. Significantly less effusion was found in the soft brace group from 5 days (p=0.002) to 12 weeks (p<0.024) postoperative. Hard brace patients presented with significantly more extension deficit from 5 days (p=0.036) to 12 months (p=0.014) postoperative but no significant difference was detected in complete ROM, laxity or thigh atrophy at any follow-up examination. Patients treated with a soft brace had significantly higher IKDC subjective ratings at 6 weeks (p=0.02) up to 12 months after operation (p=0.002) and rated significantly higher in Tegner activity score (p=0.004) and Lysholm knee scoring scale (p=0.006) 6 and 12 months (p<0.001 for both scores) postoperatively. The water-filled soft brace was superior regarding effusion, swelling, extension deficit and patient-measured midterm outcome. The soft brace presents a safe, easy-to-use and effective alternative to the hard brace.