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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Kotiuk V, Kostrub O, Blonskyi R, Podik V, Sushchenko L. How safe are partial squats after the anterior cruciate ligament reconstruction? A finite element analysis. Knee 2023; 43:192-199. [PMID: 37459692 DOI: 10.1016/j.knee.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/27/2023] [Accepted: 06/30/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Partial squats are a part of many rehabilitation programs. Progress to deeper squats can only be performed through the partial squat position. However, squats safety, onset time, and rational depth are still controversial. Most previous studies have not considered the influence of posterior tibial slope (PTS) and anterolateral ligament (ALL) on the stress on the knee anatomical elements in partial squats. METHODS We have created the new comprehensive knee computer models, which considered muscle exertions while weight bearing 75, 100, 125, and 150 kg in partial squats, included the ALL, two variants of PTS (5° and 13.9°), and two variants of anterior cruciate ligament (ACL) (a native 6 mm double-bundle ACL and an 8 mm single-bundle ACL graft). Using the finite element analysis, we have analyzed stresses in 14 anatomical elements in each model in partial squats (55° knee flexion and 10° anterior tibia tilt). RESULTS PTS change from 5° to 13.9° in a partial squat increases stress 1.2-1.3 times on the native ACL and 1.3-1.4 times on the ALL. In the case of single-bundle ACL reconstruction, PTS growth from 5° to 13.9° results in stress increasing 1.2-1.3 times on the graft and 1.3-1.4 times on the ALL. Thus, increased PTS is a significant risk factor, especially in the early postoperative period. Weight-bearing predictably increases stress on the ACL, ALL, and other joint elements proportional to the weight growth. Patients with thinner grafts after the ACL reconstruction may already reach the risk level for graft rupture in a single load in partial squatting if they weigh 125 kg or more. The risk rises with increasing PTS angle or the patient's weight. Because of the reduction of the graft strength by six weeks after surgery by 27%, partial squats in six weeks are associated with forces that may exceed the maximal ACL load even in patients with 75 kg of weight without additional load. CONCLUSION In the early postoperative period, partial squats can put the ACL graft at risk of failure. This risk is proportional to the patient's weight and PTS angle, and inversely proportional to the graft thickness. The choice of physical therapy strategies after ACL reconstruction, exercises, and their initiation timing is complex and cannot be standardized for all patients. Factors like the thickness of the graft, the method of fixation, the patient's weight, the ALL insufficiency, the PTS angle, and the patient's goals in the short and long term should be considered when planning the rehabilitation program.
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Affiliation(s)
- V Kotiuk
- Carolina Medical Center, 78 Pory Street, Warsaw 02-757, Poland.
| | - O Kostrub
- Department of Sports and Ballet Trauma, State Institute of Traumatology and Orthopedics, NAMS of Ukraine, 27 Bulvarno-Kudriavska Street, Kyiv 01601, Ukraine.
| | - R Blonskyi
- Department of Sports and Ballet Trauma, State Institute of Traumatology and Orthopedics, NAMS of Ukraine, 27 Bulvarno-Kudriavska Street, Kyiv 01601, Ukraine.
| | - V Podik
- Department of Sports and Ballet Trauma, State Institute of Traumatology and Orthopedics, NAMS of Ukraine, 27 Bulvarno-Kudriavska Street, Kyiv 01601, Ukraine.
| | - L Sushchenko
- Department of Physical Therapy, National Pedagogical Dragomanov University, 9 Pyrogova Street, Kyiv 01601, Ukraine.
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Exercise Descriptors That Determine Muscle Strength Gains Are Missing From Reported Anterior Cruciate Ligament Reconstruction Rehabilitation Programs: A Scoping Review of 117 Exercises in 41 Studies. J Orthop Sports Phys Ther 2022; 52:100-112. [PMID: 34784243 DOI: 10.2519/jospt.2022.10651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To (1) describe which strength training exercise descriptors are reported in anterior cruciate ligament reconstruction (ACLR) rehabilitation research, and (2) compare the current standards of reporting ACLR strength training exercise descriptors to international best-practice strength training guidelines. DESIGN Scoping review. LITERATURE SEARCH We searched the MEDLINE, PsycINFO, CINAHL, SPORTDiscus, Academic Search, ERIC, Health Source: Nursing, Health Source: Consumer, MasterFILE, and Africa-Wide Information databases. STUDY SELECTION CRITERIA We included level I to IV studies of ACLR rehabilitation programs with 1 or more reported strength training exercise descriptors. We used a predefined list of 19 exercise descriptors, based on the American College of Sports Medicine (ACSM) exercise recommendations, the Consensus on Exercise Reporting Template (CERT), and the Toigo and Boutellier exercise descriptor framework. DATA SYNTHESIS Completeness and the standard of reporting exercise descriptors in ACLR rehabilitation programs were assessed by means of international best-practice strength training standards. RESULTS We extracted data on 117 exercises from 41 studies. A median of 7 of the 19 possible exercise descriptors were reported (range, 3-16). Reporting of specific exercise descriptors varied across studies, from 95% (name of the strength training exercise) to 5% (exercise aim, exercise order). On average, 46%, 35%, and 43% of the exercise descriptors included in the ACSM, CERT, and Toigo and Boutellier guidelines were reported, respectively. CONCLUSION Key exercise descriptors for muscle strength gains are not reported in studies on ACLR rehabilitation. Only the exercise name, number of exercises, frequency, and experimental period were reported in most of the studies. J Orthop Sports Phys Ther 2022;52(2):100-112. Epub 16 Nov 2021. doi:10.2519/jospt.2022.10651.
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Buckthorpe M. Recommendations for Movement Re-training After ACL Reconstruction. Sports Med 2021; 51:1601-1618. [PMID: 33840081 DOI: 10.1007/s40279-021-01454-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS.
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Health and Applied Science, St Marys University, Twickenham, London, TW1 4SX, UK.
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Abstract
Outcomes following anterior cruciate ligament (ACL) reconstruction need improving, with poor return-to-sport rates and high risk of secondary re-injury. There is a need to improve rehabilitation strategies after ACL reconstruction, if we can support enhanced patient outcomes. This paper discusses how to optimise the mid-stage rehabilitation process after ACL reconstruction. Mid-stage is a difficult and vitally important stage of the functional recovery process and provides the foundation on which to commence late-stage rehabilitation training. Often many aspects of mid-stage rehabilitation (e.g. knee extensors isolated muscle strength) are not actually restored prior to return-to-sport. In addition, if we are to allow time for optimal late-stage rehabilitation and return-to-sport training, we need to optimise the mid-stage rehabilitation approach and complete it in a timely manner. This paper forms a key part of a strategy to optimise the ACL rehabilitation approach and considers factors more specific to mid-stage rehabilitation characterised in 3 areas: (1) muscle strength: muscle and joint specific, in particular at the knee level, with the knee extensors and flexors and distally with the triceps surae and proximally with the lumbo-pelvic-hip complex, as well as closed kinetic chain strength; (2) altered basic motor patterning (movement quality) and (3) fitness re-conditioning. In addition, the paper provides recommendations on how to implement these into practice, discussing training planning and programming and suggests specific screening to monitor work and when the athlete is able to progress to the next stage (e.g. late-stage rehabilitation criteria).
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You YL, Lin CJ, Chieh HF, Tsai YJ, Lee SY, Lin CF, Hsu YC, Kuo LC, Su FC. Comparison of knee biomechanical characteristics during exercise between pinnacle and step trainers. Gait Posture 2020; 77:201-206. [PMID: 32058284 DOI: 10.1016/j.gaitpost.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A novel stair-climber called a pinnacle trainer (PT) provides both sagittal and frontal plane exercise, making it different from a step trainer (ST), which provides only sagittal plane exercise. Exercise with different trajectories may produce different biomechanical responses. There are currently no guidelines for choosing between a PT and a ST for different training or rehabilitation purposes. RESEARCH QUESTIONS Are there differences in the electromyographic patterns of lower extremity musculature and biomechanical responses of the knee joint during exercise between using a PT and a ST? METHODS This study utilizes a prospective observational study design. Eighteen healthy males participated in the study. A six-axis force and torque transducer embedded in the machine pedal synchronized with a three-dimensional motion capture system were utilized to measure kinematic and kinetic data of the right knee during the stepping movement. The activities of six lower extremity muscles of the same limb were captured with surface electromyography during exercise on the two trainer types. RESULTS The co-activation index of the vastus lateralis (VL) and the biceps femoris (BF) recorded during ST exercise was significantly greater than that for the PT exercise. Moreover, exercise using the ST produced a significantly greater knee downward force compared to that for the PT. Exercise with the PT produced a significantly greater internal knee varus moment compared to that for the ST. SIGNIFICANCE The ST provided greater co-activation of the BF and VL and a greater knee joint downward force, which may decrease the antero-posterior displacement of the tibia relative to the femur. Exercise with the PT produced a significant internal knee varus moment and a more balanced muscular activation on the vastus medialis and VL compared to that for the ST, which may decrease the maltracking of the patella.
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Affiliation(s)
- Yu-Lin You
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Ju Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Feng Chieh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Jung Tsai
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Su-Ya Lee
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Musculoskeletal Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Musculoskeletal Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chi Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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De Vroey H, Staes F, Vereecke E, Vanrenterghem J, Deklerck J, Van Damme G, Hallez H, Claeys K. Lower extremity gait kinematics outcomes after knee replacement demonstrate arthroplasty-specific differences between unicondylar and total knee arthroplasty: A pilot study. Gait Posture 2019; 73:299-304. [PMID: 31401372 DOI: 10.1016/j.gaitpost.2019.07.196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study is to compare sagittal gait kinematics of ankle, knee and hip joints between subjects with unicondylar and total knee arthroplasty and age matched healthy controls. Since unicondylar knee replacement is a less invasive procedure, which more closely preserves knee joint anatomy, we hypothesized that one year post unicondylar knee arthroplasty patients would demonstrate more normal gait patterns than patients with total knee arthroplasty. RESEARCH QUESTION Do unicondylar and total knee arthroplasty patients display similar gait kinematics one year after surgery? METHODS Fourteen subjects (8 posterior stabilized and 6 medial unicondylar knee replacements) that were one year post surgery, and 6 healthy control subjects underwent a 3D gait analysis and a physical examination (range of motion, muscle strength). Statistical parametric mapping was used to compare gait kinematics of the lower limbs between groups. Additionally, differences in peak angles and clinical outcomes were assessed using a one-way ANOVA between subjects analysis. RESULTS Both knee replacement groups showed reduced knee flexion range of motion and reduced muscle strength at the operated leg compared to the control group. Subjects with TKA demonstrated reduced knee flexion at loading response and midstance of the gait cycle. Both UKA and TKA demonstrated significantly less knee flexion during swing. SIGNIFICANCE The results of this study demonstrate arthroplasty-specific differences in muscle strength, range of motion and gait kinematics of the lower limb one year after knee surgery. Future planning of post-surgery follow-up should addresses these arthroplasty-specific weaknesses and gait deviations.
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Affiliation(s)
- Henri De Vroey
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Filip Staes
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Evie Vereecke
- Department of Development and Regeneration, KULAK, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Jan Deklerck
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Geert Van Damme
- Department of Orthopaedic Surgery, AZ Sint-Lucas, Sint-Lucaslaan 29, 8310 Bruges, Belgium.
| | - Hans Hallez
- Department of Computer Science, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
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Lin YH, Lee SY, Su WR, Kao CC, Tai TW, Chen TB. Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement. J Clin Nurs 2018; 27:1836-1845. [PMID: 29603823 DOI: 10.1111/jocn.14368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement. BACKGROUND Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life. DESIGN A experimental and longitudinal study design. METHODS The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n = 100) or to receive usual care (nontraining group, n = 100). Data were collected and followed up with the patients before surgery (T1) and at 2 weeks (T2), 1 month (T3), 2 months (T4) and 3 months (T5) after discharge. RESULTS The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2 weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does. CONCLUSIONS This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home. RELEVANCE TO CLINICAL PRACTICE When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.
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Affiliation(s)
- Yu-Hua Lin
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Su-Ying Lee
- Nursing Department, National Cheung Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheung Kung University, Tainan, Taiwan
| | - Chia-Chan Kao
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Ta-Wei Tai
- Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, Kaohsiung, Taiwan
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Abstract
Context: Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process. Objective: To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees. Data Sources: A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included anterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy. Study Selection: Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load. Results: A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance. Conclusion: These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials.
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Affiliation(s)
- Juan Antonio Luque-Seron
- Department of Physical Therapy, Physical Therapy Section, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Ivan Medina-Porqueres
- Department of Physical Therapy, Physical Therapy Section, Faculty of Health Sciences, University of Malaga, Malaga, Spain
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Anderson MJ, Browning WM, Urband CE, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthop J Sports Med 2016; 4:2325967116634074. [PMID: 27047983 PMCID: PMC4794976 DOI: 10.1177/2325967116634074] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). PURPOSE To quantify the number of systematic reviews and meta-analyses published on the ACL in the past decade and to provide an overall summary of this literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all ACL-related systematic reviews and meta-analyses published between January 2004 and September 2014 was performed using PubMed, MEDLINE, and the Cochrane Database. Narrative reviews and non-English articles were excluded. RESULTS A total of 1031 articles were found, of which 240 met the inclusion criteria. Included articles were summarized and divided into 17 topics: anatomy, epidemiology, prevention, associated injuries, diagnosis, operative versus nonoperative management, graft choice, surgical technique, fixation methods, computer-assisted surgery, platelet-rich plasma, rehabilitation, return to play, outcomes assessment, arthritis, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on the ACL can supply the surgeon with a single source for the most up-to-date synthesis of the literature.
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Affiliation(s)
| | | | | | | | - Leslie J. Bisson
- The State University of New York at Buffalo, Buffalo, New York, USA
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Eraslan A, Ulkar B. Glucosamine Supplementation after Anterior Cruciate Ligament Reconstruction in Athletes: A Randomized Placebo-controlled Trial. Res Sports Med 2015; 23:14-26. [DOI: 10.1080/15438627.2014.975809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ali Eraslan
- Department of Sports Medicine, Antalya Education and Research Hospital, Antalya, Turkey
| | - Bulent Ulkar
- Department of Sports Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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Uçar M, Koca I, Eroglu M, Eroglu S, Sarp U, Arik HO, Yetisgin A. Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction. J Phys Ther Sci 2014; 26:1875-8. [PMID: 25540486 PMCID: PMC4273046 DOI: 10.1589/jpts.26.1875] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/29/2014] [Indexed: 01/29/2023] Open
Abstract
[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after
open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and
Methods] The subjects comprised 11 female and 47 male patients who are randomly divided
into two groups: which performed a CKC exercise program Group I and Group II which
performed an OKC exercise program. Pain intensity was evaluated using visual analogue
scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh
circumference measurements were taken with a tape measure at baseline and at 3 months and
6 months after the treatment. Lysholm scores were used to assess knee function. [Results]
There were no significant differences between the two groups at baseline. Within each
group, VAS values and knee flexion were improved after the surgery. These improvements
were significantly higher in the CKC group than in the OKC group. There were increases in
thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater
improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion]
The CKC exercise program was more effective than OKC in improving the knee functions of
patients with ACL reconstruction.
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Affiliation(s)
- Mehmet Uçar
- Department of Physical Medicine and Rehabilitation, Bozok University School of Medicine, Turkey
| | - Irfan Koca
- Department of Physical Medicine and Rehabilitation, Şanlıurfa Education and Research Hospital, Turkey
| | - Mehmet Eroglu
- Department of Orthopaedics and Traumatology, Mardin State Hospital, Turkey
| | - Selma Eroglu
- Department of Physical Medicine and Rehabilitation, Mardin State Hospital, Turkey
| | - Umit Sarp
- Department of Physical Medicine and Rehabilitation, Yozgat State Hospital, Turkey
| | - Hasan Onur Arik
- Department of Orthopaedics and Traumatology, Yozgat State Hospital, Turkey
| | - Alparslan Yetisgin
- Department of Physical Medicine and Rehabilitation, Şanlıurfa Education and Research Hospital, Turkey
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Lobb R, Tumilty S, Claydon LS. A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation. Phys Ther Sport 2012; 13:270-8. [PMID: 23068905 DOI: 10.1016/j.ptsp.2012.05.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/23/2012] [Accepted: 05/04/2012] [Indexed: 01/07/2023]
Abstract
The aim of this systematic review of systematic reviews was to critically appraise systematic reviews on Anterior Cruciate Ligament (ACL) reconstruction rehabilitation to determine which interventions are supported by the highest quality evidence. Electronic searches were undertaken, of MEDLINE, AMED, EMBASE, EBM reviews, PEDro, Scopus, and Web of Science to identify systematic reviews of ACL rehabilitation. Two reviewers independently selected the studies, extracted data, and applied quality criteria. Study quality was assessed using PRISMA and a best evidence synthesis was performed. Five systematic reviews were included assessing eight rehabilitation components. There was strong evidence (consistent evidence from multiple high quality randomised controlled trials (RCTs)) of no added benefit of bracing (0-6 weeks post-surgery) compared to standard treatment in the short term. Moderate evidence (consistent evidence from multiple low quality RCTs and/or one high quality RCT) supported no added benefit of continuous passive motion to standard treatment for increasing range of motion. There was moderate evidence of equal effectiveness of closed versus open kinetic chain exercise and home versus clinic based rehabilitation, on a range of short term outcomes. There was inconsistent or limited evidence for some interventions. Recommendations for clinical practice are made at specific time points for specific outcomes.
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Affiliation(s)
- Ryan Lobb
- Centre for Physiotherapy Research, University of Otago, 325 Great King Street, PO Box 56, Dunedin, New Zealand
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McHenry CL, Shields RK. A biomechanical analysis of exercise in standing, supine, and seated positions: Implications for individuals with spinal cord injury. J Spinal Cord Med 2012; 35:140-7. [PMID: 22507023 PMCID: PMC3324830 DOI: 10.1179/2045772312y.0000000011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE The distal femur is the primary fracture site in patients with osteoporosis after spinal cord injury (SCI). OBJECTIVE To mathematically compare the compression and shear forces at the distal femur during quadriceps stimulation in the standing, supine, and seated positions. A force analysis across these positions may be a consideration for people with SCI during neuromuscular electrical stimulation of the quadriceps. DESIGN A biomechanical model. SETTING Research laboratory. OUTCOME MEASURES Compression and shear forces from the standing, supine, and seated biomechanical models at the distal femur during constant loads generated by the quadriceps muscles. RESULTS The standing model estimated the highest compressive force at 240% body weight and the lowest shear force of 24% body weight at the distal femur compared with the supine and seated models. The supine model yielded a compressive force of 191% body weight with a shear force of 62% body weight at the distal femur. The seated model yielded the lowest compressive force of 139% body weight and the highest shear force of 215% body weight. CONCLUSIONS When inducing a range of forces in the quadriceps muscles, the seated position yields the highest shear forces and lowest compressive forces when compared with the supine and standing positions. Standing with isometric contractions generates the highest compressive loads and lowest shear forces. Early active resistive standing may provide the most effective means to prevent bone loss after SCI.
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Affiliation(s)
- Colleen L McHenry
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Abstract
Anterior cruciate ligament (ACL) injuries in skeletally immature individuals remain a challenge for the child, the parents, orthopaedic surgeons, and physical therapists. The main challenges are the potential risk of recurrent instability, secondary injuries following nonoperative treatment, and the risks involved with surgical treatment due to the vulnerability of the epiphyseal growth plates. We first present the physiological background for considerations that must be made when advising on treatment alternatives for skeletally immature individuals after ACL injury. The implications of continuous musculoskeletal development for treatment decisions are emphasized. No randomized controlled trials have been performed to investigate outcomes of different treatment algorithms. There is no consensus in the literature on clinical treatment decision criteria for whether a skeletally immature child should undergo transphyseal ACL reconstruction, physeal sparing ACL reconstruction, or nonoperative treatment. Additionally, well-described rehabilitation programs designed for either nonoperative treatment or postoperative rehabilitation have not been published. Based on the currently available evidence, we propose a treatment algorithm for the management of ACL injuries in skeletally immature individuals. Finally, we suggest directions for future prospective studies, which should include development of valid and reliable outcome measures and specific rehabilitation programs.
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Myers CA, Torry MR, Shelburne KB, Giphart JE, LaPrade RF, Woo SLY, Steadman JR. In vivo tibiofemoral kinematics during 4 functional tasks of increasing demand using biplane fluoroscopy. Am J Sports Med 2012; 40:170-8. [PMID: 21997729 DOI: 10.1177/0363546511423746] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) has been well defined as the main passive restraint to anterior tibial translation (ATT) in the knee and plays an important role in rotational stability. However, it is unknown how closely the ACL and other passive and active structures of the knee constrain translations and rotations across a set of functional activities of increasing demand on the quadriceps. HYPOTHESIS Anterior tibial translation and internal rotation of the tibia relative to the femur would increase as the demand on the quadriceps increased. STUDY DESIGN Controlled laboratory study. METHODS The in vivo 3-dimensional knee kinematics of 10 adult female patients (height, 167.8 ± 7.1 cm; body mass, 57 ± 4 kg; body mass index [BMI], 24.8 ± 1.7 kg/m(2); age, 29.7 ± 7.9 years) was measured using biplane fluoroscopy while patients completed 4 functional tasks. The tasks included an unloaded knee extension in which the patient slowly extended the knee from 90° to 0° of flexion in 2 seconds; walking at a constant pace of 90 steps per minute; a maximum effort isometric knee extension with the knee at 70° of flexion; and landing from a height of 40 cm in which the patient stepped off a box, landed, and immediately performed a maximum effort vertical jump. RESULTS Landing (5.6 ± 1.9 mm) produced significantly greater peak ATT than walking (3.1 ± 2.2 mm) and unweighted full extension (2.6 ± 2.1 mm) (P < .01), but there was no difference between landing and a maximum isometric contraction (5.0 ± 1.9 mm). While there was no significant difference in peak internal rotation between landing (19.4° ± 5.7°), maximum isometric contraction (15.9° ± 6.7°), and unweighted full knee extension (14.5° ± 7.7°), each produced significantly greater internal rotation than walking (3.9° ± 4.2°) (P < .001). Knee extension torque significantly increased for each task (P < .01): unweighted knee extension (4.7 ± 1.2 N·m), walking (36.5 ± 7.9 N·m), maximum isometric knee extension (105.1 ± 8.2 N·m), and landing (140.2 ± 26.2 N·m). CONCLUSION Anterior tibial translations significantly increased as demand on the quadriceps and external loading increased. Internal rotation was not significantly different between landing, isometric contraction, and unweighted knee extension. Additionally, ATT and internal rotation from each motion were within the normal range, and no excessive amounts of translation or rotation were observed. CLINICAL RELEVANCE This study demonstrated that while ATT will increase as demand on the quadriceps and external loading increases, the knee is able to effectively constrain ATT and internal rotation. This suggests that the healthy knee has a safe envelope of function that is tightly controlled even though task demand is elevated.
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Affiliation(s)
- Casey A Myers
- Biomechanics Research Laboratory, Steadman Philippon Research Institute, Vail, Colorado, USA
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Han GY, Park SA, Kim JH, Lee EK, Kim HJ, Seo YK, Park JK, Kim CW. Effects of vibration on the proteome expression of anterior cruciate ligament cells. Exp Biol Med (Maywood) 2011; 236:783-9. [DOI: 10.1258/ebm.2011.010358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recent reports have suggested that vibration has beneficial effects on knee healing response; however, the biomechanism of these beneficial effects still need to be determined on the anterior cruciate ligament (ACL) cell level. In this study, we applied a 20 Hz vibration to ACL cells, which produced a 20% increase ( P < 0.001) in cell activity and 17% increase ( P < 0.001) in intracellular sulfated glycosaminoglycan levels. In the 20 Hz vibration-stimulated ACL cell group, eight up-regulated (100 ∼ 300%) protein spots were identified compared with the control group by proteomics analysis. Among these proteins, Annexin A2 and Prolyl 4 hydroxylase (PH4B) were shown to have a 71% and 16% higher expression, respectively, in the 20 Hz vibration-stimulated ACL cell group by Western blotting ( P < 0.001). These results indicate that vibration produces a positive cellular environment, and Annexin A2 and prolyl 4 hydroxylase are expected to help ligament repair and ACL cell proliferation by controlling cell membrane and extracellular matrix formation.
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Affiliation(s)
- Gi-Yeon Han
- School of Life Sciences and Biotechnology, Korea University, 1-5, Anam Dong, Seongbuk-Gu, Seoul 136-701
| | - Seung-Ah Park
- School of Life Sciences and Biotechnology, Korea University, 1-5, Anam Dong, Seongbuk-Gu, Seoul 136-701
| | - Ji-Hye Kim
- School of Life Sciences and Biotechnology, Korea University, 1-5, Anam Dong, Seongbuk-Gu, Seoul 136-701
| | - Eun-Kyung Lee
- School of Life Sciences and Biotechnology, Korea University, 1-5, Anam Dong, Seongbuk-Gu, Seoul 136-701
| | - Hyun-Jung Kim
- School of Life Sciences and Biotechnology, Korea University, 1-5, Anam Dong, Seongbuk-Gu, Seoul 136-701
| | - Young-Kwon Seo
- Dongguk University Research Institute of Biotechnology, Dongguk University3-26, Pil Dong, Choong-Gu, Seoul 100-715, Korea
| | - Jung-Keug Park
- Dongguk University Research Institute of Biotechnology, Dongguk University3-26, Pil Dong, Choong-Gu, Seoul 100-715, Korea
| | - Chan-Wha Kim
- School of Life Sciences and Biotechnology, Korea University, 1-5, Anam Dong, Seongbuk-Gu, Seoul 136-701
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[Importance of open and closed kinetic chain exercises after anterior cruciate ligament reconstruction]. VOJNOSANIT PREGL 2011; 68:170-4. [PMID: 21456311 DOI: 10.2298/vsp1102170d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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