1
|
Pamboris GM, Pavlou K, Paraskevopoulos E, Mohagheghi AA. Effect of open vs. closed kinetic chain exercises in ACL rehabilitation on knee joint pain, laxity, extensor muscles strength, and function: a systematic review with meta-analysis. Front Sports Act Living 2024; 6:1416690. [PMID: 38887689 PMCID: PMC11180725 DOI: 10.3389/fspor.2024.1416690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are common among physically active individuals, often requiring ACL reconstruction (ACLR) for recovery. Rehabilitating these injuries involves determining the appropriate timing for initiating open kinetic chain (OKC) exercises. Although OKC exercises are effective post-ACLR, their use in rehabilitation remains a subject of debate. Therefore, this study aims to conduct a systematic review to determine whether OKC or closed kinetic chain (CKC) exercises result in differences in laxity, strength of the knee extensor muscle group, function, and functional performance in ACL rehabilitation. Five electronic databases were searched for randomized controlled between-group trials (RCTs). Two reviewers independently evaluated the risk of bias using the PEDro scale. We performed a meta-analysis using a random-effects model or calculated mean differences (fixed-effect) where appropriate. Certainty of evidence was judged using the GRADE approach. The systematic literature search yielded 480 articles, of which 9 met the inclusion criteria. The evidence for all outcomes ranged from very low to low certainty. Across all comparisons, inconsistent results were found in outcome measures related to knee function between OKC and CKC exercises post-ACLR. A significant increase in quadriceps isokinetic strength was found in post-ACLR and ACL-deficient knees in favor of OKC exercises at 3 (p = 0.03) and 4 (p = 0.008) months, respectively. A significant decrease in knee laxity was observed in ACL-deficient knees in favor of OKC at 10 weeks (p = 0.01), although inconsistency was noted at 4 months. Finally, a significant decrease in pain was found in favor of early OKC compared to late OKC (p < 0.003). Additionally, in ACL-deficient knees, low load resistance training (LLRT) OKC showed no significant laxity difference compared to controls (p > 0.05). In contrast, high load resistance training (HLRT) OKC had less laxity than controls at 6 weeks (p = 0.02) but not at 12 weeks (p > 0.05). OKC exercises appear to be superior to CKC for improving quadriceps strength 3-4 months post-injury, whether as a part of conservative or post-surgery rehabilitation. On the other hand, OKC exercises seem to be either superior or equally effective to CKC for improving knee laxity, thus presenting their importance in being included in a rehabilitation protocol from the initial phase. Systematic Review Registration PROSPERO [CRD42023475230].
Collapse
Affiliation(s)
- George M. Pamboris
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Kyriakos Pavlou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Eleftherios Paraskevopoulos
- Department of Physiotherapy, Aegean College, Athens, Greece
- Laboratory of Biomechanics, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
| | - Amir A. Mohagheghi
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
| |
Collapse
|
2
|
Yu F, Xiao LE, Wang T, Hu Y, Xiao J. Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction. Orthop Nurs 2024; 43:163-178. [PMID: 38861747 DOI: 10.1097/nor.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.
Collapse
Affiliation(s)
- Fang Yu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Li-En Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Tao Wang
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Yong Hu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Jun Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| |
Collapse
|
3
|
Forelli F, Mazeas J, Zeghoudi Y, Vandebrouck A, Duffiet P, Ratte L, Kakavas G, Hewett TE, Korakakis V, Rambaud AJM. Intrinsic graft laxity variation with open kinetic chain exercise after anterior cruciate ligament reconstruction: A non-randomized controlled study. Phys Ther Sport 2024; 66:61-66. [PMID: 38335650 DOI: 10.1016/j.ptsp.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To determine whether quadriceps and hamstring strengthening in a rehabilitation program involving early open kinetic chain (OKC) and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3, and 6 months after anterior cruciate ligament reconstruction (ACLR). DESIGN Retrospective study. METHODS Two groups (n = 53) of ACLR patients (combination of OKC and CKC exercises group compared to a CKC exercise group) were recruited. OKC protocol was introduced at 2 weeks post-operatively without external resistance and progressed at 4 weeks with load. Comparative ACL graft laxity measurement and isokinetic strength testing were prospectively performed up to 6 months in both groups. RESULTS No significant differences were observed in the knee laxity at 1 (p = 0.263), 3 (p = 0.263), and 6 months (p = 0.256) follow up between the groups. Similarly, no significant results were observed in within-group knee laxity between 1 and 6 months after ACLR in the intervention (p = 0.155) and control group (p = 0.690). CONCLUSION The early initiation of OKC along with CKC exercises doesn't seem to increase the ACLR graft laxity as compared to a rehabilitation program with only CKC exercises.
Collapse
Affiliation(s)
- Florian Forelli
- Orthosport Rehab Center, 16 Rue de Paris, 95330 Domont, France; Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France; SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes Du Sport, Pierrefitte/Seine, France.
| | - Jean Mazeas
- Orthosport Rehab Center, 16 Rue de Paris, 95330 Domont, France; Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Yannis Zeghoudi
- Orthosport Rehab Center, 16 Rue de Paris, 95330 Domont, France; Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Amaury Vandebrouck
- Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Pascal Duffiet
- Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Louis Ratte
- Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Georgios Kakavas
- Fysiotek Spine & Sports Lab, Athens, Greece; Department of Physical Education and Sport Sciences, ErgoMech-Lab, University of Thessaly, Trikala, Greece
| | - Timothy E Hewett
- Department of Orthopaedic Surgery, Marshall University, Huntington, WV, United States
| | - Vasileios Korakakis
- Department of Health Sciences, School of Life Sciences and Health Sciences, PhD in Physiotherapy Program, University of Nicosia, Cyprus; Hellenic Orthopaedic Manipulative Therapy Education (HOMT Edu), Athens, Greece
| | - Alexandre J M Rambaud
- SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes Du Sport, Pierrefitte/Seine, France; IFMK Saint Etienne, Saint Michel Campus, 42000 Saint Etienne, France
| |
Collapse
|
4
|
Shin HJ, Kim SH, Cho HY. The effect of types of sensory feedback on the acquisition and retention of squat performance: A randomized, double-blind, controlled trial. Scand J Med Sci Sports 2024; 34:e14531. [PMID: 37916599 DOI: 10.1111/sms.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
Various sensory feedback methods are considered important for motor learning, but the effect of each sensory feedback method on effective squat learning still needs to be clarified. This study aimed to investigate the effect of sensory feedback types on the acquisition and retention of a squat. A double-blinded, randomized controlled trial was carried out. Thirty-healthy people were recruited and randomly assigned to the visual feedback group (VFG = 10), tactile feedback group (TFG = 10), and control group (CG = 10). VFG received visual feedback through video data of the participant performing squats, and TFG received tactile feedback through manual contact with a physical therapist. Both groups received feedback on the movements that needed correction after each set was completed. CG maintained rest without receiving any feedback. The retro-reflexive marker, force plate, and electromyography were used to measure body angle, foot center of pressure (COP), and muscle activity. All assessments were measured to confirm a squat acquisition. VFG and TFG showed significant differences in neutral knee position (NKP), trunk forward lean (TFL), anterior knee displacement (AKD), and anteroposterior (AP) foot COP (p < 0.050). In addition, the acquisition was retained until 3 days later for NKP and a week later for TFL, AKD, and AP foot COP in VFG (p < 0.050), while the acquisition was not retained in TFG (p > 0.050). There was no statistically significant change in CG (p > 0.050). This study demonstrated that visual feedback positively affects the acquisition and retention of squats. Therefore, we recommend the use of visual feedback for squat acquisition and retention in exercise novices.
Collapse
Affiliation(s)
- Ho-Jin Shin
- Department of Physical Therapy, Gachon University, Incheon, Republic of Korea
| | - Sung-Hyeon Kim
- Department of Physical Therapy, Gachon University, Incheon, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, Gachon University, Incheon, Republic of Korea
| |
Collapse
|
5
|
Forelli F, Barbar W, Kersante G, Vandebrouck A, Duffiet P, Ratte L, Hewett TE, Rambaud AJ. Evaluation of Muscle Strength and Graft Laxity With Early Open Kinetic Chain Exercise After ACL Reconstruction: A Cohort Study. Orthop J Sports Med 2023; 11:23259671231177594. [PMID: 37441511 PMCID: PMC10334004 DOI: 10.1177/23259671231177594] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background Open kinetic chain (OKC) exercise is an effective method to improve muscle function during rehabilitation after anterior cruciate ligament reconstruction (ACLR); however, there is controversy about its use in the early phase of rehabilitation. Purpose To determine (1) whether the use of OKC and closed kinetic chain (CKC) exercises improves quadriceps and hamstring strength in the early phase of rehabilitation after ACLR and (2) whether the early use of OKC exercise affects graft laxity at 3 and 6 months postoperatively in patients with a hamstring tendon graft. Study Design Cohort study; Level of evidence, 3. Methods This study included an intervention group that underwent OKC + CKC exercises (n = 51) and a control group that underwent CKC exercise only (n = 52). In the intervention group, OKC exercise for the quadriceps and hamstring was started at 4 weeks after ACLR. At 3 and 6 months postoperatively, isokinetic testing was performed to calculate the limb symmetry index (LSI) and the peak torque to body weight ratio (PT/BW) for the quadriceps and hamstring. Anterior knee laxity was measured by an arthrometer. Results At 3 and 6 months postoperatively, quadriceps strength was higher in the intervention group than in the control group for the LSI (3 months: 76.14% ± 0.22% vs 46.91% ± 0.21%, respectively; 6 months: 91.05% ± 0.18% vs 61.80% ± 0.26%, respectively; P < .001 for both) and PT/BW (3 months: 1.81 ± 0.75 vs 0.85 ± 0.50 N·m/kg, respectively; 6 months: 2.40 ± 0.73 vs 1.39 ± 0.70 N·m/kg, respectively; P < .001 for both). There were similar findings regarding hamstring strength for the LSI (3 months: 86.13% ± 0.22% vs 64.26% ± 0.26%, respectively; 6 months: 91.90% ± 0.17% vs 82.42% ± 0.24%, respectively; P < .001 at three months, P = .024 at 6 months) and PT/BW (3 months: 1.09 ± 0.36 vs 0.67 ± 0.39 N·m/kg, respectively; 6 months: 1.42 ± 0.41 vs 1.07 ± 0.39 N·m/kg, respectively; P < .001 for both). No significant difference in laxity was observed between the intervention and control groups at 3 or 6 months. Conclusion Early use of OKC exercise for both the quadriceps and the hamstring, in addition to conventional CKC exercise, resulted in better correction of quadriceps and hamstring strength deficits without increasing graft laxity.
Collapse
Affiliation(s)
- Florian Forelli
- Orthosport Rehab Center, Domont,
France
- Clinique de Domont, Ramsay Santé,
Domont, France
- Medical and Research Center for High
Sport Performance, Eaubonne, France
- Société Française des Masseurs
Kinésithérapeutes du Sport, Pierrefitte-sur-Seine, France
| | - Wassim Barbar
- Orthosport Rehab Center, Domont,
France
- Clinique de Domont, Ramsay Santé,
Domont, France
| | - Gwendal Kersante
- Orthosport Rehab Center, Domont,
France
- Clinique de Domont, Ramsay Santé,
Domont, France
| | | | | | - Louis Ratte
- Clinique de Domont, Ramsay Santé,
Domont, France
| | - Timothy E. Hewett
- Department of Orthopaedic Surgery,
Marshall University, Huntington, West Virginia, USA
| | - Alexandre J.M. Rambaud
- Société Française des Masseurs
Kinésithérapeutes du Sport, Pierrefitte-sur-Seine, France
- Sports Medicine Unit, Department of
Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Faculty of
Medicine, Jean Monnet University, Saint-Etienne, France
| |
Collapse
|
6
|
Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 2023; 57:500-514. [PMID: 36731908 DOI: 10.1136/bjsports-2022-106158] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
Collapse
Affiliation(s)
- Roula Kotsifaki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Vasileios Korakakis
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Olivia Barbosa
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Michail Pantouveris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Bjerregaard
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julius Luomajoki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan Wilhelmsen
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rodney Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| |
Collapse
|
7
|
Nichols ZW, O'Brien D, White SG. Is resistance training intensity adequately prescribed to meet the demands of returning to sport following anterior cruciate ligament repair? A systematic review. BMJ Open Sport Exerc Med 2021; 7:e001144. [PMID: 34422294 PMCID: PMC8323367 DOI: 10.1136/bmjsem-2021-001144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To identify, critique and synthesise the research findings that evaluate the use of resistance training (RT) programmes on return to sport outcome measures for people following ACL repair (ACLR). Design and data sources This systematic review included a comprehensive search of electronic databases (EBSCO health databases (CINAHL, MEDLINE, SPORTDiscus), Scopus and Pedro) performed in June 2020 and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were appraised using the Downs and Black checklist. Eligibility criteria Randomised and non-randomised controlled trials, longitudinal cohort studies and case series were considered for inclusion where an adequate description of the RT intervention was provided as a part of the study's ACLR rehabilitation protocol. Articles that did not include outcome measures related to return to sport criteria were excluded. Results Eleven articles met the inclusion criteria and were subjected to appraisal and data extraction. Study quality ranged from poor to excellent. RT intensity varied considerably among studies (between 5% and >80% of one repetition maximum). Only one identified study specifically investigated the effect of a low-intensity versus high-intensity RT protocol. The majority of studies reported participant outcomes that would not meet commonly used return to sport criteria. Conclusion There appears to be considerable variation in the intensity of RT prescribed in research for people following ACLR. Furthermore, in most of the identified studies, RT protocols promoted muscle endurance and hypertrophy without progressing to strength or power-based RT. The findings of this review provide insight into potential factors limiting returning to sport and contributing to reinjury for people following ACLR.
Collapse
Affiliation(s)
- Zackary William Nichols
- Physiotherapy, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Daniel O'Brien
- Physiotherapy, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Steven Gordon White
- Physiotherapy, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| |
Collapse
|
8
|
Postoperative Rehabilitation of Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Med Arthrosc Rev 2021; 29:63-80. [PMID: 33972483 DOI: 10.1097/jsa.0000000000000314] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent studies have investigated the various components of postoperative rehabilitation protocols following anterior cruciate ligament reconstruction (ACLR). The objective of this article was to access and summarize the latest evidence for postoperative rehabilitation protocols following ACLR to evaluate common timeframes, number of phases, exercises, as well as the length of rehabilitation protocol. Common interventions include vibration training, open-chain and closed-chain exercises, electrical stimulation, postoperative bracing, and aquatic therapy. The eligibility criteria included English-language articles published from 2000 to 2019 pertaining to rehabilitation following ACLR, excluding addresses, commentaries, and editorials. Two blinded reviewers screened, graded, and extracted data from articles. Recommendations on various aspects of rehabilitation were summarized. A total of 3651 articles were retrieved from the database search, and 62 level 1 to 2 studies were available for extraction. On the basis of the evidence, vibration training can be safely incorporated into the postoperative rehabilitation protocol following ACLR. Accelerated rehabilitation may give patients short-term functional benefits. Open kinetic chain exercises may have additional strength and endurance benefits. Postoperative bracing does not confer additional benefits. Long-term use of neuromuscular electrical stimulation seems to be more beneficial than short-term use. Aquatic rehabilitation may be beneficial in the early phases of anterior cruciate ligament rehabilitation.
Collapse
|
9
|
de Araujo FX, de Castro MP, Schell MS, Vidmar MF, Marques FO, Pierri CAA, Silva MF. Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes: Letter to the Editor. Am J Sports Med 2018; 46:NP55-NP57. [PMID: 30169143 DOI: 10.1177/0363546518788318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
10
|
The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2018; 48:552-566. [PMID: 29685058 DOI: 10.2519/jospt.2018.7656] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament reconstruction (ACLR) due to the belief that increased strain on the graft could cause damage. Objectives To determine whether OKC quadriceps exercises result in differences in anterior tibial laxity, strength, function, quality of life, or adverse events in the ACLR population, when compared to closed-kinetic-chain (CKC) quadriceps exercises. Methods Seven electronic databases (MEDLINE, Embase, AMED, CINAHL, SPORTDiscus, PEDro, and the Cochrane Central Register of Controlled Trials) were searched through April 2017. A systematic review with meta-analysis was conducted on randomized controlled trials comparing OKC versus CKC exercises following ACLR. Outcomes of interest were tibial laxity, strength, and function. A methodological quality assessment of the included studies was completed, and the results were synthesized using meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten studies were included in the review. The meta-analysis demonstrated low- to moderate-quality evidence of no between-group differences in anterior tibial laxity, strength, or patient-reported function at any time point. Meta-analysis was unable to be performed for functional outcomes. Conclusion There was limited to moderate-quality evidence of no difference in anterior tibial laxity, strength, patient-reported function, or physical function with early or late introduction of OKC exercises in the ACLR population, when compared to CKC exercises, at all follow-up time points. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(7):552-566. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7656.
Collapse
|
11
|
Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. JOURNAL OF SPORTS MEDICINE 2017; 2017:4721548. [PMID: 28913413 PMCID: PMC5585614 DOI: 10.1155/2017/4721548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 11/24/2022]
Abstract
Background There is no consensus on whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. Methods A systematic search identified randomized controlled trials of OKC versus CKC exercise training in people who had undergone ACL reconstructive surgery. All published studies in this systematic review were comparisons between OKC and CKC groups. Results Seven studies were included. Lysholm knee scoring scale was not significantly different between OKC and CKC exercise patients: MD: −1.03%; CI: −13.02, 10.95; p value = 0.87 (Chi2 = 0.18, df = 1, and p value = 0.67). Hughston clinic questionnaire scores were not significantly different between OKC and CKC exercise patients: MD: −1.29% (−12.02, 9.43); p value = 0.81 (Chi2 = 0.01, df = 1, and p value = 0.93). Conclusions While OKC and CKC may be beneficial during ACL surgical rehabilitation, there is insufficient evidence to suggest that either one is superior to the other.
Collapse
|
12
|
Kim K, Jeon K, Mullineaux DR, Cho E. A study of isokinetic strength and laxity with and without anterior cruciate ligament injury. J Phys Ther Sci 2016; 28:3272-3275. [PMID: 28174432 PMCID: PMC5276741 DOI: 10.1589/jpts.28.3272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/31/2016] [Indexed: 12/17/2022] Open
Abstract
[Purpose] The purpose of this study was to provide useful information for future treatments and to organize rehabilitation programs for anterior cruciate ligament injury by assessing isokinetic muscle strength and laxity of knee joints in athletes with anterior cruciate ligament injuries. [Subjects and Methods] Thirty-one high school athletes with anterior cruciate ligament injuries participated in this study. Isokinetic muscle strength at 60°/sec and anterior cruciate ligament laxity for non-involved and involved sides, classified on the basis of the severity of anterior cruciate ligament injury, were assessed. [Results] A comparison of isokinetic muscle strength measured from the non-involved and involved sides showed a significant difference in the maximum strength and knee flexor muscle strength. For laxity, a significant difference was observed in the anterior drawer test results obtained with a force of 88 N. [Conclusion] In conclusion, this study has shown that the assessment of isokinetic muscle strength and ligament laxity from athletes with anterior cruciate ligament injury should be utilized to provide baseline data for prevention and prediction of injury.
Collapse
Affiliation(s)
- Kewwan Kim
- Division of Sport Science, Incheon National University, Republic of Korea
| | - Kyoungkyu Jeon
- Division of Sport Science, Incheon National University, Republic of Korea; Sport Science Institute, Incheon National University, Republic of Korea
| | - David R Mullineaux
- School of Sport and Exercise Science, University of Lincoln, United Kingdom
| | - Eunok Cho
- Division of Sport Science, Incheon National University, Republic of Korea
| |
Collapse
|
13
|
Hu C, Huang Q, Yu L, Zhou Y, Gu R, Ye M, Ge M, Xu Y, Liu J. Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction. J Phys Ther Sci 2016; 28:2196-8. [PMID: 27630396 PMCID: PMC5011560 DOI: 10.1589/jpts.28.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the long-term interventions effects of
robot-assisted therapy rehabilitation on functional activity levels after anterior
cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6
males and 2 females) who received anterior cruciate ligament reconstruction. The subjects
participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test,
10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus
lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee
joint were evaluated before and after the intervention. [Results] The average value of the
of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor
strength of the knee joint isokinetic movement increased significantly, and the time of
the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that
walking ability and muscle strength can be improved by robotic walking training as a
long-term intervention.
Collapse
Affiliation(s)
- Chunying Hu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Qiuchen Huang
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Lili Yu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Yue Zhou
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Rui Gu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Orthopedic and Orthopedic Rehabilitation China Rehabilitation Research Center, China
| | - Miao Ye
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Meng Ge
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| | - Yanfeng Xu
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| | - Jianfeng Liu
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| |
Collapse
|
14
|
Kim DK, Park WH. Sex differences in knee strength deficit 1 year after anterior cruciate ligament reconstruction. J Phys Ther Sci 2015; 27:3847-9. [PMID: 26834366 PMCID: PMC4713805 DOI: 10.1589/jpts.27.3847] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/18/2015] [Indexed: 12/16/2022] Open
Abstract
[Purpose] Little is known about the outcome differences between men and women after anterior cruciate ligament (ACL) reconstruction. Therefore, the present study aimed to compare knee muscle strength between men and women 1 year after ACL reconstruction. [Subjects and Methods] Retrospective and outcome study. Between 2012 and 2015, 35 males (mean age, 29.7 ± 010.7 years) and 35 females (mean age, 28.2 ± 11.3 years) who had undergone primary ACL reconstruction were recruited from Samsung medical centers. We assessed the strength deficit in the quadriceps (extensor) and hamstrings (flexor) at 60°/sec and 180°/sec with isokinetic testing equipment. Statistical analysis was conducted with a t-test to determine if sex differences existed in knee strength deficit. [Results] Significant differences were noted between men and women with respect to extensor muscle strength deficit. Women reported less extensor muscle strength than men did, at the angular velocities 60°/sec and 180°/sec. However, no significant sex differences were found at either velocity with respect to the strength deficit of the knee flexor muscles. [Conclusion] Compared to male patients, female patients reported significantly less extensor muscle strength and less improvement 1 year after reconstruction.
Collapse
Affiliation(s)
- Do Kyung Kim
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Won Hah Park
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| |
Collapse
|
15
|
Kim DK, Hwang JH, Park WH. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction. J Phys Ther Sci 2015; 27:2693-6. [PMID: 26504270 PMCID: PMC4616071 DOI: 10.1589/jpts.27.2693] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/25/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability.
Collapse
Affiliation(s)
- Do Kyung Kim
- Department of Physical & Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical & Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Won Hah Park
- Department of Physical & Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| |
Collapse
|
16
|
Zhang F, Wang J, Wang F. Comparison of the clinical effects of open and closed chain exercises after medial patellofemoral ligament reconstruction. J Phys Ther Sci 2014; 26:1557-60. [PMID: 25364112 PMCID: PMC4210397 DOI: 10.1589/jpts.26.1557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/12/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To compare the effects of open-chain exercise (OCE) and closed-chain exercise (CCE) for patients after medial patellofemoral ligament (MPFL) reconstruction. [Subjects and Methods] Forty patients after MPFL reconstruction were randomly divided into an OCE group and a CCE group. All the patients were evaluated at four different time points. [Results] The mean change of thigh circumference decrease in the CCE group was lower than that in the OCE group at both the 3rd and 6th month after surgery. The Lysholm score of the CCE group was higher than that of the OCE group at both the 3rd and 6th month. At the 3rd month after surgery, the visual analog scale score of the CCE group was lower than that of the OCE group. [Conclusion] CCE is better than OCE for both short and long term outcomes of patients after MPFL reconstruction.
Collapse
Affiliation(s)
- Feng Zhang
- Department of Rehabilitation Medicine, Third Hospital of Hebei Medical University, China ; Hebei Provincial Orthopedic Biomechanics Key Laboratory, China
| | - Jun Wang
- Depatrtment of Orthopedics, Cangzhou Central Hospital, China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, China ; Hebei Provincial Orthopedic Biomechanics Key Laboratory, China
| |
Collapse
|