Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study

2007 ◽  
Vol 15 (4) ◽  
pp. 402-414 ◽  
Author(s):  
Annette Heijne ◽  
Suzanne Werner
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Outcome Study ◽  
Kinetic Chain ◽  
Open Kinetic Chain ◽  
Late Start ◽  
Hamstring Grafts

scholarly journals Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction

2002 ◽  
Vol 82 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Matthew C Morrissey ◽  
Wendy I Drechsler ◽  
Dylan Morrissey ◽  
Philippa R Knight ◽  
Paul W Armstrong ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Resistance Training ◽  
Acl Reconstruction ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Early Period ◽  
Kinetic Chain ◽  
Reconstruction Surgery ◽  
Open Kinetic Chain ◽  
Anterior Cruciate

Abstract Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

A Prospective Comparison Of Bone-patellar Tendon-bone And Hamstring Grafts For ACL Reconstruction In Female Patients

2005 ◽  
Vol 37 (Supplement) ◽  
pp. S143
Author(s):  
Ninni Sernert ◽  
Michael Svensson ◽  
Lars Ejerhed ◽  
J??n Karlsson ◽  
J??ri T. Kartus
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Female Patients ◽  
Prospective Comparison ◽  
Hamstring Grafts ◽  
Bone Patellar Tendon

ACL reconstruction: patellar tendon versus hamstring grafts—economical aspects

2006 ◽  
Vol 14 (6) ◽  
pp. 536-541 ◽  
Author(s):  
Magnus Forssblad ◽  
Anders Valentin ◽  
Björn Engström ◽  
Suzanne Werner
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Hamstring Grafts

ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline

2021 ◽  
pp. 194173812110568
Author(s):  
Alexander W. Brinlee ◽  
Scott B. Dickenson ◽  
Airelle Hunter-Giordano ◽  
Lynn Snyder-Mackler
Keyword(s):  
Injury Prevention ◽  
Acl Reconstruction ◽  
Clinical Data ◽  
Practice Guidelines ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Acl Injury ◽  
Quadriceps Strength ◽  
Kinetic Chain ◽  
Open Kinetic Chain

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians’ current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. Evidence Acquisition: Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention. Study Design: Clinical review. Level of Evidence: Level 5. Results: Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey–Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. Conclusion: Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. Strength of Recommendation Taxonomy (SORT): B.

A Prospective Comparison Of Bone-patellar Tendon-bone And Hamstring Grafts For ACL Reconstruction In Female Patients

2005 ◽  
Vol 37 (Supplement) ◽  
pp. S143
Author(s):  
Ninni Sernert ◽  
Michael Svensson ◽  
Lars Ejerhed ◽  
Jón Karlsson ◽  
Jüri T. Kartus
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Female Patients ◽  
Prospective Comparison ◽  
Hamstring Grafts ◽  
Bone Patellar Tendon

scholarly journals Intra-articular Morphine and Ropivacaine Injection Provides Efficacious Analgesia As Compared With Femoral Nerve Block in the First 24 Hours After ACL Reconstruction: Results From a Bone–Patellar Tendon–Bone Graft in an Adolescent Population

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098590
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds ◽  
Tracey P. Bastrom ◽  
...  
Keyword(s):  
Pain Management ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Single Shot ◽  
Pain Scores ◽  
Peripheral Block ◽  
Bone Patellar Tendon

Background: Opioid consumption and patient satisfaction are influenced by a surgeon’s pain-management protocol as well as the use of adjunctive pain mediators. Two commonly utilized adjunctive pain modifiers for anterior cruciate ligament (ACL) reconstruction are femoral nerve blockade and intra-articular injection; however, debate remains regarding the more efficacious methodology. Hypothesis: We hypothesized that intra-articular injection with ropivacaine and morphine would be found to be as efficacious as a femoral nerve block for postoperative pain management in the first 24 hours after bone–patellar tendon–bone (BTB) ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Charts were retrospectively reviewed for BTB ACL reconstructions performed by a single pediatric orthopaedic surgeon from 2013 to 2019. Overall, 116 patients were identified: 58 received intra-articular injection, and 58 received single-shot femoral nerve block. All patients were admitted for 24 hours. Pain scores were assessed every 4 hours. Morphine milligram equivalents (MMEs) consumed were tabulated for each patient. Results: Opioid use was 24.3 MMEs in patients treated with intra-articular injection versus 28.5 MMEs in those with peripheral block ( P = .108). Consumption of MMEs was greater in the intra-articular group in the 0- to 4-hour period (7.1 vs 4.6 MMEs; P = .008). There was significantly less MME consumption in patients receiving intra-articular injection versus peripheral block at 16 to 20 hours (3.2 vs 5.6 MMEs; P = .01) and 20 to 24 hours (3.8 vs 6.5 MMEs; P < .001). Mean pain scores were not significantly different over the 24-hour period (peripheral block, 2.7; intra-articular injection, 3.0; P = .19). Conclusion: Within the limitations of this study, we could identify no significant difference in MME consumption between the single-shot femoral nerve block group and intra-articular injection group in the first 24 hours postoperatively. While peripheral block is associated with lower opioid consumption in the first 4 hours after surgery, patients receiving intra-articular block require fewer opioids 16 to 24 hours postoperatively. Given these findings, we propose that intra-articular injection is a viable alternative for analgesia in adolescent patients undergoing BTB ACL reconstruction.

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