Effects of Continuous Passive Motion Following ACL Reconstruction with Autogenous Patellar Tendon Grafts

1992 ◽  
Vol 1 (2) ◽  
pp. 121-131 ◽  
Author(s):  
Carlan K. Yates ◽  
Michael R. McCarthy ◽  
Howard S. Hirsch ◽  
Mark S. Pascale
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Pain Medication ◽  
Continuous Passive Motion ◽  
Passive Motion ◽  
Subjective Pain ◽  
Anterior Cruciate

This study examined the benefits and possible risks of immediate continuous passive motion after autogenous patellar tendon reconstruction of the anterior cruciate ligament. Thirty patients scheduled to undergo ACL reconstruction were prospectively randomized into two groups, CPM and non-CPM. Postoperatively, those in the non-CPM group wore a hinged knee brace. Those in the CPM group were kept on a CPM machine 16 hrs a day while in the hospital and they used it 6 hrs a day for the first 2 weeks postoperatively. After surgery the patients were assessed for hemovac drainage, range of motion, swelling, effusion, subjective pain, and use of pain medication. The CPM group had significantly less swelling and effusion, required less pain medication, and had greater knee flexion. No differences were found in hemovac drainage, passive knee extension, or subjective pain reports despite a significantly greater use of pain medication in the non-CPM group. The results suggest that immediate CPM after ACL reconstruction is safe and facilitates early range of motion by decreasing the amount of pain medication, effusion, and soft tissue swelling.

Effects of Continuous Passive Motion on Anterior Laxity Following ACL Reconstruction with Autogenous Patellar Tendon Grafts

1993 ◽  
Vol 2 (3) ◽  
pp. 171-178 ◽  
Author(s):  
Michael R. McCarthy ◽  
Barton P. Buxton ◽  
Carlan K. Yates
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Continuous Passive Motion ◽  
Anterior Tibial Translation ◽  
Postoperative Rehabilitation ◽  
Passive Motion ◽  
Early Motion ◽  
Anterior Laxity ◽  
Tibial Translation

Continuous passive motion (CPM) is a modality used in the treatment, management, and rehabilitation of a variety of orthopedic problems. Recently, CPM devices have been therapeutically employed immediately after autogenous patellar tendon reconstruction of the anterior cruciate ligament (ACL). Whereas the concept of early motion is indicated, there is a concomitant concern that the implementation of immediate passive motion may stretch or rupture the graft. Twenty subjects scheduled to undergo ACL reconstruction were randomized into two groups (10 CPM and 10 non-CPM). All subjects performed the same postoperative rehabilitation with the exception of the CPM. Objective anterior tibial translation measurements were recorded with a KT-1000 for a 30-1b (133.5-N) Lachman test at 1 year postreconstruction. The results of this study indicated that the implementation of immediate continuous passive motion did not have any deleterious effects on the stability of the ligament reconstruction.

scholarly journals The Utility of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110138
Author(s):  
Taylor D’Amore ◽  
Somnath Rao ◽  
John Corvi ◽  
Robert A. Jack ◽  
Fotios P. Tjoumakaris ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Pain Medication ◽  
Continuous Passive Motion ◽  
Cruciate Ligament Reconstruction ◽  
Passive Motion ◽  
Anterior Cruciate

Background: The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship–trained surgeons report using CPM machines postoperatively. Purpose: To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January 1, 2020, for studies with evidence levels 1 to 3 on the use of CPM for ACLR rehabilitation. Included studies were those that comparatively evaluated postoperative outcomes after ACLR between at least 2 groups of patients, with 1 having received CPM rehabilitation and the other not having received CPM. Results: A total of 12 studies from 1989 to 2019 met the inclusion criteria. These studies included 808 patients who underwent ACLR. There was no evidence of CPM improving knee stability, final postoperative ROM, or subjective pain scores. Additionally, CPM did not lead to decreased muscle atrophy or improved International Knee Documentation Committee scores. Regarding pain medication intake during postoperative hospitalization, 2 studies found that the CPM group used less pain medication, 1 study found the CPM group used more pain medication, and 1 study found that there was no difference between the 2 groups. Complications varied widely, with 2 of 12 studies reporting complications that required a return to the operating room. Conclusion: A clinical benefit of postoperative CPM use after ACLR was not identified in this review. While our systematic review identified a number of studies that suggest CPM use may be associated with lower usage of pain medication in hospitalized patients, this cannot be confirmed without further investigation with standardized CPM protocols and larger sample sizes. Routine CPM use after ACLR was not supported by this systematic review.

scholarly journals GRAFT CHOICE FOR ADOLESCENT ATHLETES RETURNING TO HIGH-RISK SPORTS: A MATCHED COHORT ANALYSIS OF PATELLAR TENDON AND HAMSTRING AUTOGRAFTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Crystal Perkins ◽  
Michael Busch ◽  
Melissa Christino ◽  
Belinda Schaafsma ◽  
S. Clifton Willimon
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Graft Rupture ◽  
Graft Choice ◽  
Anterior Cruciate

Background: Graft selection for skeletally mature adolescents undergoing anterior cruciate ligament (ACL) reconstruction is guided by surgeon and patient preference. In young patients returning to high-risk cutting and pivoting sports, graft rupture is the most feared complication of ACL reconstruction. Some studies have demonstrated slightly lower rates of graft failure and decreased laxity in the short term associated with patellar tendon (BTB) autografts as compared to hamstring (HS) autografts, but these studies are limited by their heterogeneity of ages and activity level1-3. The purpose of this study is to compare the rates of graft failure between BTB and HS ACL reconstruction cohorts matched by age, sex, and sport. Methods: A single-institution retrospective review was performed of consecutive patients less than 19 years of age treated with ACL reconstructions using either patellar tendon (BTB) or hamstring (HS) autograft performed by a single surgeon. Skeletally mature or nearly mature patients in “high-risk” ACL injury sports (basketball, football, soccer, lacrosse, and gymnastics) were initially treated with hamstring autografts but the graft preference transitioned to BTB autografts as the preferred graft choice during the study period. This transition in graft preference for adolescents participating in “high risk” sports allows for a comparison of outcomes based on graft types. Inclusion criteria were ages 13 – 18 years, participation in a “high risk” sport, and minimum 6-month follow-up. The two cohorts of patients were matched by age, gender, and sport. The primary outcome measure was graft rupture. Results: One hundred fifty-two patients with an average age of 16 years (range 13 – 18 years) underwent ACL reconstruction during the study period. There were 71 BTB reconstructions and 81 HS reconstructions. There were 64 females and 88 males. There was no difference in age, sex, BMI, or laterality between groups. There were more patients who played soccer in the BTB cohort (44%) vs HS cohort (20%) and fewer who played basketball in the BTB cohort (24%) vs HS cohort (41%), p = 0.005. There were no differences between the BTB and HS cohorts in terms of meniscus tears (61% v 72%, p = 0.15), meniscus repair (21% v 32%, p = 0.13), or partial meniscectomy (32% v 33%, p = 0.90). Mean duration of follow-up was 28 months (range 7-57 months). There was no difference in follow-up between cohorts (BTB 28 months and HS 29 months, p = 0.19). There were a total of 16 graft ruptures (10.5%). There was no difference in the rate of graft rupture between cohorts (BTB 8.5% vs HS 12.3%, p = 0.60). Mean time to graft rupture was 21 months (range 8 – 35 months) and Kaplan-Meier survival curves demonstrated no difference between cohorts. Conclusions: ACL reconstruction in adolescents returning to high-risk sports can be performed utilizing BTB or HS autografts with similar rates of graft rupture. There is a trend toward lower rates of graft rupture associated with BTB autografts, but additional patients will be necessary to determine if this trend will become a statistically significant difference. Beynnon BD, Johnson RJ, Fleming BC, et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 2002;84(9):1503-1513. Ho B, Edmonds EW, Chambers HG et al. Risk factors for early ACL reconstruction failure in pediatric and adolescent patients: a review of 561 cases. J Pediatr Orthop 2016. Samuelsen BT, Webster KE, Johnson NR, et al. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res 2017;475(10):2459-2468.

Comparison of the Position-Matching and Position-Reproducing Tasks to Detect Deficits in Knee Position Sense After Reconstruction of the Anterior Cruciate Ligament

2020 ◽  
Vol 29 (1) ◽  
pp. 87-92
Author(s):  
Takuma Hoshiba ◽  
Hiroki Nakata ◽  
Yasuaki Saho ◽  
Kazuyuki Kanosue ◽  
Toru Fukubayashi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Position Sense ◽  
Matching Task ◽  
Control Group ◽  
Knee Position ◽  
Anterior Cruciate

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

scholarly journals Strength deficits and flexion range of motion following primary anterior cruciate ligament reconstruction differ between quadriceps and hamstring autografts

2020 ◽  
pp. jisakos-2020-000481
Author(s):  
Peta T Johnston ◽  
Julian A Feller ◽  
Jodie A McClelland ◽  
Kate E Webster
Keyword(s):  
Anterior Cruciate Ligament ◽  
Range Of Motion ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Peak Torque ◽  
Strength Testing ◽  
Isokinetic Strength ◽  
Isokinetic Strength Testing ◽  
Anterior Cruciate ◽  
Anterior Knee

ObjectiveTo determine if anterior cruciate ligament (ACL) reconstruction with a quadriceps tendon (QT) could achieve faster postoperative recovery compared with hamstring tendon (HT) ACL reconstruction.MethodsThirty-seven QT patients were matched for gender, age and preinjury activity level with 74 HT patients. A 6-month postoperative assessment included standardised reported outcome measures: patient-reported outcome measures (PROMs) (International Knee Documentation Committee-subjective knee evaluation form, Knee injury and Osteoarthritis Outcome Score-knee related quality of life subscale, ACL-Return to Sport after Injury scale, Marx activity scale, anterior knee pain), range of motion (active, standing and passive), anterior knee laxity testing, hop tests (single and triple crossover hop for distance) and isokinetic strength testing of the knee extensors and flexors. T-tests or Mann Whitney U tests were used to compare data between groups.ResultsThere were no significant differences between the two groups for any of the PROMs. The HT group had reduced active and standing knee flexion range compared with the QT group (p<0.001). Isokinetic strength testing showed significant deficits in limb symmetry indices for both concentric hamstring peak torque at 60°/s (p<0.001) and 180°/s (p=0.01) in the HT group. There were significantly greater deficits in limb symmetry indices for concentric quadriceps peak torque at 60°/s (p<0.001) and 180°/s (p=0.001) in the QT group.ConclusionThe QT graft does not appear to offer a more rapid recovery in terms of knee symptoms or function which could have allowed for faster progression to the dynamic phases of rehabilitation.Level of evidenceLevel III.

scholarly journals Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale

2017 ◽  
Vol 45 (7) ◽  
pp. 1567-1573 ◽  
Author(s):  
Nathan D. Schilaty ◽  
Nathaniel A. Bates ◽  
Thomas L. Sanders ◽  
Aaron J. Krych ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Population Based ◽  
Contralateral Side ◽  
Activity Level ◽  
Acl Injuries ◽  
Acl Tear ◽  
Anterior Cruciate

Background: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. Purpose: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type. Results: Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012). Conclusion: The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.

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