Current Concepts on Accelerated ACL Rehabilitation

1994 ◽  
Vol 3 (4) ◽  
pp. 304-318 ◽  
Author(s):  
Mark S. De Carlo ◽  
Kecia E. Sell ◽  
K. Donald Shelbourne ◽  
Thomas E. Klootwyk
Keyword(s):  
Range Of Motion ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Extension ◽  
Autogenous Bone ◽  
Second Phase ◽  
Rehabilitation Protocol ◽  
Rehabilitation Programs ◽  
Accelerated Rehabilitation ◽  
Patient Will

It is well established that intra-articular anterior cruciate ligament reconstruction with autogenous bone-patellar tendon-bone graft provides satisfactory long-term stability. However, the rehabilitation programs employed following this surgical procedure have been a topic of considerable debate. This paper describes an accelerated rehabilitation protocol that is divided into four phases. The first phase encompasses the preoperative period, during which the patient will work to decrease swelling and restore range of motion and strength. The second phase involves Weeks 1 and 2 following surgery, with the patient emphasizing immediate terminal knee extension and weight bearing. The final two phases involve improving lower extremity strength and full return to daily and athletic activities. This accelerated rehabilitation protocol has resulted in an earlier return of range of motion and strength without compromising ligamentous stability.

scholarly journals Rehabilitation following meniscal repair: a systematic review

2018 ◽  
Vol 4 (1) ◽  
pp. e000212 ◽  
Author(s):  
Robert C Spang III ◽  
Michael C Nasr ◽  
Amin Mohamadi ◽  
Joseph P DeAngelis ◽  
Ara Nazarian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Clinical Studies ◽  
Weight Bearing ◽  
Meniscal Repair ◽  
Rehabilitation Protocol ◽  
Early Motion ◽  
Accelerated Rehabilitation ◽  
Rehabilitation Protocols ◽  
Meta Analyses

ObjectiveTo review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.Methods and data sourcesFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies.ResultsSeventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.ConclusionsThere is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.

ACL Surgery and Accelerated Rehabilitation: Revisited

1997 ◽  
Vol 6 (2) ◽  
pp. 144-156 ◽  
Author(s):  
Mark De Carlo ◽  
Thomas E. Klootwyk ◽  
K. Donald Shelbourne
Keyword(s):  
Cruciate Ligament ◽  
Weight Bearing ◽  
Full Range ◽  
Knee Extension ◽  
Rehabilitation Program ◽  
Accelerated Program ◽  
Lower Extremity Strength ◽  
Accelerated Rehabilitation ◽  
Anterior Cruciate ◽  
Two Phases

Rehabilitation following intraarticular anterior cruciate ligament (ACL) reconstruction has undergone a dramatic evolution during the last decade. This paper describes our accelerated rehabilitation program, which is divided into four phases. The preoperative phase begins immediately after injury and emphasizes control of swelling and restoration of full range of motion (ROM) and strength before surgery. Phase II, which includes the first 2 weeks after surgery, emphasizes helping the patient obtain full terminal knee extension and weight bearing. The final two phases focus on improving lower extremity strength and full return to daily and athletic activities. This accelerated program has resulted in an earlier return of ROM and strength as well as a decrease in postoperative procedures, without compromising ligamentous stability.

scholarly journals Multi-Ligament Knee Injury with Concomitant Tibial Tubercle Fracture: A Challenging Case Report and Review of the Pertinent Literature

2021 ◽  
Author(s):  
Mohammad Tahami ◽  
Arash Sharafat Vaziri ◽  
Mohammad Naghi Tahmasebi ◽  
Fardis Vosoughi ◽  
Majid Khalilizad ◽  
...  
Keyword(s):  
Case Report ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Full Range ◽  
The Body ◽  
Tibial Tubercle ◽  
Partial Weight Bearing ◽  
Rehabilitation Protocol ◽  
Partial Weight

Background: Multi-ligament knee injury (MLKI) combined with a comminuted tibial tubercle avulsion fracture in the literature has been reported as a very rare condition. To the best of our knowledge, there was no case report of this condition associated with open proximal tibia fractures. Case Report: A 32-year-old man was referred to our center, with a comminuted tibial tubercle fracture, patella alta, fracture of the tibia at the proximal meta-diaphyseal junction, a Segond fracture, and proximal tibiofibular dislocation on X-ray images. Further assessment of intra-articular pathologies was performed during the operation and complete tear of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tear were identified. Radial tear of the body and anterior root avulsion of medial meniscus were also noted. All of the extra-articular and intra-articular injuries were addressed surgically, except ACL and PCL tear, which were postponed to a second stage. Proximal tibiofibular dislocation was not approached surgically. The rehabilitation protocol included 6 weeks of non-weight-bearing followed by 6 weeks of crutch-assisted partial weight-bearing ambulation, and forbidden active knee extension during the first 6 weeks and allowing the patient to perform passive flexion of the knee to 90 degrees starting from the second week. Following the rehabilitation program, the patient achieved near-full range of motion (ROM) by the end of 6 months of clinical follow-up. Conclusion: By means of our specific surgical technique and post-operative rehabilitation protocol, we led the patient with this specific condition to have fracture union and near-normal ROM by the end of 6 months.

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.

scholarly journals Correlation between Dorsiflexion Ankle Range of Motion and Patellofemoral Pain Syndrome

2018 ◽  
Vol 20 (2) ◽  
pp. 135
Author(s):  
Isabella Pereira Da Silva ◽  
Baldomero Antonio Kato da Silva ◽  
Daniel Martins Pereira ◽  
Ana Carolina Dos Santos Demarchi ◽  
Silvio Assis de Oliveira-Junior ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Movement Pattern ◽  
Pain Syndrome ◽  
Patellofemoral Pain ◽  
Patellar Tendinopathy ◽  
Iliotibial Band ◽  
Control Group ◽  
Iliotibial Band Syndrome

Abstract The change in lower extremity movement pattern has been previously associated with severe knee disorders, including anterior cruciate ligament rupture, patellar tendinopathy, iliotibial band syndrome, and patellofemoral pain (PFP). The aim of this study was to verify the clinical reliability of ankle dorsiflexion range of motion (ADROM) measurement with weight bearing (WB) using an app on the smartphone (iHand) and to verify if there is correlation between the limitation of the ADROM and the PFP. A total of 67 women, mean age 34.3 ± 2.4, height 182 ± 3.6, weight 73.7 ± 4.2, were allocated to the control group (n = 23) and the PFP group (n = 23). Two examiners evaluated the active ADROM (lunge test) in both ankles at two times to test inter-examiner and intra-examiner reliability. It was observed in the PFP group that the mean ADROM was 17.7 ± 2.5 and the control group was 35.3 ± 6.2 (right) and 17.1 ± 2.9 and 32.9 ± 5, 4 (left). It is concluded that the use of the smartphone app proved to be reliable for clinical application in the evaluation of ADROM with WB and that there is a relation between the low DFT of DFT with the presence of patellofemoral pain.Keywords: Data Accuracy. Ankle. Patellofemoral Pain Syndrome.Resumo A alteração no padrão de movimento da extremidade inferior tem sido previamente associada com severas desordens do joelho, incluindo a ruptura do ligamento cruzado anterior, tendinopatia patelar, síndrome da banda iliotibial e dor patelofemoral - DPF. O objetivo do estudo foi verificar a confiabilidade clínica da mensuração da dorsiflexão de tornozelo - DFT com descarga de peso - WB utilizando um app no smartphone (iHand) e verificar se há correlação entre a limitação da DFT com a DPF. Participaram 67 mulheres, idade média 34,3±2,4, altura 182±3,6, peso 73,7±4,2, alocadas em grupo controle (n=23) e grupo DFP (n=23). Dois examinadores avaliaram a DFT ativa (lunge test) em ambos os tornozelos em dois momentos para se testar a confiabilidade inter-examinador e intra-examinador. O coeficiente de correlação intraclasse - CCI foi utilizado para a análise da confiabilidade das medidas. Observou-se alta confiabilidade (0,9965 [p<0,0001]) e (0,9949 [p<0,0001]) para tornozelo direito e esquerdo respectivamente. Observou-se no grupo DFP que a ADM média de DFT foi de 17,7±2,5 e grupo controle de 35,3±6,2 (direito) e 17,1±2,9 e 32,9±5,4 (esquerdo). Conclui-se que a utilização do app de smartphone se mostrou confiável para aplicação clínica na avaliação da DFT com WB e que há relação entre a baixa ADM de DFT com a presença de dor patelofemoral.Palavras-chave: Acurácia dos Dados. Tornozelo. Síndrome da Dor Patelofemoral

scholarly journals Lower-Extremity Compensations Following Anterior Cruciate Ligament Reconstruction

2000 ◽  
Vol 80 (3) ◽  
pp. 251-260 ◽  
Author(s):  
Gregory P Ernst ◽  
Ethan Saliba ◽  
David R Diduch ◽  
Shepard R Hurwitz ◽  
Donald W Ball
Keyword(s):  
Anterior Cruciate Ligament ◽  
Lower Extremity ◽  
Cruciate Ligament ◽  
Vertical Jump ◽  
Weight Bearing ◽  
Knee Extension ◽  
Isokinetic Testing ◽  
Anterior Cruciate ◽  
Platform System ◽  
Femoris Muscle

AbstractBackground and Purpose. Several studies have demonstrated that patients with knee injury scored within a normal range during one-legged hop tests yet showed quadriceps femoris muscle weakness with non–weight-bearing isokinetic testing. This study evaluated lower-extremity kinetics while subjects performed a single-leg vertical jump (VJ) and a lateral step-up (LSU) in an attempt to explain this phenomenon. Subjects and Methods. Using a motion analysis and force platform system, hip, knee, and ankle extension moments of 20 subjects with anterior cruciate ligament (ACL) reconstructions and 20 matched subjects were measured while they performed an LSU and a VJ. Results. An analysis of variance revealed that the knee extension moment of the ACL-reconstructed extremity was lower than that of the uninjured and matched extremities during the LSU, VJ take-off, and VJ landing. However, there was no difference in summated extension moment (hip + knee + ankle) among extremities during the LSU and VJ take-off. The summated extension moment of the ACL-reconstructed extremity during VJ landing was less than that of the uninvolved and matched extremities. Conclusions and Discussion. These results suggest that the hip or ankle extensors may compensate for the knee extension moment deficit. The decrease in summated extension moment in the ACL-reconstructed extremity during VJ landing represents inadequate attenuation of landing forces, which may expose the skeleton and joint structures to injury.

PHYSIOTHERAPY AFTER SURGICALLY STABILIZED PROXIMAL TIBIA FRACTURE

2020 ◽  
Vol 18 (2) ◽  
pp. 156-160
Author(s):  
R. Tasheva
Keyword(s):  
Proximal Tibia ◽  
Weight Bearing ◽  
Lateral Compartment ◽  
Recovery Phase ◽  
Knee Extension ◽  
Tibia Fracture ◽  
Extension Deficit ◽  
Proximal Tibia Fracture ◽  
Ao Classification ◽  
Correct Function

THE AIM OF THIS STUDY is to present the physiotherapy for overcoming the substitution movements and to restore the correct function in the phase of relative protection after surgical stabilized proximal tibia fracture. Material and method Seven patients after fracture in the proximal lateral compartment of the tibia (type b1 in AO classification) with an average age of 42, 9 years were treated. After surgery, an average of 30 days of the brace was used for relative protection. The aim of the physiotherapy was to overcome muscle imbalance to achieve proper movement in the respective planes. Emphasis on recovery was the proper weight bearing on the operated lower limb. RESULTS The results of the first recovery phase demonstrated very limited knee flexion in range of 22, 7º, and knee extension deficit in the range of -15º. After two weeks the results progressed to 115, 5º flexion and full restoration of the extension. Control of edema and hypotrophy of the thigh were proven by circumference. CONCLUSION The adequate physiotherapy provides overcoming of the substitution movements and to restore the correct knee function in the phase of relative protection after surgical stabilized fracture in the proximal tibia.

Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements

2017 ◽  
Vol 30 (08) ◽  
pp. 829-834
Author(s):  
Frank Madsen ◽  
Anders Odgaard ◽  
Jens Borgbjerg
Keyword(s):  
Range Of Motion ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Patient Assessment ◽  
Limits Of Agreement ◽  
Self Assessment ◽  
Knee Motion ◽  
Bland Altman Method ◽  
Flexion And Extension ◽  
Patient Self Assessment

AbstractThe purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of −2.1 degrees (−42.5 to 38.3 degrees) for flexion and −8.1 degrees (−28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.

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