scholarly journals Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Daniel Jewiss ◽  
Cecilia Ostman ◽  
Neil Smart
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Kinetic Chain ◽  
Randomized Controlled ◽  
Open Kinetic Chain ◽  
Closed Kinetic Chain ◽  
Anterior Cruciate ◽  
Open Versus

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.

scholarly journals Evaluation of the Effect of Two Exercise Regimes in Producing Forces on Anterior Cruciate Ligaments: A Systematic Review

2007 ◽  
Author(s):  
Carla van Usen ◽  
Barbara Pumberger
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Methodological Quality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
The Body ◽  
Kinetic Chain ◽  
Significant Difference ◽  
Open Kinetic Chain ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are common. A goal of rehabilitation is to restore functional capacity. Currently, there are contrary opinions regarding the effectiveness of using either closed or open kinetic chain exercises (CKC, OKC) only, or a combination of both, following ACL injury, to obtain the most effective outcome. The debate also reflects the approach which places the least force on the ACL itself. Objective: To identify the evidence of effectiveness of closed versus open kinetic chain exercises, or a combination of both, in anterior cruciate ligament rehabilitation. Methods: A systematic review was undertaken of experimental studies published since 1990. Included studies were on humans with ACL injury. The ACL ligament could be healthy, ruptured, deficient or reconstructed. Studies on animals and cadavers were excluded. The methodological quality of included studies was appraised with the PEDro tool. Studies were graded according to hierarchy level, methodological quality, statistical significance, effect size, and clinical relevance. Recommendations were made on the strength of the body of evidence. The outcome measure of interest was force on the ACL during exercise. Results: 23 eligible studies were included. The majority of studies reflected lower level experimental designs with moderate methodological quality. Three studies showed a significant difference in ACL force comparing CKC and OKC exercises, 11 demonstrated trends towards significant differences in outcome and nine showed no significant differences. Conclusion: There is moderate evidence to recommend CKC exercises or a combination of CKC and OKC exercises, rather than OKC exercises alone, for ACL rehabilitation when considering forces on the ACL.

Anterior Cruciate Ligament Reconstruction Alone Versus With Lateral Extra-articular Tenodesis With Minimum 2-Year Follow-up: A Meta-analysis and Systematic Review of Randomized Controlled Trials

2021 ◽  
pp. 036354652110049
Author(s):  
James Randolph Onggo ◽  
Hari Krishnan Rasaratnam ◽  
Mithun Nambiar ◽  
Jason Derry Onggo ◽  
Vishal Pai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cruciate Ligament Reconstruction ◽  
Randomized Controlled ◽  
Anterior Cruciate

Background: Lateral extra-articular tenodesis (LEAT) aims to improve anterolateral stability of the injured knee during anterior cruciate ligament reconstruction (ACLR) surgery. Inconclusive evidence surrounding the efficacy and safety of LEAT has propelled clinical interest and ongoing discussions. Purpose: To establish level 1 evidence by assessing randomized controlled trials (RCTs) with minimum 2-year follow-up that directly compared ACLR with LEAT (LEAT group) and ACLR alone (non-LEAT group) in terms of clinical outcomes and complications. Study Design: Meta-analysis and systematic review; Level of evidence, 1. Methods: Meta-analysis was performed with a multidatabase search (Cochrane, EMBASE, OVID Medline, PubMed, and Web of Science) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on September 9, 2020. Data from published RCTs meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. Results: A total of 7 RCTs were included, consisting of 517 LEAT and 589 non-LEAT patients. Only autografts were used for ACLR and LEAT. A variety of LEAT techniques and autograft fixation methods were used. We found improved stability (residual positive pivot shift: risk ratio [RR], 0.59; 95% CI, 0.39-0.88; P = .01) and better clinical outcomes (International Knee Documentation Committee [IKDC] score: mean difference [MD], 2.31; 95% CI, 0.54-4.09; P = .01; and Lysholm score: MD, 2.71; 95% CI, 0.68-4.75; P = .009) in the LEAT than non-LEAT group. Graft rerupture rate was 3 times less likely (RR, 0.31; 95% CI, 0.17-0.58; P < .001) in the LEAT group than the non-LEAT group. Conclusion: Good-quality evidence is available to support the efficacy of LEAT in improving anterolateral knee stability and reducing graft reruptures in primary ACLR. LEAT should be considered in patients with high risk factors. Although Lysholm and IKDC scores were statistically better in the LEAT group, these are unlikely to be clinically significant. Future studies should aim to identify patient populations that would best benefit from LEAT with ACLR.

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