scholarly journals Evaluation of the intensive rehabilitation protocol after arthroscopically assisted anterior cruciate ligament reconstruction

2006 ◽  
Vol 134 (11-12) ◽  
pp. 532-536 ◽  
Author(s):  
Emilija Dubljanin-Raspopovic ◽  
Marko Kadija ◽  
Dragana Matanovic
Keyword(s):  
Statistical Tests ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Thigh Circumference ◽  
Hop Test ◽  
Arthroscopically Assisted ◽  
Approach Method ◽  
Anterior Cruciate ◽  
A Prospective Study ◽  
Intensive Rehabilitation

Introduction: Optimal treatment of ACL (anterior cruciate injury) injuries is one of the most dynamic topics of contemporary orthopedics. Despite huge amount of publications on this subject, golden rehabilitation standard has not been established yet. Objective: The aim of our study was to compare two different rehabilitation groups in respect to dynamics and safety of recovery, and accordingly to recommend contemporary rehabilitation approach. Method: A prospective study included 45 patients with unilateral ACL rupture who were randomized into conservative (THC) and intensive rehabilitation (TH-I) group. The arthroscopic reconstruction of ACL was performed using the BTBP or STG graft. After the operation, in the TH-C group, ROM was limited to 0-0-90? and weight bearing was not allowed in the first 4 postoperative weeks. In the TH-I group, progression depended only on the knee edema and pain. The groups were compared in relation to demographic, anamnestic, and clinical characteristics (knee circumference, thigh circumference, stability tests, Lysholm, Tegner and one-leg hop test, and single stance test). Data were recorded preoperatively and postoperatively after 6 weeks, 4, 6, 9 and 12 months, and compared with parametric and non-parametric statistical tests. Results: The investigated groups clearly differed already after 6 weeks by range of motion (p<0.05), thigh circumference (p<0.01) and Lysholm test score (p<0.01), after 4 months in relation to one leg hop test (p<0.05), and after 6 months according to Tegner test (p<0.01). In the TH-I group, graft integrity was not compromised in any of these patients, nor did postoperative arthrofibrosis develop. Conclusion: Our investigation has undoubtedly revealed that early intensive rehabilitation approach leads to faster functional recovery without complications compared to conventional rehabilitation treatment.

Effect of Drain Placed in the Donor Site in the Early Postoperative Period after Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendons

2005 ◽  
Vol 33 (6) ◽  
pp. 900-906 ◽  
Author(s):  
Mustafa Karahan ◽  
Bülent Erol ◽  
Nural Bekiroglu ◽  
Derya Uyan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Early Postoperative Period ◽  
Thigh Circumference ◽  
Cruciate Ligament Reconstruction ◽  
Arthroscopically Assisted ◽  
Anterior Cruciate

Background No scientific study has addressed the effects of the routine use of postoperative drains in the donor site after arthroscopic anterior cruciate ligament reconstruction using hamstring tendons. Hypothesis Patients who have drains placed in their donor sites have less lower extremity edema, more motion, and more comfort in the early postoperative period. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Thirty-four patients undergoing arthroscopically assisted quadruple hamstring tendon anterior cruciate ligament reconstruction were randomly assigned to either receive a drain for 24 hours placed at the donor site (17 patients) or have no drain at the donor site (17 patients). Data were collected on postoperative days 1, 3, 5, and 7 regarding knee flexion, knee extension, thigh circumference, leg circumference, and visual analog scale (measuring pain). Results In the study group versus the control group, there were increased knee flexion measurements on postoperative day 7 (84° vs 69°, P <. 05); smaller thigh circumference measurements on postoperative day 7 (36.8 vs 40.1 cm, P <. 05); smaller leg circumference measurements on postoperative days 3 (33.2 vs 36.4 cm, P <. 05), 5 (32.7 vs 36.0 cm, P <. 05), and 7 (31.8 vs 35.7 cm, P <. 001); and a lower visual analog scale score on postoperative days 3 (40.38 vs 57.50, P =. 001), 5 (38.46 vs 60.35, P =. 001), and 7 (38.07 vs 61.43, P =. 001). Conclusion Drain placement at the donor site after anterior cruciate ligament reconstruction gives more comfort to the patient and provides better flexion within the first week.

scholarly journals Comparison of Lower Extremity Recovery After Anterior Cruciate Ligament Reconstruction With Transphyseal Hamstring Versus Extraphyseal Iliotibial Band Techniques in Skeletally Immature Athletes

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876804 ◽  
Author(s):  
Dai Sugimoto ◽  
Benton E. Heyworth ◽  
Sara E. Collins ◽  
Ryan T. Fallon ◽  
Mininder S. Kocher ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Test Performance ◽  
Dynamic Balance ◽  
Cruciate Ligament ◽  
Iliotibial Band ◽  
Thigh Circumference ◽  
Hop Test ◽  
Male Patients ◽  
Anterior Cruciate ◽  
Hamstring Grafts

Background: The influence of graft type on recovery after anterior cruciate ligament reconstruction (ACLR) has not been adequately studied in pediatric patients. Purpose: To describe lower extremity functional recovery parameters at the 6-month mark after ACLR across 3 distinct groups of skeletally immature patients: pediatric male patients with transphyseal hamstring grafts (PM-HS), pediatric female patients with transphyseal hamstring grafts (PF-HS), and pediatric male patients with extraphyseal iliotibial band grafts (PM-ITB). Study Design: Cohort study; Level of evidence, 3. Methods: Thigh circumference, knee range of motion, lower extremity strength, dynamic balance, and hop test performance were assessed in all patients 6 months postoperatively. All participants were ≤15 years of age with open physes. The limb symmetry index was used to compare deficits between the operated and uninvolved limbs for all 3 groups (PM-HS, PF-HS, and PM-ITB). Analysis of variance with post hoc correction was employed. Results: A total of 93 pediatric patients who underwent ACLR (PM-HS: n = 21 [mean age, 13.6 ± 1.0 years]; PF-HS: n = 33 [mean age, 13.4 ± 0.7 years]; PM-ITB: n = 39 [mean age, 12.5 ± 1.3 years]) were examined. There was no statistically significant difference in thigh circumference, range of motion, dynamic balance, or hop test performance between the groups. Of the various additional comparisons analyzed, there were statistical differences in hamstring strength deficits among the 3 groups ( P = .004). The PM-HS group showed a greater hamstring strength deficit (–32.2% relative to healthy limb) than the PM-ITB group (–5.4% relative to healthy limb) ( P = .012). The hamstring strength deficit of the PF-HS group (–18.7% relative to healthy limb) was less than that of the PM-HS group and greater than that of the PM-ITB group but not statistically significant in either case. Conclusion: Significant hamstring strength deficits were detected in the PM-HS group compared with the PM-ITB group at 6 months following ACLR. Such findings may influence decisions regarding graft selection, timing of return to sports, and postoperative rehabilitation regimens.

Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Willem M.P. Heijboer ◽  
Mathijs A.M. Suijkerbuijk ◽  
Belle L. van Meer ◽  
Eric W.P. Bakker ◽  
Duncan E. Meuffels
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Model ◽  
Gracilis Tendon ◽  
Thigh Circumference ◽  
Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

scholarly journals USE CAUTION WHEN ASSESSING PRE-OPERATIVE LEG LENGTH DISCREPANCY IN PEDIATRIC PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT INJURIES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0028
Author(s):  
Lindsay M. Schlichte ◽  
Peter D. Fabricant ◽  
Christine Goodbody ◽  
Daniel W. Green
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Acl Injury ◽  
Leg Length ◽  
Full Extension ◽  
X Ray ◽  
Length Discrepancy ◽  
Anterior Cruciate

Background: Pre- and post-operative standing hip to ankle radiography is critical for monitoring potential post-operative growth arrest and resultant length and angular deformities after pediatric anterior cruciate ligament (ACL) reconstruction. During acquisition of pre-operative standing alignment radiographs, it is possible that patients are lacking full extension, not weight bearing comfortably, or leaning resulting in inaccurate measurements. Purpose: This study aims to assess both pre- and post-operative radiographic measurements to assess if the standing pre-operative x-ray is a accurate and reliable source for baseline measurements. Methods: We retrospectively reviewed prospectively collected pre-operative and first post-operative full-length hip-to-ankle radiographs in a cohort of skeletally immature athletes who presented with an acute ACL injury and underwent subsequent surgical reconstruction. Initially, leg length discrepancy for 25 patients was measured by 3 orthopedic surgeons (top of femoral head to center of tibial plafond). The intraclass correlation was almost perfect (ICC (2,1) = .996) therefore, 1 surgeon measured the remaining 94 radiographs. Measurements for both the injured and uninjured legs were obtained for comparison and surgeons were blinded to the injured side. Results: A total of 119 pediatric patients (mean age 13.4, range 7-14 years) were included (83 males and 36 females). Patient were categorized as either having ≥5mm, ≥10mm, or ≥15mm LLD on pre-operative standing x-ray. Sixty-two patients (52%) were found to have a pre-operative LLD ≥ 5mm. Forty-one (66%) of these patients tore their ACL on the limb measuring shorter. At 6 month post-operative standing x-ray, 35 patients (56%) resolved to ≤5mm LLD. Eighteen patients had a pre-operative LLD of ≥ 10mm. At 6 month post-operative standing x-ray, 13 (72%) patients resolved to ≤5mm LLD. Five patients had a pre-operative LLD of ≥ 15mm. At 6 month post-operative standing x-ray, 4 (80%) resolved ≤5mm. All patients with a pre-operative LLD of ≥ 13mm had sustained an ACL injury on the limb measuring shorter Conclusion: Of the pediatric ACL patients initially presenting with a pre-operative LLD of ≥ 10mm, 72% demonstrated apparent correction of their LLD on their 6 month standing x-ray. This high rate of LLD pre-operatively but not post operatively calls into question the accuracy of pre-operative standing alignment radiographs for patients after an ACL tear. Surgeons and radiology technicians should be aware of injured patients potentially lacking full extension, leaning, or not weight bearing comfortably, and should consider delaying preoperative radiographic length and alignment analysis until after the patient is able to fully straighten the injured knee and weight bear comfortably.

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