High Frequency Transcutaneous Electrical Nerve Stimulation in the Immediate Postoperative Period of Anterior Cruciate Ligament Reconstruction and Its Effects on Drug Costs During Hospitalization

The Purpose was to improve the treatment outcomes of patients who undergo ACL reconstruction under arthroscopic control through a comprehensive approach to their rehabilitation program. Materials and methods. We have implemented a system of comprehensive rehabilitation of patients after the ACL reconstruction under arthroscopic control, which relied on the phase of the clinical course of the postoperative period.Results. The study involved 40 patients who underwent anterior cruciate ligament reconstruction under arthroscopic control. Experimental group (20 people) who applied a comprehensive approach in rehabilitation after ACL reconstruction, taking into account the phase of the clinical course of the postoperative period. The second group was the control group (20 patients) in which rehabilitation was carried out under the existing program. The use of cryotherapy with adjustable pulse compression in patients of the experimental group from the first day allowed to reduce twice the use of non-narcotic analgesics. Analyzing the dynamics of flexion in the knee joint, it was found that patients of the experimental group on the 25th day performed flexion by 88.46% of the appropriate maximum. Whereas in the control group just - 69.23%. Positive dynamics were noted in the indicators of myotonometry of the quadriceps muscle and measurement of the perimeter of the knee joint.Conclusions. The program of physical rehabilitation of patients after the anterior cruciate ligament reconstruction under arthroscopic control, which was built taking into account the phase of the clinical course of the postoperative period, has been developed and offered positive results in clinical practice. The effectiveness of the program was shown by the improvement of such indicators as: decrease in intensity of pain syndrome in the early postoperative period, increase in the range of motion in the knee joint, faster restoration of the tone of the quadriceps muscle of the thighs of patients of the experimental group as opposed to the control group

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Our Point of View at Rehabilitation After Anterior Cruciate Ligament Reconstruction

10.37647/0132-2486-2020-106-3-9-17 ◽

2020 ◽

Vol 106 (3) ◽

pp. 9-17

Author(s):

I.M. Zazirnyi ◽

O.O. Kostrub ◽

V.V. Kotiuk ◽

O.V. Plugatar

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Postoperative Period ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Rehabilitation Program ◽

Early Postoperative Period ◽

Sports Activity ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Summary. The article presents rehabilitation program for the patients after anterior cruciate ligament reconstruction. The program is used at the Feofaniya Hospital’s Center of Orthopedics, Traumatology and Sports Medicine and at the Department of Sports and Ballet Injuries of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The rehabilitation course is divided on five periods: 1) preoperative period; 2) early postoperative period (acute) (0–2 weeks); 3) function restoring period (up to 9 week); 4) period of preparing and gradual returning to recreation and sports activity (from 9 week); 5) period of returning to full sports activity (after 6–9 months, depending on the type of sport). Principles of postoperative care and rehabilitation in our clinics are as follows: 1) decreasing pain, swelling, and inflammation; 2) full load of the operated on limb with or without crutches; 3) immediate exercises to restore range of motion from 0° to 60–90°, with gradually increase to 120° and full flexion after 6–9 weeks postoperatively (using continuous passive motion; passive, active assisted, and active exercises); 4) exercises for training quadriceps muscle, shin flexor muscles and all lower limb and pelvis muscles, with increasing resistance in close and open kinetic chains; 5) exercises for training proprioception and coordination (from early postoperative period); 6) return to work after 3–6 weeks, health-improvement and sports activity after 4, 6, and 9 months; 7) close cooperation between a surgeon, a rehabilitologist, and a patient during rehabilitation. We focus on achieving the fastest full extension of the knee joint, muscle control and restoration of proprioception. Exercises are performed in closed and open kinetic chains, with muscles tension in the back of the thigh and shin, in the way to avoid too much stress on transplantate. In cases of athletes and recreational active patients, elements of sports specific exercises were included to the rehabilitation program (from early postoperative period). That helped to restore proper patterns of movements and to overcome physical barrier in returning to full sports activity. Return to sport was allowed patients when achieved full range of motion, normal proprioception and balance of muscles; functional tests results were about 90% of the norm and there was no pain or swelling during exercise loads.

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Editorial Commentary: Tranexamic Acid Is Beneficial in the Very Early Postoperative Period in Anterior Cruciate Ligament Reconstruction Patients

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.03.016 ◽

2021 ◽

Vol 37 (6) ◽

pp. 1890-1891

Author(s):

En-Rung Chiang ◽

Kun-Hui Chen ◽

Hsiao-Li Ma

Keyword(s):

Anterior Cruciate Ligament ◽

Tranexamic Acid ◽

Anterior Cruciate Ligament Reconstruction ◽

Postoperative Period ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Early Postoperative Period ◽

Cruciate Ligament Reconstruction ◽

Editorial Commentary ◽

Anterior Cruciate

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Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120982293 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098229

Author(s):

Patrick J. Burroughs ◽

Joseph B. Kahan ◽

Harold G. Moore ◽

Jonathan N. Grauer ◽

Elizabeth C. Gardner

Keyword(s):

Anterior Cruciate Ligament ◽

Physical Therapy ◽

Anterior Cruciate Ligament Reconstruction ◽

Postoperative Period ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Study Cohort ◽

Cruciate Ligament Reconstruction ◽

The Mean ◽

Anterior Cruciate

Background: Physical therapy (PT) rehabilitation is critical to successful outcomes after anterior cruciate ligament reconstruction (ACLR). Later-stage rehabilitation, including sport-specific exercises, is increasingly recognized for restoring high-level knee function. However, supervised PT visits have historically been concentrated during the early stages of recovery after ACLR. Purpose/Hypothesis: To assess the number and temporal utilization of PT visits after ACLR in a national cohort. We hypothesized that PT visits would be concentrated early in the postoperative period. Study Design: Descriptive epidemiological study. Methods: The Humana PearlDiver database was searched to identify patients who underwent ACLR between 2007 and 2017. Patients with additional structures treated were excluded. The mean ± SD, median and interquartile range (IQR), and range of number of PT visits for each patient were determined for the 52 weeks after ACLR. PT visits over time were also assessed in relation to patient age and sex. Results: In total, 11,518 patients who underwent ACLR met the inclusion criteria; the mean age was 32.62 ± 13.70 years, and 42.7% were female patients. Of this study cohort, 10,381 (90.4%) had documented PT postoperatively; the range of PT visits was 0 to 121. On average, patients had 16.90 ± 10.60 PT visits (median [IQR], 16 [9-22]) after ACLR. Patients completed a mean of 52% of their PT visits in the first 6 weeks, 75% in the first 10 weeks, and 90% in the first 16 weeks after surgery. Patients aged 10 to 19 years had the highest number of PT visits (mean ± SD, 19.67 ± 12.09; median [IQR], 18 [12-25]), significantly greater than other age groups ( P < .001). Conclusion: PT after ACLR is concentrated in the early postoperative period. Physicians, therapists, and patients may consider adjusting the limited access to PT to optimize patient recovery. Clinical Relevance: As supervised PT visits may be limited, the appropriate temporal utilization of supervised PT visits must be maximized. Strategies to ensure sessions for later neuromuscular and activity-specific rehabilitation are needed.

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