scholarly journals The Impact of Various Physiotherapy Programs on the Balance, Knee Proprioception, and Flexors/Extensors Strength after Anteriorcruciate Ligament Reconstruction

2020 ◽  
Vol 2 (5) ◽  
Author(s):  
Vilma Juodžbalienė ◽  
Akvilė Šimkuvienė ◽  
Marius Brazaitis ◽  
Tomas Darbutas
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Neuromuscular Training ◽  
Control Group ◽  
Static Balance ◽  
Trial Group ◽  
Physiotherapy Program ◽  
Anterior Cruciate ◽  
Knee Flexors

The decrease in knee flexors and extensors strength and poor balance are related to the impairment of the knee proprioception after anterior cruciate ligament reconstruction [1, 2]. Therefore, it is important to assess the impact of various physiotherapy programs on static balance, knee proprioception, and thigh muscle strength, and at the same time pursue the qualitative rehabilitation as well as look for the possibilities of assessment of knee proprioception using the isokinetic dynamometer. Twenty volunteers (aged 26–36 years) participated in the study four–five weeks after anterior cruciate ligament reconstruction. The participants were divided into two groups: trial group (n = 10; two women, eight men) and control group (n = 10; two women, eight men). Complementary neuromuscular training and the ordinary physiotherapy program were applied to the trial group for three weeks; the control group received only the ordinary physiotherapy program. Static balance (using Balance error scoring system), knee proprioception (using the isokinetic dynamometer), and thigh muscle strength (using Lovett scale) were determined before and after the three-week intervention period. Participants had to indicate the position of the tested leg, i. e. whether the knee was flexed at 30 or 60 degrees. We established the difference between the indicated and real position of the leg in degrees. The mentioned difference indicated the state of knee proprioception. The outcomes of static balance significantly improved after three weeks of physiotherapy in both groups: trial group — from 12.3 ± 3.4 to 2.1 ± 0.8 errors (p < 0.01), control group – from 12.2 ± 1.6 to 4.2 ± 0.9 errors (p < 0.01). Also, the trial and control groups demonstrated improved condition of knee proprioception at both angular velocities of 15 degrees/s and 30 degrees/s. There were no differences between standard means of knee flexors strength before the intervention. The outcomes of knee flexors strength of the trial group were significantly higher as compared to the outcomes demonstrated by the control group (p < 0.05). There were no significant differences in knee extensors strength between both groups. Thus, values of static balance, knee proprioception, and flexors/extensors strength change more rapidly when frequent and longer neuromuscular training is applied. The ordinary physiotherapy program has a positive but less effect on the above mentioned variables.Keywords: anterior cruciate ligament, static balance, proprioception, muscle strength, neuromuscular training.

scholarly journals A complex approach in rehabilitation of the patients after the anterior cruciate ligament reconstruction

2019 ◽  
Vol 5 (3) ◽  
pp. 37
Author(s):  
I.Ya Hrubar ◽  
Yu.O. Hrubar ◽  
N.M. Grabyk
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Postoperative Period ◽  
Ligament Reconstruction ◽  
Clinical Course ◽  
Cruciate Ligament ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Experimental Group

<p><strong>The Purpose</strong> was to improve the treatment outcomes of patients who undergo ACL reconstruction under arthroscopic control through a comprehensive approach to their rehabilitation program.<strong> </strong></p><p><strong>Materials and methods. </strong>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.</p><p><strong>Results. </strong>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.</p><strong>Conclusions.</strong> 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

scholarly journals Effectiveness of platelet-rich plasma in the treatment of anterior cruciate ligament injuries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Wenfan Gan ◽  
Zheng Xu ◽  
Chunmei Wu ◽  
Junzhi He
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Abstract Background: Recently, a number of randomized controlled trials (RCTs) have researched the efficacy of anterior cruciate ligament reconstruction (ACLR) combined with platelet-rich plasma (PRP) in the treatment of anterior cruciate ligament (ACL) injuries. Therefore, we updated a systematic review based on these RCTs to evaluate the effects of PRP on knee function and pain with different time.Methods: We searched in PubMed, Embase, Cochrane, Web of Science(WOS), China National Knowledge Infrastructure(CNKI), and WANFANG DATABASE, for human RCTs comparing the efficacy of intraarticular injection with no injection of PRP. Descriptive summaries and quality assessments were performed for all studies included in this meta-analysis. The outcomes of the stydy included the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS), and Lysholm score.Results: Finally, we included 6 RCTs stydies, involving 315 patients. The control group consisted of blank group or placebo group. Follow-up periods ranged from 3 to 18 months. The results of bias risk assessment showed that all the 6 stuydies are unclear risk of bias. Compared with the control group, PRP group significantly improved IKDC score at 3, 6 and 12 months after operation (P = 0.00, 0.01, respectively). Lysholm score and VAS score also has significant differences at 3 months after operation (both P = 0.00).Conclusion: Our study has proved that PRP was more effective in the recovery of knee function and early pain relief after the ACLR than the ACLR alone. Review registration: PROSPERO CRD42021224182. Registered 6 April 2021. Keywords:anterior cruciate ligament injury; anterior cruciate ligament reconstruction; platelet rich plasma; system review; META analysisReview registration: PROSPERO CRD42021224182. Registered 6 April 2021.

scholarly journals Neural Excitability Alterations After Anterior Cruciate Ligament Reconstruction

2015 ◽  
Vol 50 (6) ◽  
pp. 665-674 ◽  
Author(s):  
Brian G. Pietrosimone ◽  
Adam S. Lepley ◽  
Hayley M. Ericksen ◽  
Amy Clements ◽  
David H. Sohn ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Spinal Reflex ◽  
Voluntary Activation ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Corticomotor Excitability ◽  
Neuromuscular Dysfunction ◽  
Anterior Cruciate

Context Neuromuscular dysfunction is common after anterior cruciate ligament reconstruction (ACL-R). However, little is known about quadriceps spinal-reflex and descending corticomotor excitability after ACL-R. Understanding the effects of ACL-R on spinal-reflex and corticomotor excitability will help elucidate the origins of neuromuscular dysfunction. Objective To determine whether spinal-reflex excitability and corticomotor excitability differed between the injured and uninjured limbs of patients with unilateral ACL-R and between these limbs and the matched limbs of healthy participants. Design Case-control study. Setting Laboratory. Patients or Other Participants A total of 28 patients with unilateral ACL-R (9 men, 19 women; age = 21.28 ± 3.79 years, height = 170.95 ± 10.04 cm, mass = 73.18 ± 18.02 kg, time after surgery = 48.10 ± 36.17 months) and 29 participants serving as healthy controls (9 men, 20 women; age = 21.55 ± 2.70 years, height = 170.59 ± 8.93 cm, mass = 71.89 ± 12.70 kg) volunteered. Main Outcome Measure(s) Active motor thresholds (AMTs) were collected from the vastus medialis (VM) using transcranial magnetic stimulation. We evaluated VM spinal reflexes using the Hoffmann reflex normalized to maximal muscle responses (H : M ratio). Voluntary quadriceps activation was measured with the superimposed-burst technique and calculated using the central activation ratio (CAR). We also evaluated whether ACL-R patients with high or low voluntary activation had different outcomes. Results The AMT was higher in the injured than in the uninjured limb in the ACL-R group (t27 = 3.32, P = .003) and in the matched limb of the control group (t55 = 2.05, P = .04). The H : M ratio was bilaterally higher in the ACL-R than the control group (F1,55 = 5.17, P = .03). The quadriceps CAR was bilaterally lower in the ACL-R compared with the control group (F1,55 = 10.5, P = .002). The ACL-R group with low voluntary activation (CAR &lt; 0.95) had higher AMT than the control group (P = .02), whereas the ACL-R group with high voluntary activation (CAR ≥ 0.95) demonstrated higher H : M ratios than the control group (P = .05). Conclusions The higher VM AMT in the injured limbs of ACL-R patients suggested that corticomotor deficits were present after surgery. Higher bilateral H : M ratios in ACL-R patients may be a strategy to reflexively increase excitability to maintain voluntary activation.

Anterior Cruciate Ligament Reconstruction with and without a Ligament Augmentation Device

2002 ◽  
Vol 30 (6) ◽  
pp. 851-856 ◽  
Author(s):  
Jon Olav Drogset ◽  
Torbjørn Grøntvedt
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Long Term Effects ◽  
Cruciate Ligament Reconstruction ◽  
Ligament Augmentation ◽  
Significant Difference ◽  
Anterior Cruciate

Background Ligament augmentation devices have been used in anterior cruciate ligament reconstruction since the suggestion of Kennedy et al. in 1980 that such devices would allow grafts to heal faster and more safely. Hypothesis Patients who had augmentation will have better outcomes after 8 years. Study Design Prospective randomized case control study. Methods Between 1991 and 1993, 100 patients were randomized to groups undergoing anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts with (49) or without (51) use of a Kennedy ligament augmentation device. Of these 100 patients, 94 were examined at an average of 8 years after surgery. Fifteen patients were excluded because of rupture in the other knee and 11 because of rerupture in the same knee. Results Of the remaining 68 patients, the mean Lysholm function score was 84 in the augmentation group and 87 in the control group. There was a statistically significant relationship between preoperatively detected cartilage injury and osteoarthritis. Almost half of the patients had developed osteoarthritis. We observed no significant difference between the two groups concerning rerupture rate, Lysholm or Lachman test scores, or KT-1000 arthrometer measurements. Conclusions We found no positive long-term effects supporting the use of augmentation in anterior cruciate ligament reconstruction.

scholarly journals Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach (Preprint)

2019 ◽  
Author(s):  
Jan-Dierk Clausen ◽  
Niclas Nahen ◽  
Hauke Horstmann ◽  
Florian Lasch ◽  
Werner Krutsch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Intervention Group ◽  
Maximum Strength ◽  
Control Group ◽  
Serious Gaming ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

BACKGROUND Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. OBJECTIVE Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. METHODS We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. RESULTS In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and –4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention – control) of 59.7 N (95% CI 10.1-109.3; <i>P</i>=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. CONCLUSIONS Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement.

scholarly journals Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Fatih Karaaslan ◽  
Sinan Karaoğlu ◽  
Musa Uğur Mermerkaya
Keyword(s):  
Anterior Cruciate Ligament ◽  
Blood Loss ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Double Blind Study ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis. Methods: The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively. Results: The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005). Conclusion: This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.

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