A multifactorial interdisciplinary intervention reduces frailty, increases function and is cost-effective in older adults who are frail: randomised controlled trial

Abstract

ament (ACL) reconstruction, with different techniques and contradictory results. Purpose: To compare rehabilitation outcomes following ACL reconstructionwith andwithout tourniquet use. Authors hypothesized that although the use of a tourniquet reduces the surgical time by improving visualization, postoperative functional outcome would be superior with non tourniquet use. Methods: Sixty-three patients were treated for ACL tears with an anatomical single bundle ACL reconstruction operated by one orthopedic surgeon. They were randomized into 2 groups: Tourniquet group (T) (n= 30) with mean age of (25.5± 3.9) and female/male ratio (4/26), and Non Tourniquet group (NT) (n= 33) with mean age of (24.9± 4.5), and female/male ratio (5/28). All patients received the accelerated rehabilitation program. Pain was assessed 4 times using visual analogue scale (VAS), 4 hours after surgery; then every 6 hours thereafter. Heamarthrosis was assessed after 1 week, 2 weeks, and one month, according to the classification of Coupens andYates. TheBiodex Isokinetic System 3 had been used to assess the hamstring and quadriceps strength at one week preoperative, then 6 month post-operative by the same examiner. Thigh and calf circumference were measured one week preoperative, then after 2 weeks and 6 month. Results: The scores of VAS showed a statistically significant difference between groups after 4 and 10 hours in favor ofNTgroup, but non-significant difference at 16 and 22 hours postoperatively. Grades of heamarthrosis after 1 and 2 weeks showed a statistically significant difference between groups in favor of NT group but non-significant after one month. Isokinetic testing showed a statistically non-significant difference between groups in strength of the hamstrings and the quadriceps neither preoperatively nor postoperatively. The calf and thigh girth showed a statistically non-significant difference between the 2 groups preoperatively. However, at 2 weeks a highly significant girth difference between the 2 groups was noticed (P value = 0.001) in favor of the NT group. This difference was again non-significant at 6 months postoperative. Conclusion(s): All patients despite the use or non-use of thigh tourniquet during ACL reconstruction improved with the accelerated rehabilitation program. Implications: Accelerated rehabilitation program after arthroscopic ACL reconstruction is effective in improving pain, heamarthrosis, muscle strength and girth regardless of the use or non-use of thigh tourniquet. Short term results were only reported and long term functional effects of tourniquet versus non-tourniquet still require to be investigated.