Abstract
Objective. To systematically review the published information regarding the effectiveness and safety of early postoperative quadriceps muscle exercise training on pain, joint laxity, function and range of motion in postoperative anterior cruciate ligament (ACL) reconstruction adult patients. Data sources. Five databases (CINAHL, PEDro, Pubmed, Science Direct and the Cochrane Library) were searched for studies published from January 1990 to May 2007. Study selection. Publications describing research into the effectiveness of early quadriceps exercises after ACL reconstruction were included. A total of three eligible articles met the inclusion criteria. Data extraction. A review of the three eligible studies was undertaken to describe the key study components. The PEDro Scale was used to determine the methodological quality of the selected trials and the level of evidence of all the eligible studies was categorised according to the evidence hierarchy by Lloyd-Smith.24 Relevant data were extracted by the two reviewer groups to reduce bias. Data synthesis. Due to study heterogeneity a meta-analysis could not be conducted. Effect sizes were calculated provided that sufficient data were provided. Outcome measures included range of motion (ROM), functional performance, pain and knee laxity. The methodological quality of the studies did not vary considerably across the studies and the average PEDro score was 66%. Marginal significant differences were noted in knee ROM at 1 month postoperatively, pain day 1 postoperatively, knee laxity and subjective evaluation of function at 6 months postoperatively. Conclusion. Early quadriceps exercises can be performed safely in the first 2 postoperative weeks, but clinically significant gains in ROM, function, pain and knee laxity were not evident. Further research should include standardised interventions, measurement time frames and outcome measurement tools to allow for a meta- analysis to be conducted
Highlights
Anterior cruciate ligament (ACL) rupture is one of the most common debilitating knee injuries.[36]
Despite advances in ACL repair after reconstructive surgery to optimise the mechanical stability, functional instability of the knee may still be evident in the post-surgery stage.[2]
Eligibility criteria were specified Subjects were randomly allocated to groups Allocation was concealed Groups were similar at baseline regarding important prognostic indicators Blinding of all subjects Blinding of all therapists who administered the therapy Blinding of all assessors who measured at least one key outcome Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups Subjects for whom outcome measures were available received the treatment or control condition, if not, data for at least one key outcome was analysed by ‘intention to treat’ Results of between-group statistical comparisons are reported for at least one key outcome Provided both point measures and measures of variability for at least one key outcome
Summary
Anterior cruciate ligament (ACL) rupture is one of the most common debilitating knee injuries.[36]. Despite advances in ACL repair after reconstructive surgery to optimise the mechanical stability, functional instability of the knee may still be evident in the post-surgery stage.[2]
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