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

Abstract

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. 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. A prospective study included 45 patients with unilateral ACL rupture who were randomized into conservative (TH-C) 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 degrees 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. 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. Our investigation has undoubtedly revealed that early intensive rehabilitation approach leads to faster functional recovery without complications compared to conventional rehabilitation treatment.