Long-term results of complex medical rehabilitation of patients after reconstruction of the anterior cruciate ligament performed at different times after injury

Abstract

BACKGROUND: Despite the overall success of arthroscopic anterior cruciate ligament reconstruction, the scientific literature contains studies reporting high recurrence rates (up to 30%), often accompanied by other lesions such as meniscal tears and cartilage damage. The main reasons for this development of events are considered: repeated injury of the anterior cruciate ligament, possible technical errors during surgery, as well as the timing of reconstructive operations after injury.
 AIM: Assessment of long-term (after 1 year) results of complex medical rehabilitation of patients after reconstruction of the anterior cruciate ligament, performed at different times after injury.
 MATERIALS AND METHODS: The study involved 175 patients aged 18–55 years with an isolated rupture of the anterior cruciate ligament of the knee joint, who underwent rehabilitation measures after arthroscopic reconstruction of the anterior cruciate ligament. Using the stratification method, all patients were divided into two groups depending on the time of arthroscopic reconstruction of the anterior cruciate ligament. In the group with early reconstruction (88 patients), anterior cruciate ligament reconstruction was performed early after the injury, from the 2nd to the 6th week inclusive. Patients of the second group (delayed reconstruction of the anterior cruciate ligament, 87 patients) were operated on late after the injury from the 7th week to 1 year. Each of these stratification groups was divided into two groups using a simple fixed randomization method: control (with a basic rehabilitation complex) and main (with the additional inclusion of high-frequency magnetic therapy and hydrocortisone ultraphonophoresis). The basis of the follow-up study was the results of questionnaires for subjective assessment of the functional state of joints, as well as an assessment of the level of quality of life of patients obtained using MOS SF-36.
 RESULTS: A comparative comparison of long-term results obtained in groups where arthroscopic reconstruction of the anterior cruciate ligament was performed early after injury made it possible to establish the advantage of the proposed complex of medical rehabilitation based on high-frequency magnetic therapy and hydrocortisone ultraphonophoresis. This was manifested by a significantly low level of pain according to visual analog scale and a statistically significant excess on scales of subjective assessment of the functional state of the knee joint.
 CONCLUSION: The obtained results of positive dynamics of the condition of the knee joint of patients 1 year after reconstruction of the anterior cruciate ligament and rehabilitation indicate the restoration of stability and kinematics of the knee joint. However, comparison of the results obtained between the main groups with different periods of reconstruction of the anterior cruciate ligament made it possible to establish that the assessed parameters differed favorably in patients with early reconstruction of the anterior cruciate ligament.