Outcome of home-based rehabilitation program following arthroscopic anterior cruciate ligament reconstruction in nonathletic patient

Abstract

Abstract Background: Rehabilitation following anterior cruciate ligament (ACL) reconstruction is thought to be important by almost all surgeons. It has even been considered by some to be as important as surgery itself. As the surgical procedure for these injuries evolved, so has the rehabilitation. A traditional approach to rehabilitation which focused on delayed weight bearing and mobilization is now being replaced by accelerated rehabilitation which advocates early weight bearing and results in early return to sports. Materials and Methods: This is a observational case-control comparative study conducted in our department from September 2019 to February 2021. About 30 cases of more than 20 years of age with comparable matching group are included in our study. Assessment of Lysholm score, International Knee Documentation Committee (IKDC) score, ACL quality of life score, and Tegner activity level is done. Functional assessment was carried out by Carioca test, one leg hop test, and Shuttle test. Assessment of clinical status is done by anterior drawer test, Lachman test, and Pivot shift test. Results: All patients participating in study although nonathletic had complaints of instability and giving away episodes of knee in their day to day activities and therefore were considered as candidates for surgery. Following an arthroscopic ACL reconstruction, they were given written home-based protocols with goals and exercises being explained to them at the time of discharge. All the patients participating in the study were able to return to their preinjury activity level as assessed by the Tegner activity scale at the final follow up. Their functional outcome as measured by Lysholm score, IKDC score, and ACL quality of life score was significantly lower when compared to an age, sex, and activity matched control group. The patients functional performance as assessed by one leg hop test, Carioca test, and Shuttle test was also below the level of what was seen in control groups. More than 90% patients had a stable knee as assessed by the anterior drawer test, Lachman test and pivot shift test (29 patients has anterior drawer of ≤5 mm, 27 patients had Lachmann test ≤5 mm and all 30 patients had pivot shift grades in absent or glide category). Conclusions: Home-based rehabilitation is an effective method of rehabilitation in low demand individuals following ACL reconstruction. In the future, adequately powered randomized controlled trials are needed to assess the usefulness of one rehabilitation protocol over other in these group of low demand patients.