Accelerated Rehabilitation Program Research Articles

Possibilities of using the accelerated rehabilitation program (ERAS) for gastric cancer in elderly patients

The aim of this work is to evaluate the possibility of implementing the concept of enhanced recovery after surgery (ERAS) in perioperative treatment of an 80-year-old female patient with gastric stump carcinoma.Analysis of the clinical case and available literature data was performed. The concept of ERAS demonstrates its effectiveness not only in standard oncosurgical practice, but also can be successfully extended to difficult clinical situations including in elderly patients. However, personalized approach to development of a specific ERAS protocol is necessary taking into account surgery volume, concomitant pathology and individual patient characteristics.The use of individually selected points of the ERAS protocol taking into account oncological diagnosis, comorbidity, the type and technical features of the upcoming operation make the surgical stage of treatment not only safe, devoid of postoperative complications, but also more comfortable for the patient, positively affecting their quality of life. Оur experience can be successfully applied in real clinical practice.

A RANDOMIZED CONTROLLED TRIAL EVALUATING AN ACCELERATED WEIGHT-BEARING REHABILITATION PATHWAY AFTER MATRIX-INDUCED AUTOLOGOUS CHONDROCYTE IMPLANTATION FOR SYMPTOMATIC KNEE CARTILAGE DEFECTS

INTRODUCTION & AIMS Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in treating symptomatic knee cartilage lesions which, if untreated, can progress toward early osteoarthritis. Rehabilitation is imperative to optimize outcome, though has been traditionally conservative. This study investigated the long-term outcomes of an accelerated return to full weight bearing (WB) after MACI. METHODS This prospective randomized controlled trial (RCT) allocated 35 patients (37 knees) to a 6-week (n=18) or 8-week (n=19) return to full WB after MACI. Patients were evaluated pre-operatively and at 1, 2, 5 and ≥10 years, via patient-reported outcome measures (PROMs) including the Knee Osteoarthritis Outcome Score (KOOS). Single limb hop capacity and peak knee extensor and flexor torque were assessed, with limb symmetry indices (LSIs) calculated. Magnetic resonance imaging (MRI) evaluated repair tissue, while a validated MRI composite graft score was calculated. RESULTS While the 6-week WB group reported significantly better 1-year KOOS Quality of Life scores, no other differences (p>0.05) in PROMs existed. The peak knee extensor torque LSI significantly improved (p<0.0001) over time, with mean LSIs of 100.8 (6-week) and 99.1 (8-week) at ≥10 years. No group differences (p>0.05) were observed in hop LSIs. A non-significant decline (p>0.05) was observed for the MRI composite score from 1-year to final ≥10-year review and, apart from a significant group effect (p=0.028) for graft tissue intensity in favor of the 6-week group suggesting repair tissue more reflective of native cartilage, no other MRI-based differences (p>0.05) existed. At ≥10-years, no grafts on MRI had failed, though 3 patients (6-week n=1, 8-week n=2) had progressed toward knee arthroplasty. CONCLUSION The 6-week accelerated rehabilitation program provided comparable clinical and MRI-based outcomes beyond 10 years post-surgery, without jeopardizing the graft.

Clinical Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Controlled Accelerated Rehabilitation.

Background An anterior cruciate ligament (ACL) tear is one of the most common sports injuries in the knee region. Currently, anatomical ACL reconstruction with quadrupled hamstring tendon autograft and controlled accelerated rehabilitation is a frequently used treatment approach. This study aims to add to the literature the early and mid-term clinical results of the controlled accelerated rehabilitation program we implemented in our clinic to enable patients to return to their daily activities faster after ACL reconstruction. Methodology In this retrospective study, 51 patients (50 males, 1 female) diagnosed with ACL tear and undergoing ACL reconstruction with quadrupled hamstring tendon graft were included in our study.In the femoral fixation of the graft, the transfix method was used in 22 patients and the Endobutton-CL method was used in 29 patients. A controlled accelerated rehabilitation program developed by Shelbourne was employed with some modifications to the patients. Clinical evaluation of patients was performed using Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee (IKDC) scoring systems. Results The mean postoperative follow-up period was 18.7 months (range = 6-36 months). During the physical examination, Lachman, anterior drawer, and pivot shift, 49 (96%) patients achieved excellent or good results, while only two (5%) patients experienced fair clinical outcomes. On clinical assessment using the Lysholm and IKDC scoring systems, 50 (98%) patients demonstrated excellent or good results, whereas only one (2%) patient showed fair results. Excellent and good outcomes were observed in all patients using the Cincinnati scoring system. We found a significant decrease in Tegner activity score pre-surgery, which significantly increased post-surgery. Conclusions The combination of Endobutton and cross-pin for femoral fixation and staples and interference screw for tibial fixation is thought to be safe in patients undergoing controlled accelerated rehabilitation after ACL reconstruction. The implementation of controlled accelerated rehabilitation enables patients to return to their social lives earlier without resulting in clinically poor outcomes in grafts and implants applied in the early and middle stages.

Perioperative managment for gynecological surgery in accelerated rehabilitation programme

The Enhanced Recovery After Surgery (ERAS), or Fast Track Surgery, aims to minimise the physiological stress of surgery and optimise patient rehabilitation. However, data on surgical interventions in obstetrics and gynaecology are limited. The aim of the study was to analyse the use of elements of the ERAS programme in gynaecologic surgery clinics and to assess the benefits of this approach. Analytical processing was carried out on systematic reviews and meta-analyses, articles and scientific reports published before June 2023, found and available through the PubMed, EMBASE, Cochrane Central Register of Controlled Trials databases. The data were obtained from relevant published studies, including changes in quality of life, postoperative pain, use of opioids or anaesthesia, postoperative nausea and vomiting, rate of readmission, cost of hospitalisation, and clinically significant increase in patient satisfaction. The ERAS programme is a multimodal and multidisciplinary programme aimed at optimising perioperative treatment and improving postoperative outcomes in operative gynaecology by minimising the patient’s stress response, promoting functional recovery and achieving rapid recovery, where the patient is in the field of view of a number of specialists. The presented publications demonstrate that this concept of FTS is a fundamentally new approach to the surgical treatment of gynaecological patients and covers all stages of perioperative therapy: preoperative, intraoperative and postoperative. Conclusions. The initial stage of the surgeon’s and anaesthetist’s acquaintance with the patient is very important, as communication and rational presentation of information using illustrative and video material helps the patient understand the disease, consciously choose the proposed method of treatment, reduces anxiety, increases the role of the surgical team in treatment and satisfaction with its outcome, reduces the risk of dissatisfaction from false expectations (duration of the perioperative period, pain, changes in nutrition and mobility, sutures, etc.). The introduction of evidence-based medicine into the practice of operative gynaecology restructures classical approaches and principles of patient treatment, raises awareness of doctors and heads of surgical departments, and also contributes to the improvement of the outcome of operations.

Water-Tight Arthrotomy Joint Closure of Modified Intervastus Approach in Total Knee Arthroplasty.

The joint closure technique used for total knee arthroplasty cases can have an impact on outcomes, especially when considering accelerated rehabilitation programs that follow surgery. In this study, we describe the details of the technical steps involved in performing the water-tight arthrotomy joint closure technique that we developed and use. A total of 536 patients (average age: 62 years, average body mass index: 34 kg/m2) with primary osteoarthritis of the knee underwent total knee arthroplasty using the modified intervastus approach between 2019 and 2021. We used the water-tight arthrotomy joint closure technique to close the knee arthrotomy incision. Any infections and complications, as well as the duration of surgery and cost related to this wound closure technique, are also reported. Few complications were noted with this closure technique. When we first started using it, there was one case of drainage through the proximal capsular repair which required a return to the operating room 5 days postoperatively for an irrigation and debridement. We also had two cases of superficial skin necrosis along a small part of the incision line which were observed on a weekly basis and which healed uneventfully with application of betadine once daily on the necrotic area. The average time for performing wound closure after total knee arthroplasty was 45 min. We conclude that the water-tight closure approach can achieve very durable, water-tight capsule repairs and results in a decrease in postoperative wound drainage.

Effect of Accelerated Rehabilitation Program and Neuromuscular Rehabilitation Program on Knee Range of Motion and Knee Function in Patients with ACL Reconstruction

Effect of Accelerated Rehabilitation Program and Neuromuscular Rehabilitation Program on Knee Range of Motion and Knee Function in Patients with ACL Reconstruction

Clinical outcomes of a standardized rehabilitation protocol for meniscal repair: A retrospective case series

Background/Purpose: To examine clinical and functional outcomes of patients who underwent meniscal repair with a modified accelerated rehabilitation program. Methods: This study represents a case series of patients who underwent meniscal repair from 2017 to 2019. The mean patient age was 26.6 (range: 15–47) years. Of the 28 total patients, 22 had concomitant anterior cruciate ligament tears that were treated with single-bundle hamstring reconstruction at the time of meniscal repair. All patients were enrolled in a standardized rehabilitation program, allowing early-phase protected weight-bearing and knee mobilization. Patient-reported symptoms, the McMurray test, and the International Knee Documentation Committee (IKDC) were used to evaluate outcomes. The mean follow-up period was 13 ± 3.1 (range: 9–20) months. Results: Of the participating patients, 75% (22 of 28) returned to their original sports activities. Most patients displayed satisfactory clinical outcomes with significant improvements in IKDC scores. No re-tears were detected. Conclusion: Early protected weight-bearing with progressive early knee mobilization is a safe rehabilitation option after meniscal repair.

Accelerated rehabilitation program following medial patellofemoral ligament reconstruction does not increase risk of recurrent instability

BackgroundRehabilitation protocols following medial patellofemoral ligament (MPFL) reconstruction were historically restrictive, with patients often immobilized and/or given weightbearing restrictions. However, more recently published protocols have been more aggressive. We compared patient-reported outcomes and recurrent dislocation risk between patients treated with a restrictive rehabilitation program (early post-operative bracing and weightbearing restrictions) and an accelerated rehabilitation protocol (no post-operative bracing or weightbearing restrictions) following MPFL reconstruction. MethodsPatients who underwent isolated MPFL reconstruction at an academic center between 2008 and 2016 were identified. Patient demographics, anatomical measurements, surgical details, and outcomes were collected. During this period, the rehabilitation protocol at the center transitioned from a restrictive to an accelerated rehabilitation protocol. Failure risk and patient-reported outcomes were compared based on rehabilitation protocol. ResultsOf the163 isolated MPFL reconstructions performed during the study period, 123 (75%) were available for minimum one-year follow up at a mean of 4.0 years post-operative. Overall, 53 knees (43%) underwent the accelerated rehabilitation protocol and the remaining 70 knees (57%) underwent the restrictive protocol. There were 3 recurrent dislocations during the study period (2.4%), all of which occurred in the restrictive rehabilitation group. Multiple linear regression demonstrated that being in the accelerated rehabilitation group was not associated with poorer Knee injury and Osteoarthritis Outcome Score (KOOS) subscales controlling for age, sex, body mass index, Caton-Deschamps Index, tibial tubercle-trochlear groove distance, sulcus angle, MPFL graft choice, and length of follow-up. ConclusionAn accelerated rehabilitation protocol without immobilization or weightbearing restrictions does not increase risk of recurrent patellar dislocation or poorer patient-reported outcome following isolated MPFL reconstruction.

Accelerated rehabilitation following thumb ulnar collateral ligament repair with suture tape augmentation: A case series of professional basketball players

Study DesignCase series. IntroductionRehabilitation protocols following thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) repair typically do not allow for return to sport until 12 weeks post-surgery. The potential for accelerated rehabilitation following thumb MCP UCL repair with suture tape augmentation has yet to be explored. Purpose of the StudyTo describe the accelerated rehabilitation following thumb MCP UCL repair with the suture tape augmentation in professional basketball players. MethodsThree professional basketball players underwent thumb MCP UCL repair with suture tape augmentation. The athletes followed an accelerated rehabilitation program post-surgery that began with range-of-motion exercises at 2-3 days, proximal strengthening at 7-10 days, grip/pinch strengthening at 1-2 weeks, followed by progressive sport specific intervention with a custom orthosis. ResultsAt 5-6 weeks post-surgery, active thumb MCP range of motion returned to 83%-100%, grip strength to 81%-100%, and tripod pinch strength to 73%-78% of the contralateral side. All athletes successfully returned to sport within 5-6 weeks post-surgery. Discussion/ConclusionThis is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. In this series, professional basketball players were able to return to sport in half the routine recovery time. Further prospective studies re-thinking current rehabilitation protocols are warranted.

Isolated Bioinductive Arthroscopic Repair of Partial-Thickness Rotator Cuff Tears Using a Resorbable Collagen Implant.

A diagnostic arthroscopy is performed via a posterior viewing portal, paying particular attention to the insertion of the posterosuperior rotator cuff onto the humeral head. The subacromial space is entered posteriorly and visualized. With use of electrocautery through a lateral portal, all soft tissue is cleared from the undersurface of the acromion and from the superficial rotator cuff. The coracoacromial ligament is released from the underside of the acromion, and an acromioplasty is performed if indicated. The partial-thickness rotator cuff tear is visualized and examined for tissue quality, tear area, and residual tendon thickness. The size of the tear is measured, and an appropriate implant size is chosen. The lateral portal is enlarged so that the graft can be inserted and unfolded with use of a specialized delivery guide. The implant is centered over the tear, ensuring that it covers as much of the lateral footprint as possible. To complete the procedure, the implant is secured to the tendon with use of soft-tissue staples and to the lateral osseous footprint with use of bone staples. First-line treatment is often nonoperative and entails activity modification, pharmacological therapies, and targeted physiotherapy directed toward strengthening parascapular muscles and the remaining rotator cuff. Surgical treatment is considered for persistent symptoms. Conventional operative strategies include subacromial decompression, rotator cuff debridement, in situ repair, and conversion to a full-thickness defect and repair. Partial-thickness tears substantially increase intratendinous strain. This increased strain leads to further tissue degeneration and tear enlargement5, likely influencing the high rate of tear propagation observed with nonoperative treatment and nonanatomic operative treatment, such as subacromial decompression. Isolated bioinductive repair of partial-thickness tears with use of a resorbable collagen implant does not involve tendon excision or repair of the tendon to the bone, which can sometimes be challenging. This technique offers a simple solution to a complex problem and has the benefit of an accelerated rehabilitation program compared with formal rotator cuff repair. Accordingly, patient satisfaction with the procedure is high, making this treatment an appealing option4. Short and midterm results following isolated bioinductive repair of partial-thickness tears demonstrate that it is a safe procedure associated with a reduction in pain, increased range of motion, and improvement in functional outcomes. Patients should be counselled regarding the safety of a resorbable collagen patch and its potential to promote healing and improve symptoms4-6. If the tear is articular, it should be marked with a needle so that the graft can be centered over the tear within the subacromial space.When positioning the implant, ensure that it covers the defect and the lateral footprint.Position the cannulas so that they allow the staples to enter the tissue perpendicular to the tendon and osseous footprint.To prevent tearing of the patch, do not depress the staples with excessive force. MRI = magnetic resonance imagingPEEK = polyetheretherketoneVAS = visual analogue scaleASES = American Shoulder and Elbow Surgeons Shoulder Score.

Achilles' tendon rupture dancing the 'Jerusalema' - A case series.

Introduction and importanceThe weekend warrior has long been prey to musculoskeletal injuries as a result of intermittent, high intensity activity. The Achilles tendon is known to be particularly vulnerable in this population cohort but during the COVID-19 lockdowns in Ireland and all over the world there has been a certain level of detraining and deconditioning among all age groups and populations.Throughout the worldwide restrictions, viral internet challenges and dances have encapsulated the spirit of a global community with the ‘Jerusalema’ dance being no exception. The rise of this particular viral sensation was at the detriment of the Achilles tendons of three middle aged gentlemen on who we base our case series.Presentation of casesOver the space of ten days three cases of Achilles tendon rupture repair presented to the emergency department in Midlands Regional Hospital Tullamore (MRHT) with the mechanism of tendon rupture being through the ‘Jerusalema’ dance.These patients were surgically managed in line with local institution practice and postoperative outcomes were good with no complications noted. Follow up is ongoing.Clinical discussionThis retrospective case series is based on the impact of the ‘Jerusalema Dance’ on presentations of Achilles tendon rupture to the Emergency Department in a single regional hospital from January to March 2021. We used these cases in conjunction with a review of current literature to highlight the benefit of an integrated Achilles Tendon rehabilitation programme in this at-risk patient cohort.ConclusionThis paper highlights the dangers inherent when well intentioned, but physically deconditioned individuals endeavour to perform a physical exercise which is deceptively demanding. Going forward, viral challenges such as the ‘Jerusalema’ may contribute to new and interesting mechanisms of injuries in our ‘weekend warrior’ cohort. In addition to this, given the global deconditioning seen due to the COVID 19 pandemic and subsequent lockdowns we may see a higher rate of Achilles tendon injuries in the near future across a multitude of patient cohorts. Level one evidence suggests that conservative treatment is just as effective as surgical treatments in the majority of patients with an Achilles tendon rupture, as long as a protocol of rehabilitation with early weightbearing is performed. Our accelerated rehabilitation programme in MRHT is in line with others however internal audit and new literature in the future may enable us to refine it further.

CORR Insights®: Compliant Compression Reconstruction of the Proximal Femur Is Durable Despite Minimal Bone Formation in the Compression Segment.

CORR Insights®: Compliant Compression Reconstruction of the Proximal Femur Is Durable Despite Minimal Bone Formation in the Compression Segment.

Modified Broström-Gould With Gracilis Autograft Augmentation Surgery and Accelerated Noncasted Rehabilitation in High Demand Patients With Lateral Ankle Instability

Lateral ankle instability that has failed conservative management can be physically debilitating. Good outcomes are obtained from Broström-Gould augmented repair techniques, however there are few studies evaluating the use of a gracilis autograft augmentation coupled with an accelerated rehabilitation program in high functional demand patients. We believe that the modified Broström-Gould technique utilizing a Gracilis autograft will provide significant improvements in stability while maintaining normal ankle biomechanics in young, high demand patients. The prospective cohort study involved 19 patients (20 ankles) who underwent surgery for chronic lateral ankle instability by a single surgeon, at a single institution between October 2014 and April 2016. Patients were followed for 33.8 ± 11.7 (range 12-48) months. Patients were assessed both pre- and postoperatively for talar tilt angle radiographically and with both American Orthopaedic Foot and Ankle Society Ankle and Hindfoot scores and Karlsson-Peterson scores. A Tegner activity score was taken at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score increased from 68.85 ± 10.57 to 91.56 ± 5.31 points (p < .01) and mean Karlsson-Peterson score increased from 50.9 ± 15.53 to 88.11 ± 8.64 points (p value <.01) when compared preoperatively to mean postoperative follow-up of 33.8 months. Tegner activity score was 7.05 ± 0.89 at last follow-up. The technique was found to be effective in treating chronic lateral ankle instability and in combination with an accelerated rehabilitation protocol, patients returned to their premorbid level of activity with improved stability and no significant effect on donor graft site morbidity.

Enhanced recovery in thoracic surgery

To present an experience of adapting the accelerated rehabilitation protocol at the thoracic surgery department of the Moscow City Clinical Oncology Hospital No. 1. An effectiveness of the accelerated rehabilitation program in the city oncology hospital was retrospectively analyzed for the period from February to December 2019. Lung resections were performed in 252 patients with median age 66 (59; 71) years and an equal ratio of men and women (124/128). Primary non-small cell lung cancer was noted in 194 (77%) patients, secondary malignant neoplasms of lungs - in 58 (23%) cases. ASA grading system of anesthetic risk was applied (American Society of Anesthesiologists): grade II - 56 (22.2%) patients, grade III - 203 (75.2%) patients, grade IV - 7 (2.8%) patients. Lobectomy was performed in 147 patients, segmentectomy - in 32, bilobectomy, pneumonectomy and marginal resection - in 1, 3 and 69 cases, respectively. Endoscopic operations made up 13.6% (n=20), 12.5% (n=4) and 78% (n=54). Postoperative 30-day complications occurred in 19 (7.5%) out of 252 patients (95% CI 4.9-11.5). Postoperative 30-day mortality was 1.98% (5 out of 252 patients, 95% CI 0.9-4.6). Median postoperative hospital-stay was 7 (6; 8) days. Implementation of fast track protocol requires time and the first results can be assessed after 6-12 months. Continuous monitoring of implementation of the protocol elements by all members of multidisciplinary team, analysis of complications and long-term results are required to realize all potential benefits of this program.

Experience of application of accelerated rehabilitation programs in patients with distal pancreas resection

Introduction. The implementation of ERAS (Enhanced recovery after surgery) protocols has been shown to be effective in orthopedics, bariatric and colorectal surgery. However, the safety and feasibility of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection is not well studied. The objective was to analyze the results of the application of accelerated rehabilitation protocols in patients underwent distal pancreatic resection. Methods and materials . A retrospective - prospective, single-center study was conducted. The study included 60 patients. Patients were divided into two groups (control group - 30 patients, perioperative management was carried out according to standard methods and the main group - 30 patients, perioperative management was carried out according to the accelerated rehabilitation protocol). All patients included in the study underwent distal pancreas resection. Results. Patients in the analyzed groups were comparable by gender, age, body mass index, and ASA score. The frequency and severity of postoperative complications in the compared groups was comparable. The frequency of early activation of patients was significantly higher in the main group (86.7 vs 56.7; p&lt;0.001). Postoperative recovery of gastrointestinal tract function was faster in the main group ((2.4±0.9) vs (3.6±1.2); p&lt;0.001). The total duration of the postoperative hospital bed in the compared groups was comparable ((12.9±6.8) vs (14.1±6.1); p=0.2), however, when analyzing a subgroup of patients without complications and with minor complications, the differences in the duration of the postoperative hospital bed in the main and control groups was statistically significant ((8.9±3.6) and (11.7±3.4), respectively, p=0.01). Conclusion. The study showed the safety and effectiveness of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection.

Results of an Accelerated Rehabilitation Program after Arthroscopic Broström Ankle Ligament Repair Augmented with an Arthroscopically Applied Suture Tape

Category:Arthroscopy; Ankle; SportsIntroduction/Purpose:The Broström-Gould is the gold standard in repair of the lateral ankle ligaments for chronic instability and arthroscopic Broström repairs have become increasingly popular with outcomes comparable to the open procedure. Despite demonstrated success, the arthroscopic Broström, like the open procedure, does not achieve the same mechanical strength as the intact native ankle ligaments and is therefore not appropriate for early aggressive rehabilitation. Suture tape augmentation of an open Broström procedure has been shown to further strengthen the repair and produce favorable outcomes in preventing recurrent instability. Studies reporting long-term clinical outcomes of patients who undergo this procedure are lacking. This study reports clinical and functional outcomes after an arthroscopic repair with arthroscopically applied suture tape augmentation and an accelerated post-operative rehabilitation protocol.Methods:Ninety-three patients with chronic recurrent ankle instability who had failed non-operative treatment (bracing, taping, physical therapy) underwent arthroscopic lateral ligament repair augmented by a suture tape applied in a novel all-arthroscopic fashion (double stranded polyethylene tape fixed to talus and fibula with interference screws). Postoperatively patients were placed in a CAM walker and allowed to bear weight immediately. On postoperative day 8 patients were placed in a functional brace and began physical therapy to include motion, strength, and proprioceptive activities. At week 4 patients began sports specific activities and were allowed to return to unrestricted activity at week 8. Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), Tegner Score, and range of motion measurements were performed. Statistical analysis was done to determine averages, ranges, and standard deviations of scores. Paired t-test was utilized to find statistically significant differences in scores.Results:Eighty-five patients (42 males, 43 females; average age 30.42 years) were available at a minimum of 24 months post- operatively (range 24-68). Postoperatively, average VAS scores fell to 0.85 from 4.67, (p<2.2e-16), average FAAM ADL scores rose from 69.44 to 93.09, (p<2.2e-16), average FAAM Sports scores rose from 49.76 to 89.61. (p<2.2e-16), average Ankle ROM scores decreased from 56.12o to 54.76o, (p=.001523) and average HF ROM decreased from 20.07o to 18.19o (p=1.225e-11). The average Tegner score postoperatively was 7.45 (4-10). Patients reported 75% excellent, 24% good, and 1% fair results. Average time to desired level of activity was 5.14 months. There were 5 complications: one wound dehiscence, 2 cases of anterolateral impingement, and two cases of superficial peroneal neuritis. There was no recurrent instability.Conclusion:The results indicate that acclerated rehabilitation after arthroscopic lateral ligament repair augmented with arthroscopically applied suture tape is a safe and effective procedure that produces favorable outcomes for patients with chronic recurrent ankle instability.

Perioperative nutritional support for surgical patients

The article presents an algorithm for perioperative nutritional support of surgical patients operated on as planned. Today, planned surgical care is provided in accordance with the canons of the accelerated rehabilitation Program (ARP). The relevance of the problem of nutritional insufficiency, which is an important component of ARP, is due to the dependence of the results of surgical treatment on the initial nutritional status of the patient. Methods of screening for nutritional deficiency and options for correcting protein-energy disorders are described. The predominant method is the enteral delivery of nutrients and energy. Oral supplemental nutrition by sipping is a convenient way to correct nutritional disorders at all stages of the perioperative period.

Accelerated rehabilitation is vital post anterior cruciate ligament reconstruction

An ideal rehabilitation program post anterior cruciate ligament reconstruction enables an individual to return to pre injury levels at a faster rate with minimal to no risk of reinjury to the graft. The aim of our study is to assess the outcome of accelerated rehabilitation post anterior cruciate ligament (ACL) reconstruction. A rehabilitation program for a duration of 6 months is sufficient when compared to 9 months 106 patients were operated by a single surgeon underwent arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus and gracilis graft and partial meniscectomy for associated meniscal tear. Patients were put on an accelerated rehabilitation protocol designed in our institute on first post-operative day, under the guidance of a physical therapist in consultation with the operated surgeon. Patients were followed up at 3weeks, 6 months and 9 months post onset of rehabilitation. Patients were assessed using KT1000 Arthrometer and Lysholm knee scoring system. Out of 106 patients, who were selected, 96 (91%) were males and 10 (9%) were females. The mean pre-operative Lysholm score was 55.09. Post operatively, while on accelerated rehabilitation program the Lysholm scores were 69.73 at 3 weeks, 89.13 at 6 months and 89.19 at 9 months. In our pre-operative evaluation mean KT 1000 arthrometer score was 10.53 and post-operative at six months was 3.49. At nine months 105 patients had excellent results whereas 1 patient had good result. Accelerated rehabilitation protocol enables the patient to functionally recover faster to pre injury levels. A rehabilitation protocol for 6 months is sufficient in enabling a patient to get back to pre-injury levels. Functional outcome is the same with or without associated meniscal injuries. KT 1000 knee Arthrometer plays a vital role in diagnosing anterior cruciate ligament injuries and can be used to compare preoperative and post-operative ligament status.

Application of accelerated rehabilitation program for the treatment of intertrochanteric fracture of femur in the elderly

To evaluate the clinical value of accelerated rehabilitation in the treatment of intertrochanteric fracture of femur in the elderly. Eighty elderly patients with intertrochanteric fractures were selected from January 2016 to October 2018, and were divided into accelerated rehabilitation group and traditional rehabilitation group according to different treatment schemes, 40 cases in each group. There were 22 males and 18 females in accelerated rehabilitation group with an average age of (78.5±9.1) years old; 19 males and 21 females in traditional rehabilitation group with an average age of (80.6±8.1) years old. The perioperative blood loss, incidence of complications, hospitalization time, hospital stay, Harris hip score and improved BADL scale were compared between the two groups. Eighty patients were followed up for more than 12 months, with an average follow-up time of (15.4±2.6) months. The total perioperative blood loss in the accelerated rehabilitation group was significantly lower than that in the traditional rehabilitation group(P<0.001). Although the incidence of complications in the accelerated rehabilitation group was lower than that in the traditional rehabilitation group, there was no significant difference between the two groups(P>0.05). The time from admission to operation of the accelerated rehabilitation group(1.48±0.51) days was significantly shorter than that of the traditional rehabilitation group(4.35±1.55) days(P<0.01);the hospitalization time of the accelerated rehabilitation group was(6.4±1.1) days was significantly shorter than that of the traditional rehabilitation group (9.9±1.9) days(P<0.01). At 12 months after operation, there was no significant difference in Harris score between the two groups(P>0.05), and there was no significant difference in modified BADL score between the two groups(P>0.05). The application of accelerated rehabilitation program in elderly intertrochanteric fracture is safe and effective. It can reduce perioperative bleeding, shorten hospitalization time and accelerate the recovery of hip function.

The Effect of Virtual Rehabilitation Added to an Accelerated Rehabilitation Program After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Objective: This study aimed to determine the effectiveness of virtual rehabilitation on balance and functionality in patients with anterior cruciate ligament (ACL) reconstruction. Methods: A total of 22 males who had undergone ACL reconstruction were divided into Nintendo and control groups. Both of the groups received six week accelerated rehabilitation in our department, and the Nintendo Wii© (Nintendo, Washington, USA) balance games were added to Nintendo group after three weeks for forty minutes a day, three times a week. Patients were evaluated for pain (visual analog scale), functionality (Lower Extremity Functional Scale), center of gravity (COG) and balance (Nintendo Wii©) at the baseline and end of the 3th and 6th week of rehabilitation program. Results: Similar improvements were determined in the pain, functionality, COG and balance scores of the two groups at the end of the treatment program and there were no significant differences between the groups in the amount of change in all parameters (p= 0.256, 0.393, 0.707, 1.000).Conclusion: According to the results of this study the Nintendo Wii© balance games applied in the clinic under physiotherapist supervision did not change the outcome of the rehabilitation in early period after ACL reconstruction.