Accelerated Rehabilitation Protocol Research Articles

"Accelerated postoperative rehabilitation protocol for Medial Open Wedge High Tibial Osteotomy enhances early return to routine activities"

ObjectiveThe primary objective of this research was to investigate the timeframe required for the resumption of daily activities following medial open wedge high tibial osteotomy (HTO) with accelerated rehabilitation protocol. Methodology: This study encompassed a cohort of 26 patients, consisting of 11 males and 15 females, all diagnosed with medial compartment osteoarthritis (grades 2 and 3). Each patient underwent medial open wedge HTO and was subsequently monitored for a minimum period of 8 weeks. Patients were advised to engage in early weight-bearing walking, with or without assistance, based on their comfort levels. The assessment of functionality involved the utilization of the Visual Analog Scale (VAS) score, Katz Index of Independence in Activities of Daily Living (ADL), and Lawton index, performed at intervals of postoperative day 1, 2 weeks, 4 weeks, 6 weeks, and 8 weeks. ResultsThe average age of the patients at the time of surgery was 51.5 ± 7.2 years. The mean preoperative VAS score registered at 8.6, which exhibited a substantial reduction to 1.3 at the 8-week postoperative follow-up (p < 0.001). On average, patients were capable of walking with full weight-bearing without any external support at 6.9 weeks post-surgery. The initial preoperative Katz index was tabulated at 6, and within 6 weeks, all patients had successfully regained their pre-surgery functional levels, restoring the Katz index to its original value of 6. In addition, the mean Lawton index both before surgery and at the 8-week postoperative mark remained stable, with no significant variation (n.s.). ConclusionsThe immediate outcomes observed in knee preservation surgery are indeed promising. Within the 8-week timeframe, a majority of patients successfully reinstated their preoperative levels of independence, accompanied by a notable alleviation of pain.

The Effectiveness of the Modified Side-Locking Loop Suture Technique with Early Accelerated Rehabilitation for Acute Achilles Tendon Rupture in Athletes

Background/Objectives: An early accelerated rehabilitation is generally recommended after surgery for acute Achilles tendon ruptures (ATRs). The modified side-locking loop suture (MSLLS) is a surgical technique that provides high tensile strength to the repaired Achilles tendon and allows for a safe, early accelerated rehabilitation protocol without requiring postoperative immobilization. However, there are no reports investigating the clinical outcomes of the MSLLS technique with early accelerated rehabilitation for ATRs. To clarify the effectiveness of the MSLLS technique with an early accelerated rehabilitation protocol for ATR in athletes. Methods: We retrospectively analyzed 27 athletes (Tegner activity score ≥ 6) who underwent surgical treatment using the MSLLS technique for ATR between April 2017 and August 2022. All patients underwent an early accelerated rehabilitation protocol without immobilization. Outcome measures included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score taken preoperatively and one year postoperatively, the time required to perform 20 continuous double-leg heel raises (DHR) and single-leg heel raises (SHR), the time to return to the original sport, and the presence of any complications. Results: The mean AOFAS score significantly improved from 37.2 ± 9.7 preoperatively to 96.3 ± 5.3 one year postoperatively. The mean time to be able to perform 20 continuous DHR and SHR was 7.7 ± 1.2 weeks and 11.3 ± 1.6 weeks, respectively. All patients were able to return to their original sport at their pre-injury level in an average of 22.7 ± 3.7 weeks without complication. Conclusions: The MSLLS technique in conjunction with an early accelerated rehabilitation protocol for ATR in athletes produced satisfactory results, with all patients able to return to their original sport at their preinjury level without complication.

Safety and Early Return to Sports for Early ACL Reconstruction in Young Athletes: A Retrospective Study.

Background and Objectives: Although previous reports have shown that early anterior cruciate ligament (ACL) reconstruction is associated with an increased risk of stiffness, recommendations for delayed surgery are based on outdated literature. The advent of arthroscopic surgery and accelerated rehabilitation protocols warrants a reexamination of the optimal surgical timing. The purpose of this study was to investigate complications during early ACL reconstruction after injury in young athletes. Materials and Methods: A total of 87 patients (27 males and 60 females) were included in this study. Patients who underwent anatomic ACL reconstruction using hamstring autografts were evaluated. Patients under 25 years of age with a Tegner activity score greater than 6 were included and classified into three groups according to the time from injury to surgical treatment: one week from injury to surgery (early group), three to six weeks from injury to surgery (normal group), and three to six months from injury to surgery (delayed group). We evaluated the rates of various complications such as graft rupture, contralateral injury, the need for manipulation for loss of ROM, infection, and fracture around the knee up to 2 years postoperatively. In addition, we investigated postoperative muscle strength, Lysholm score, Tegner activity score, and period of the return to sport from injury. Results: Patients in the delayed group were younger than those in the other groups (p = 0.009). Patients in the early group had a lower range of motion than those in the other groups preoperationly. However, the 1-month postoperative range of motion was comparable between groups. Patients in the early group had greater postoperative Tegner activity scores than those in the other groups. The period of return to sport from injury in the delayed group was longer than in the other groups. There were no statistically significant differences in the postoperative complication rate, muscle strength, or Lysholm score. Conclusions: ACL reconstruction performed 1 week from injury to surgery in young athletic patients indicated the rate of complications were not significantly different among the groups. Early ACL reconstruction with no postoperative complications may be related to early return to sports and a high level of sports.

Paper 21: Anatomic Medial Ulnar Collateral Ligament Reconstruction with Internal Brace Augmentation in Throwing Athletes

Objectives: Injury to the Medial Ulnar Collateral Ligament (MUCL) is a common setback experienced by many throwing athletes often requiring reconstruction with 12-18 months of rehabilitation. Current reconstructive techniques fail to anatomically restore the MUCL which may contribute to the prolonged course of rehabilitation. In recent years, we described an anatomic MUCL reconstruction with internal brace augmentation which demonstrated improved biomechanical strength when compared to the docking technique in cadaveric specimens. The purpose of this study was to evaluate the postoperative course of both amateur and professional throwing athletes that underwent anatomic MUCL reconstruction with internal brace augmentation. We hypothesized that throwers would return to the same level of play and that return to play (RTP) would be a shorter duration compared to current reported outcomes. Methods: In this surgical technique, the native MUCL is formally repaired. The graft and a suture tape are folded over a suspensory loop and secured in a socket of the medial epicondyle of the humerus to maximize tendon to bone contact. On the ulnar side, the graft and internal brace are secured proximally by two suture anchors on either side of the sublime tubercle and further secured across the sublime tubercle ridge distally to re-create the anatomic triangular insertion of the native ligament. All surgeries were performed by a single surgeon. Patient reported outcomes in addition to date of RTP, level of play, and functional outcomes were retrospectively gathered. All patients initially followed an Accelerated Rehabilitation Protocol and were converted to a Standard Paced protocol if setbacks were encountered. Results: A total of 26 baseball players underwent primary (n=23) or revision (n=3) MUCL reconstruction with the Anatomic Technique. Of these, 15 were professional and 11 were amateur athletes. 92% of throwers returned to play at a mean of 9.9 months following reconstruction. 89% were able to advance through the accelerated postoperative protocol without issues and 85% returned to the same role and level of play. Post injury KJOC scores improved from 41 to 86.9 and SANE scores improved from 32.5 to 95.5. No significant difference was identified in pre-injury versus post-reconstruction throwing velocity, ball spin rate, or horizontal/vertical ball movement. Conclusions: Anatomic reconstruction of the MUCL with internal bracing is a viable option for MUCL injuries. Advantages include increased tendon-bone contact of the reconstruction, multiple fixation points, and anatomic restoration of the MUCL. This technique allowed an expedited return to sport for these baseball athletes.

Rehabilitation and Return to Play Protocols After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review.

Rehabilitation after anterior cruciate ligament ACL reconstruction (ACLR) is crucial for safe return to play (RTP) and reducing the chances of a reinjury. Yet, there is no consensus on the ideal functional tests to assess rehabilitation progress in soccer players after ACLR. The primary objective was to highlight the existing gap in the literature concerning the most effective standardized rehabilitation protocols and testing for facilitating successful RTP among soccer players. Systematic review; Level of evidence, 4. A systematic review using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Inclusion criteria encompassed original studies (level of evidence 1-4) that examined rehabilitation protocols, metrics of knee rehabilitation, and clinical outcomes after ACLR in soccer players. This review incorporated 23 studies, predominantly retrospective case series, with a total number of 874 soccer players who underwent ACLR and rehabiliation. 5 (21.7%) studies utilized an accelerated rehabilitation protocol, while 7 (30.4%) of studies utilized a criterion-based rehabilitation. A wide heterogeneity of data was extracted including functional tests of rehabilitation and RTP such as strength test batteries, hop test batteries, and movement quality assessments. Of the 23 selected studies, 2 (8.7%) used all 3 test batteries, 8 (34.8%) used 2 test batteries, 12 (52.2%) used 1 test battery, and 1 (4.3%) used 0 of the test batteries. The mean time between surgery and RTP ranged from 3 to 8 months with only 2 (8.7%) studies reporting complications after ACLR. Lastly, out of the total studies examined, 9 (39.1%) assessed patient-reported outcome measures (PROMs), all of which demonstrated significant improvement from the initial assessment to the final follow up. Soccer-specific rehabilitation after ACLR lacks standardization. Even though many studies have assessed protocols for optimal RTP and reduced secondary ACL injuries, there is a gap in the literature regarding the most effective protocols and RTP testing. The methodology reported by Kyritsis et al could serve as a foundation for future prospective randomized multicenter studies to establish a standard rehabilitation protocol and enable a successful return to soccer.

Functional outcomes of accelerated rehabilitation protocol for anterior cruciate ligament reconstruction in amateur athletes: a randomized clinical trial.

Anterior cruciate ligament (ACL) rupture is the most common knee injury among athletes, and can result in long-term complications and career-ending conditions for sportspeople. There is no consensus in the literature on the effectiveness of rehabilitation after ACL reconstruction, or the best protocol to follow for functional outcome improvement. To determine the impact of an accelerated rehabilitation protocol on knee functional outcomes in amateur athletes with anterior cruciate ligament reconstruction (ACLR). Two-arm, parallel-group randomized comparative design. A total of 100 amateur male athletes (mean age 22.01 ± 1.79 years) with ACLR were randomly divided into experimental and control groups (n = 50/group). An accelerated rehabilitation protocol and a conventional rehabilitation protocol were used for the experimental group. In contrast, only the conventional rehabilitation protocol was used for the control group. The rehabilitation was delivered in 5 weekly sessions for 22 weeks. The primary outcome measure, knee pain, was measured using a visual analogue scale (VAS). Extensive test batteries, for hop tests, Knee Injury and Osteoarthritis Outcome Score (KOOS), and knee effusion, were measured, aiming to add more objective criteria to determine functional performance. Both groups (n = 50/group) were well-matched (p = 0.816), with insignificant differences in their demographic characteristics (p > 0.05). A multivariate analysis of variance (MANOVA) test showed no significant difference between the 2 groups (p = 0.781) at baseline. A 2-way MANOVA (2 × 2 MANOVA) of within- and between-group variations indicated overall significant treatment, time, and treatment × time interaction effects (p < 0.001) in favour of the accelerated rehabilitation group. The accelerated rehabilitation protocol was more effective in improving functional outcomes than a conventional rehabilitation protocol in amateur athletes with ACLR.

Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up

To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy. A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data. Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months. All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications. Level IV, case series, therapeutic.

SpeedBridge Repair in Degenerative Achilles Tear: A Novel Technique.

Retrocalcaneal pain in late adulthood and athletes has been attributed to insertional Achilles tendinosis (IAT). Another presentation of IAT is a degenerative Achilles tear, which can be partial or complete. Symptomatic patients with failed conservative management are treated by debridement and repair of the Achilles tendon. Often, they need augmentation with a tendon transfer. The flexor hallucis longus (FHL) is the most commonly used tendon for augmentation. The Speed Bridge technique to repair the degenerated tendoachilles tear gives better pullout strength and provides a larger surface area of contact between the bone and tendon. We included 12 patients with symptomatic degenerative Achilles tears repaired with the Speed Bridge technique and FHL augmentation. Post-operatively, all patients were allowed active ankle mobilization on day 1 and were allowed weight bearing as tolerated in an airwalker shoe. All patients went through an accelerated rehabilitation protocol. Pre-operative and post-operative American Orthopedic Foot and Ankle Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scores were compared for all the patients. The mean age was 58.1 (range 50-68) years. The mean follow-up period was 13.1 (range 12-15) months. The mean pre- and post-operative AOFAS score at 12 months was 59.5 (range 58-71) and 90.2 (range 87-100), respectively. The mean pre-operative VAS for pain was 6.8 (range 6-8), and the mean post-operative VAS score was 0.5 (range 0-2). The mean interval to weight bearing was 8.4 days (range 7-10) days. Our study indicates that accelerated early rehabilitation and an early return to active life are possible with the Speed Bridge technique and FHL augmentation in degenerative Achilles tears. The mean post-operative AOFAS scores were comparable to other studies, but early return to activity, minimal need for immobilization, and accelerated rehabilitation were the advantages of the Speed Bridge technique in the repair of degenerative Achilles tears.

Short-term results of combined anterior cruciate ligament and anterolateral ligament reconstruction using a novel hamstrings graft construct in obese patients: a pilot study

Abstract Background Elevated body mass index (BMI) was associated with increased complication rates including failures in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. We present our short-term results of our technique used for ACL reconstruction in obese patients with the aim to reduce chances for graft failure and improve outcomes. Patients and methods We present our case series of obese patients (BMI &gt; 30) operated for ACL reconstruction during the period from January 2017 to January 2022 using a dedicated technique for ACL reconstruction. We are using hamstring tendons prepared in a single construct to reconstruct both the intra-articular ACL and the anterolateral ligament. All patients received the same surgical technique and associated injuries were operated on according to their indications and guidelines. All patients completed the subjective knee evaluation form of the International Knee Documentation Committee at the time of the procedure and at the last follow-up visit and assessment of knee laxity was performed using a KT-1000 arthrometer before the surgery and at the last follow-up. Results Twenty patients underwent anterior cruciate ligament reconstruction (ACLR) using this technique during the study period, with average follow-up period of 1 year. All cases were males, mean BMI was 32.2 (30.4–36.2), 18 cases were operated on using ipsilateral Semitendinosus and Gracilis grafts, 2 cases were operated on using contralateral knee hamstrings. All cases were instructed nonweight bearing for 6 weeks after surgery and received the same standard accelerated rehabilitation protocol. Two cases developed postoperative superficial wound infection at the graft harvest site that resolved with conservative treatment of oral antibiotics and wound care. The mean postoperative International Knee Documentation Committee score improved from 45.195 to 79.245 (P&lt;0.001), and the mean KT-1000 arthrometer differential improved from 11.8 to 2.77 (P&lt;0.001) and pivot shift tests were negative in the postoperative exam for all the cases. Conclusion ACLR in obese patients should be approached with care, our technique can offer a feasible solution to obtain an acceptable outcome, Further work is required to provide insight on the long-term outcome of ACLR in obese patients.

Recurrent Instability Rate and Subjective Knee Function following Accelerated Rehabilitation after ACL Reconstruction in Comparison to a Conservative Rehabilitation Protocol.

The Purpose of the present study was to assess the outcome of anterior cruciate ligament reconstruction (ACLR) with an accelerated rehabilitation protocol and to compare it to a conservative rehabilitation protocol. It was hypothesized that an accelerated rehabilitation protocol, including brace-free early weight bearing, would result in a higher rate of recurrent instability and revision surgery compared to a conservative rehabilitation protocol. From 2016 to 2017, two different rehabilitation protocols for isolated ACLR were used at a high-volume knee surgery center. A total of 65 consecutive patients with isolated hamstring ACLR, of whom n = 33 had been treated with an accelerated (AccRehab) and n = 32 with a conservative rehabilitation protocol (ConRehab), were retrospectively included in the study. Patients were evaluated for recurrent instability, revision surgery, and other complications at a mean follow-up period of 64 ± 7.4 months. In addition, Tegner Activity Scale, Lysholm Score, and IKDC-subjective Score were evaluated. Statistical comparison between the two groups was performed utilizing Fisher's exact test and Student's t-test. Mean age (29.3 vs. 26.6 years) and preoperative Tegner Score (6.4 vs. 5.9) were comparable between both groups. At 64 ± 7.4 months after ACLR, six cases of recurrent instability were reported in the AccRehab group (18%) in comparison to three cases (9%) in the ConRehab group (p = n.s.). There was no significant difference regarding revision surgery and further complications. Furthermore, no significant difference was found between both groups regarding Tegner (5.5 ± 1.9 vs. 5.5 ± 1.2), Lysholm (93.6 ± 6.3 vs. 89.3 ± 10.7), and IKDC score (89.7 ± 7.9 vs. 86.7 ± 12.1). No significant disadvantage of an accelerated rehabilitation protocol following ACLR was found in terms of recurrent instability rate, revision surgery, or patient-reported outcome. However, a trend towards a higher reinstability rate was found for an accelerated rehabilitation protocol. Future level one trials evaluating brace-free early weight bearing following ACLR are desirable.

Rehabilitation protocol after suturing the medial meniscus of a stable knee, a retrospective series of the Francophone Arthroscopy Society

IntroductionSurgical meniscal lesions are common and 80% of cases involve the medial meniscus of a stable knee. There is a lack of consensus regarding postoperative rehabilitation protocols and a wide variation between restrictive and accelerated rehabilitation protocols exists. The main objective of this study was to report the functional results and the failure rate of the various rehabilitation protocols of the retrospective series of the French Society of Arthroscopy (SFA) after suturing the medial meniscus of a stable knee, considering whether the tear is stable or unstable. HypothesisOur hypothesis was that accelerated rehabilitation was not associated with an increased risk of failure. Materials and methodsThis retrospective, multicenter study was conducted across 10 centers (6 private hospitals and 4 public hospitals) including all patients tested for a medial meniscus suture in a stable knee between January 1, 2005 and November 31, 2017 for a minimum follow-up of 5years. Demographic, imaging, suturing, rehabilitation protocol, and functional TEGNER and KOOS scores were collected. Failure was defined as performing a secondary meniscectomy. ResultsThree hundred and sixty-seven patients were analyzed with an average follow-up of 82months. Immediate weight bearing was allowed in 85% of cases, the wearing of a brace was present in almost 74% of cases and flexion was limited in 97% of cases. Inter-group comparisons found a higher suture failure rate in the group with immediate weight bearing (35.6% vs. 20%, p=0.011) and in the group with a brace (36.9% vs. 22.4%, p<0.001). There was no difference in the 90° flexion group. The TEGNER score was higher in the non-weight bearing group (6.5 vs. 5.4, p=0.028) and the KOOS QOL score was higher in the group without a brace (82.2 vs. 66.8, p=0.025). According to a multivariate analysis, immediate weight bearing (OR=3.6, [1.62; 7.98], p=0.0016) and wearing a brace (OR=2.83, [1.54; 5.02], p<0.001) were associated with a higher failure rate. In the group of stable lesions, the use of a brace (OR=3.73, [1.62; 8.56], p=0.0019) was associated with a higher failure rate. ConclusionNo consensus regarding rehabilitation protocols has been established to date and the results of this retrospective series of the SFA affirm the great variability of practices at a national level. Although accelerated rehabilitation protocols are presently favored, the resumption of immediate full weight bearing should be considered with caution, being associated with a higher risk of failure in this series. Deferring weight bearing for 1 month can be considered in the event of a large tear or in the event of damage to the circumferential fibers. Wearing a brace does not seem to have any influence, while limited flexion achieved a consensus. Level of evidenceIV, retrospective study.

Thromboembolic Events During Weightbearing vs Nonweightbearing Accelerated Rehabilitation Protocols for Complete Achilles Tendon Ruptures.

Achilles tendon rupture can be treated nonoperatively with functional rehabilitation. However, prolonged immobilization has associated risk of venous thromboembolism (VTE). Early weightbearing may reduce VTE risk, and this was introduced to our rehabilitation protocol. We investigated the prevalence of symptomatic VTE events before and after the introduction of the early weightbearing protocol. Adults with ultrasonography-confirmed complete tendo-Achilles ruptures between January 2017 and June 2020 were included. Preprotocol, patients were instructed to not weightbear for 4 weeks. In 2018, immediate weightbearing was introduced to the treatment protocol. All patients in both cohorts were given low-molecular-weight heparin for 4 weeks. Patients with symptomatic VTE events were investigated with duplex ultrasonographic scan or chest computed tomography. Two independent anonymized examiners collected data from electronic records. Rates of symptomatic VTEs were compared. A total of 296 patients were included. Sixty-nine patients were managed with the nonweightbearing protocol, and 227 patients were managed with the early-weightbearing protocol. Two patients in each group developed deep vein thrombosis and 1 developed pulmonary embolism in the early-weightbearing group. Rates of VTEs were lower in the early-weightbearing group (1.3% vs 2.9%) but did not reach statistical significance (P = .33). In this cohort we found that symptomatic VTE after nonoperatively treated Achilles tendon rupture was uncommon. We did not demonstrate a reduction in symptomatic VTE between our early weightbearing and nonweightbearing rehabilitation protocols. We believe a larger study may help clarify whether early weightbearing is beneficial in VTE reduction. Level III, retrospective cohort study.

Evaluation of the Short-Term Results of Arthroscopic Partial Meniscectomy in Adults

Background: Arthroscopic partial meniscectomy is one of the most common orthopedic procedures; yet enormous evidence of its efficacy is under trial in comparison to repair of the meniscal injury. Objective of this study is to confirm of the clinical findings arthroscopically in case of meniscal injury of the knee joint and find out the results of Arthroscopic partial meniscectomy among the adult people. Methods: This prospective interventional study was conducted from January 2013 to December 2014 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka. Twenty (20) patients with meniscus injury were treated in the form of arthroscopic partial meniscectomy. Accelerated rehabilitation protocol was followed. Patients were visited routinely and final outcome evaluation done at 6 months. Lysholm knee scoring scale was used to compare preoperative and postoperative score and to evaluate final outcome. Results: This study was carried out on 20 Patients. Preoperatively all patient had significant knee pain with positive joint line tenderness, McMurrey test, Apley’s grinding test, squat test and Thessaly test. Post operatively significant improvement was found (p&lt;0.05). Mean preoperative Lysholm knee score was 52.8 with SD ± 2.97 and postoperative score was 93.8 with SD ± 4.24. According to Lysholm knee scoring scale, excellent results (95– 100 points) were obtained in 14 patients, good results (85–94 points) in 4 patients, fair in 2 (10%) patient. Conclusion: Arthroscopic partial meniscectomy shows excellent short-term result if the procedure performed early in the adult patients.

Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy.

Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO. Case series; Level of evidence, 4. Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with ≥6 months of follow-up. The surgical indication was primarily for patients with recurrent patellar instability. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS5]). A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 ± 12.57 years were included in the final analysis. Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67° ± 32.65° vs 131.12° ± 9.02°, respectively; P = .022). Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. The mean postoperative AKPS and KOOS5 scores were 72.98 ± 21.51 and 75.05 ± 16.02, respectively. Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols.

Indications and Limitations of Synthetic Ligament Augmentation Among Foot and Ankle Surgeons and Other Orthopedic Subspecialties

Category: Sports; Ankle; Trauma; Other Introduction/Purpose: Ligament augmentation repair (LAR) entails supplementing a ligament repair with synthetic material anchored to bone. Purported advantages include increased stability and a more aggressive rehabilitation. In recent years, the literature supporting LAR has grown rapidly, with published techniques and outcomes for many ligament and tendon repairs, including anterior talofibular ligament (ATFL), Achilles tendon, and the spring ligament complex. Despite the increased use of synthetic ligaments reported in literature, there remains a lack of clarity and consensus on the indications and postoperative rehabilitation protocols. The purpose of this study was to survey an international group of orthopedic specialists regarding their current use of LAR techniques and decision-making. Methods: We invited members of several international orthopaedic and sports medicine societies to participate in this survey between January and June 2021. Responding surgeons represented all six continents, and included 319 sports medicine specialists, 179 foot and ankle specialists, and 96 trauma specialists (some reported more than one fellowship). Survey questions fell into three general categories: 1) Surgeon demographics and training, 2) Current LAR use decision-making within respondents' subspecialty, and 3) Outcomes, complications, frequency, and benefits associated with LAR. Chi-square tests of independence were used to assess the likelihood of any dependent relationships between respondent demographics and LAR use our outcome. A p value of less than 0.05 was considered significant. Results: We collected 515 responses total with a 97% completion rate. 75% of all survey respondents report using LAR for some indication. The most frequent use was ATFL repair (69%, Figure 1). LAR is most commonly implemented for additional stability (72%), poor tissue quality (54%), and more rapid return-to-sport/work (47%). LAR users state the greatest limitation is cost (62%), while non-LAR users state their greatest deterrent to LAR is that it is unnecessary for a good outcome (46%). Foot and ankle fellowship trained surgeons are significantly more likely to use LAR (87% use LAR) compared to sports-trained surgeons (67%, p = 0.002) and surgeons without a fellowship (66% use LAR, p = 0.01). Surgeons treating professional/Olympic athletes are significantly more likely to use LAR. Conclusion: While synthetic ligaments are commonly used to supplement ligament repairs, the application, outcomes, and perceived benefit differ for each subspecialty. The reported limitations of LAR differ between LAR users and non-LAR users. For those who do not use LAR, the greatest limitation is perceived benefit, while for those that do, the greatest limitation is cost. Prospective studies of indications, outcomes and accelerated rehabilitation protocols are needed to further elucidate the value and cost-effectiveness of these implants.

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.

Distal fibula fractures in professional athletes: carbon plate fixation and accelerated rehabilitation protocol can improve return to play

Objective. The purpose of this preliminary study is to investigate whether the use of a carbon plate fixation system for distal fibula fracture, applied to an intensive rehabilitation protocol, is a good method to accelerate the return to play of professional athletes. Methods. This is a longitudinal case series with 6 months of total follow-up. Athletes of various sports, each with a minimum Tegner’s activity score of 7, who underwent fibular ORIF with carbon fiber plates in our institute for Weber B fracture were considered. The primary outcomes were: return to play (RTP) at the previous level, radiological union, and the complication rate (nonunion, hardware failure, and infection). Secondary outcomes were the AOFAS score, VAS on everyday activities and VAS after sport tested at 1, 2, 3, and 6 months. Results. Considering primary outcomes, the mean RTP measured was 75.64 days ± 10.96; for the union rate 3 patients satisfied union criteria at 1 month follow-up, 7 at 2 months, and 4 at 3 months. No complication occurred during follow-up. Conclusions. The improved elastic compatibility of the carbon plate, with respect to the bone, allows for an “extended” safety zone to accelerate the patient’s rehabilitation and return to a pre-injury athletic level.

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.

Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial.

Objective To compare the effectiveness of the early accelerated rehabilitation and delayed conservative rehabilitation protocols after arthroscopic anterior cruciate ligament reconstruction, in terms of the International Knee Documentation Committee (IKDC) score, pain (according to the Visual Analog Scale), laxity, and stiffness one year postoperatively to determine the best outcome. Materials and Methods A total of 80 subjects were divided into 2e groups (early accelerated group and delayed conservative group), which were analyzed by the Pearson Chi-squared and Wilcoxon rank-sum tests. Results One year postoperatively, knee laxity was significantly higher ( p = 0.039) in the early accelerated group compared with the delayed conservative group. Regarding postoperative pain (according to the Visual Analogue Scale) and IKDC scores, both groups presented similar results. The postoperative range of motion was better in the early accelerated group, but this was not statistically significant ( p = 0.36). Conclusion One year postoperatively, the early accelerated rehabilitation protocol was associated with significant knee laxity compared to the delayed conservative rehabilitation protocol.

Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

Background: Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. Purpose: To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. Study Design: Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4. Methods: A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs. Results: For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P > .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses. Conclusion: This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.