Early Postoperative Physical Therapy Research Articles

The relationship between spino-pelvic-hip mobility and quality of life before and after total hip arthroplasty.

Total hip arthroplasty (THA) can significantly improve quality of life (QOL) in patients with hip osteoarthritis. A relationship exists between activity levels and postoperative QOL, but its determinants are not well known. The aim of this work was to investigate the relationship between hip, pelvis and lumbar spine mobility and alignment before and after THA with QOL. Consecutive patients with hip arthrosis and an indication for THA were included prospectively between July 2019 and December 2020, and they underwent lateral radiographs in free-standing, extension, relaxed- and flexed-seated position. Spinopelvic and hip parameters were measured, as well as their changes between positions to assess hip, pelvis and lumbar spine mobility. Patients were also administered QOL questionnaires. Data were collected preoperatively and 6 and 12months postoperatively. Seventy patients were included; QOL significantly increased 6months after THA (from 18 [10; 27] to 61 [48; 72], p < 0.001). QOL further increased by 10 points or more after 6months in 18% of patients, while it decreased in 16%. The latter showed higher pelvic range of motion (between flexion and extension) than the former. This study confirmed that QOL is significantly improved by THA, and that spinopelvic alignment and function can play a role. Future work should elucidate how to better predict postoperative QOL from preoperative patient characteristics to improve patient treatment and establish early postoperative physical therapy for patients who could benefit from postoperative improvement of activity-related QOL.

Early Initiated Multimodal Postoperative Physical Therapy Program for Anterior Cervical Discectomy and Fusion: A Case Report With 2-Year Outcomes

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for cervical radiculopathy. While postoperative physical therapy (PT) has been shown to be effective after many orthopaedic surgeries, there is limited evidence available regarding postoperative PT after ACDF for cervical radiculopathy. CASE PRESENTATION: A 61-year-old male initiated early in-person PT 2 weeks following 2-level ACDF, which utilized a multimodal PT program (manual therapy, patient education, therapeutic exercise, self-management, HEP, modalities) guided by tissue healing, achievement of clinical objective milestones, and clinical reasoning. OUTCOME AND FOLLOW-UP: Significant improvement in outcome measures (numeric pain-rating scale, neck disability index, 36-item short-form health survey, global rating of change, fear avoidance beliefs questionnaire, cervical active range of motion) was achieved 12 weeks postoperatively and maintained up to 2 years with no adverse events. DISCUSSION: Early initiated in-person multimodal postoperative PT may be safe and effective for patients at all stages of healing after ACDF. Further research is needed to address the benefits to larger patient populations. JOSPT Cases 2023;3(3):163-173. Epub: 20 June 2023. doi:10.2519/josptcases.2023.11608

Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy

Background: The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of adhesions. Purpose: To evaluate patient-reported outcomes (PROs) and survivorship at a minimum of 2 years after revision hip arthroscopic surgery with capsular spacer placement for capsular adhesions. Study Design: Case series; Level of evidence, 4. Methods: Between January 2013 and June 2018, a total of 95 patients (99 hips) aged ≥18 years underwent revision hip arthroscopic surgery for the treatment of capsular adhesions with the placement of a capsular spacer. Overall, 53 patients (56 hips) met the inclusion criteria and had a minimum 2-year follow-up, forming the cohort of this study. Exclusion criteria included confounding metabolic bone diseases (eg, Legg-Calve-Perthes disease, Marfan syndrome), labral deficiency, or advanced osteoarthritis (Tönnis grade 2 or 3). Preoperative and postoperative outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sport-Specific Subscale [HOS-SSS], 12-Item Short Form Health Survey [SF-12], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected and compared in addition to the revision rate, conversion to total hip arthroplasty, and patient satisfaction. Results: The mean age of the cohort was 32 ± 11 years, with 32 female hips (57%) and a median number of previous hip arthroscopic procedures of 1 (range, 1-5). The arthroplasty- and revision-free survivorship rate at 2 years was 91%. Overall, 5 patients (6 hips; 11%) underwent revision surgery at a mean of 2.4 ± 1.4 years after capsular spacer placement, with symptomatic capsular defects being the most common finding. There were 4 patients (7%) who converted to total hip arthroplasty. For hips not requiring subsequent surgery (n = 46), there was a significant improvement in outcome scores except for the SF-12 Mental Component Summary, with rates of achieving the minimal clinically important difference of 70%, 70%, and 65% for the mHHS, HOS-ADL, and HOS-SSS, respectively. Conclusion: Capsular spacers, as part of a systematic approach including lysis of adhesions with early and consistent postoperative physical therapy including circumduction exercises, resulted in improved PROs as well as high arthroplasty– and revision-free survivorship (91%) at a minimum 2-year follow-up. Capsular spacers should be considered in revision hip arthroscopic procedures when an adequate labral volume remains but adhesions continue to be a concern.

Effects of Early Physical Therapist-supervised Walking on Clinical Outcomes after Liver Resection: Propensity Score Matching Analysis.

The study aimed to demonstrate the significance of early postoperative physical therapy interventions on clinical outcomes by determining the influence of the distance walked under the supervision of a physical therapist in the early postoperative period after liver cancer. All consecutive patients who underwent surgery for liver cancer between April 2018 and March 2020 were eligible for enrollment in the study. The total walking distance during physical therapy till the third postoperative day was examined. The clinical outcomes comprised duration of postoperative hospital stay, time to independent walking, and occurrence of postoperative complications. For data analysis, the patients were divided into two groups: those who walked more than the median total distance (the long-distance group) and those who walked less than the median distance (the short-distance group). We used propensity score matching to match the background characteristics between the groups. Of the 65 patients who were eligible, 14 patients were included in the two groups each, after matching. The long-distance walking group had a significantly shorter hospital stay (9.0 days vs. 11.0 days, p=0.008) and a shorter time to independent walking (3.5 days vs. 7.5 days, p=0.019) than the short-distance walking group. There were no significant differences in postoperative complications between the two groups (7.1% vs. 42.8%, p=0.08). In the early postoperative period after liver cancer surgery, increasing the walking distance under the supervision of a physical therapist is important for improving clinical outcomes. Further prospective studies are needed to confirm the findings of this study.

Сучасні уявлення про фізичну терапію пацієнтів після оперативного лікування переломів кісток гомілково-надп’яткового суглоба

The purpose of the study is to determine and analyze modern means of restoring motor functions used for patients with fractures of the ankle joint bones after surgical treatment. Materials and methods. The work is the result of analysis and generalization of special scientific and methodological literature of domestic and foreign authors and Internet data on the features of the use of modern methods of physical therapy for patients with fractures of the ankle joint bones after surgical treatment. Results and discussion. Physical therapy for patients with fractures of the ankle joint bones is integral to a speedy recovery. Due to the fact that after surgery, it is mandatory to apply a plaster cast or a fixator to the joint for about 6 weeks – the strength of the lower extremities is lost, joint contracture appears, there is aching pain and a decrease in the range of motion. It is necessary to start classes with a physical therapist as early as possible, already on the second day after the operation, if the general condition of the patient is satisfactory. Patients require early postoperative functional physical therapy under the supervision of a physical therapist to improve joint function and proprioception, and to promote edema regression (lymphatic drainage). Patients with fractures associated with ligament injuries especially require proprioceptive neuromuscular facilitation to protect them from the risk of chronic ankle instability. Generally, recovery for patients with this trauma is slow and requires patience. There is some evidence that early introduction of activity during the immobilization period may be beneficial for patients. By doing light ankle exercises, the range of motion is improved, pain disappears and the function of the joint improves. Also, early stress on body weight is associated with many benefits, including better mobility, shorter hospital stays, and earlier return to work. However, there are other claims that early exercise increases the risk of surgical site infection, reoperation, and surgical fixation failure. Given the lack of evidence to determine it should be noted that additional research is needed to address this issue. Conclusions. Current evidence on the physical therapy of fractures of the ankle joint bones after immobilization shows that separate physical therapies do not accelerate the recovery process. This suggests that physical therapy must be comprehensive and must necessarily focus on a progressive and structured exercise program. Also, recent studies have shown that exercise is an effective mean of physical therapy, especially balance exercises

Postoperative Rehabilitation of Multiligament Knee Reconstruction: A Systematic Review.

Multiligamentous knee injuries (MLKIs) are rare, and heterogeneous in presentation and treatment options. Consequently, optimal postoperative rehabilitation of MLKI remains unclear. To summarize the latest evidence for postoperative rehabilitation protocols following multiligamentous knee reconstruction (MLKR). A multidatabase search was conducted with the aid of a health sciences librarian. Blinded reviewers conducted multiple screenings of studies evaluating postoperative rehabilitation protocols following MLKR. All included studies were then graded based on level of evidence, and data concerning patient demographics and rehabilitation protocols were extracted. MLKR rehabilitation protocols differ widely in terms of weightbearing, bracing, initiation, and types of physical therapy, yet several established protocols were referenced frequently throughout the literature. Such protocols resulted in good outcomes, with patients returning to running in 6 to 12 months and returning to sport in 8 to 12 months. The rare nature of MLKI hinders the ability to create a standardized rehabilitation protocol. However, early postoperative physical therapy and range of motion consistently lead to improved outcomes. Randomized studies are needed to determine optimal postoperative rehabilitation following MLKR.

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

BackgroundThe purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery.MethodsFifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months.ResultsAfter surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p < 0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively.ConclusionLimited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.

Earlier Initiation of Postoperative Physical Therapy Decreases Opioid Use after Total Knee Arthroplasty.

For patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.

Effects of Early Postoperative Physical Therapy Evaluation After Total Hip and Knee Arthroplasty on Discharge Disposition

Purpose: To evaluate whether early initiation of postoperative physical therapy for patients after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is associated with discharge disposition. Methods: For this retrospective project, a total of 118 patients with THA and 129 patients with TKA were included. Cases included elective single THA and TKA performed between October 2016 and September 2017. Retrospective chart data were analyzed to identify the association between physical therapy initiation on postoperative day (POD) 0 and POD 1, and discharge disposition. Results: Initiating physical therapy POD 0 was associated with discharge to home. In the combined THA/TKA analysis, patients who received physical therapy on POD 0 were significantly more likely to be discharged home, when compared with those starting physical therapy on POD 1 (72% and 53%, respectively), χ2(1) = 8.3 [χ2(1) = 8.3, P = .004]. After controlling for age, gender, and length of stay (LOS), physical therapy initiation on POD 0 increased the odds of discharge to home 2.4 times. For men, initiating physical therapy on POD 0 was associated with a 54% improvement in the proportion of patients who were discharged home (POD 0 = 79.7%, POD 1 = 51.7%), χ2(1) = 7.8, P = .005, Cramer's V = 0.28, P = .005. Significantly more patients aged 60 to 70 were discharged home when physical therapy was initiated on POD 0, compared with POD 1 (84.4% and 58.8%, respectively), χ2(1) = 7.8, P = .005, Cramer's V = 0.28. Conclusions: We found that providing physical therapy beginning on POD 0 after THA/TKA was associated with an increased proportion of patients discharged home, particularly among men between the ages of 60 and 70 years.

ROLE OF PHYSIOTHERAPY IN IMPROVING QUALITY OF LIFE IN LIVER TRANSPLANT PATIENTS

Objective: To evaluate the impact of pre and early post operative physical therapy on quality of life (QOL) in patients of liver transplantation. Methods and materials: A Single group pre and post experimental study design was conducted in Shifa International Hospital in which 20 patients with cirrhotic liver waiting for transplant participated. Non probability Convenience Sampling technique was used. Data was collected over a period of six months using a standard questionnaire 36-Item Short Form Survey (SF-36)and a General demographic questionnaire which included age, gender, BMI, along with diabetes, hypertension, ECOG level, tidal volume, muscle power, 6 minute walk test(heart rate, SpO2, distance covered, exertion level measurement). Results: The mean ± SD age &amp; Body Mass Index of the participants (N=20) were 47.20 ± 11.49 years and 24.83 ± 2.1 respectively. 6 Minute Walk Test Heart Rate, 6 Minute Walk Test Distance, , ECOG, 6 Minute Walk Test Exertion Level and Muscle power were shown significantly improved throughout the treatment duration (p&lt;0.001). While 6 Minute Walk Test Oxygen Saturation showed significant improvement only in initial two weeks (p=0.01), but at the end of 2nd week and overall improvement was not significant (p≥0.05). The results of the study also showed significant improvement (p&lt;0.001) in all domains of quality of life (SF-36) at the end of study. Conclusion: The study indicated that early pre and post physiotherapy interventions can improve the overall health-related quality of life including the aerobic physical fitness and muscle strength in patients having liver transplantation Keywords: 6 minute walk test, ECOG, Incentive spirometry, Liver transplantation, Muscle power, Physiotherapy, Quality of life.

Early Postoperative Physical Therapy Evaluation After Total Hip and Knee Arthroplasty Reduces Hospital Length of Stay

Purpose: To evaluate whether the timing of physical therapy (PT) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is associated with inpatient length of stay (LOS), patients with PT initiated on postoperative day (POD) 0 versus POD 1 were compared. Methods: For this evidence-based quality improvement project, a total of 260 patients were studied, with 122 patients receiving THA and 138 receiving TKA. Of the patients receiving THA, 85 received PT POD 0, and of the patients receiving TKA, 91 received PT POD 0. Data were compared with patients receiving THA and TKA who had PT on POD 1 during the same timeframe. Results: The average LOS for patients undergoing THA with PT on POD 0 versus POD 1 was 2.78 (standard deviation [SD] = 1.084) and 3.68 (SD = 2.484) days, respectively, and 2.95 (SD = 1.068) and 3.26 (SD = 0.920) days for patients undergoing TKA. Pearson χ2 analysis demonstrated a statistically significant shortened LOS for the POD 0 group (THA and TKA combined, χ2 = 16.535, P &lt; .001). Patients in the POD 0 group were 3 times more likely to be discharged within 3 days compared with the POD 1 group (THA and TKA combined, 32% vs 11%). A greater proportion of the POD 0 group were discharged home compared with the POD 1 group (75% vs 46%). Conclusions: Our preliminary results show that providing PT evaluations on POD 0 is associated with a decreased LOS for patients following THA and TKA, which contributes to a considerable cost savings.

Performance milestones in postoperative physical therapy after total hip arthroplasty: impact on length of stay and discharge destination

Background: Early postoperative physical therapy (PT) regimens after total hip arthroplasty (THA) have become the standard of care at most institutions. Initiating PT on postoperative day (POD) 0 after THA has been shown to shorten hospital length of stay (LOS). However, objective performance milestones for early therapy are not well established. Methods: This study retrospectively reviewed 277 patients who underwent primary THA. Specific data assessed included demographic information, number of feet walked at the POD 0 and POD 1 PT evaluations, LOS, and discharge destination. The primary outcome assessed was the relationship between performance in PT with both LOS and discharge destination. For those patients who could not participate in therapy, reasons cited by therapy documentation were recorded. Results: Patients who received POD 0 PT had a shorter LOS (P=0.032), decreased discharge to extended care facility (ECF) (P&lt;0.001), and walked farther in PT on POD 1 (P&lt;0.001). Ambulating farther than 10 feet on POD 0 or 100 feet on POD 1 resulted in significant decreases in LOS (P=0.005, P&lt;0.001) and in the percentage of patients discharged to an ECF (P=0.027, P&lt;0.001). The most common reason for inability to participate in therapy was late arrival to the inpatient floor. Conclusions: Achieving mobility milestones is a key factor in the determination of a patient’s discharge timing and destination after THA. Limited data exist validating objective performance milestones for patients receiving early PT after THA. This study suggests that achieving mobility milestones on POD 0 and 1 can significantly improve short-term outcomes.

Early postoperative physical therapy for improving short-term gross motor outcome in infants with cyanotic and acyanotic congenital heart disease

Purpose: We analysed the gross motor recovery of infants and toddlers with cyanotic and acyanotic congenital heart disease (CHD) who received early postoperative physical therapy to see whether there was any difference in the duration to recovery.Methods: This study retrospectively evaluated the influence of early physical therapy on postoperative gross motor outcomes of patients with CHD. The gross motor ability of patients with cyanotic (n = 25, average age: 376.4 days) and acyanotic (n = 26, average age: 164.5 days) CHD was evaluated using our newly developed nine-grade mobility assessment scale.Results: Physical therapy was started at an average of five days after surgery, during which each patient’s gross motor ability was significantly decreased compared with the preoperative level. Patients (who received early postoperative physical therapy) with cyanotic (88.0%) and acyanotic CHD (96.2%) showed improved preoperative mobility grades by the time of hospital discharge. However, patients with cyanotic CHD had a significantly prolonged recovery period compared to those with acyanotic CHD (p < .01). The postoperative recovery period to preoperative mobility grade was significantly correlated with pre-, intra-, and postoperative factors.Conclusions: Our findings suggested that infants with cyanotic CHD are likely at a greater risk of gross motor delays, the recovery of which might differ between infants with cyanotic and acyanotic CHD after cardiac surgery. Early postoperative physical therapy promotes gross motor recovery.Implications of RehabilitationInfants and toddlers with cyanotic congenital heart disease are likely at greater risk of gross motor delays and have a prolonged recovery period of gross motor ability compared to those with acyanotic congenital heart disease.Early postoperative physical therapy for patients with congenital heart disease after cardiac surgery promoted gross motor recovery.The postoperative recovery period to preoperative mobility grade was affected by pre-, intra-, and postoperative factors.Rehabilitation experts should consider the risk of gross motor delays of patients with congenital heart disease after cardiac surgery and the early postoperative physical therapy to promote their gross motor recovery.

Motor-Sparing Surgical Nerve Blocks for Upper Extremity Surgery: Significantly Less Motor Paralysis Using 15 mL versus 30 mL of Mepivacaine 1.5% for Supraclavicular Block - A Prospective Randomized Double-Blinded Study

Background and objectives: We performed a prospective randomized double-blinded study evaluating if a reduced volume of local anesthetic would result in operative limb surgical anesthesia while decreasing motor paralysis during an ultrasound-guided supraclavicular nerve block. Current tendencies in clinical practice towards smaller injectate volumes during ultrasound-guided nerve block placement prompted our investigation on its impact regarding block quality. Methods: 43 patients were consented for this prospective, double-blinded randomized clinical trial. Each patient was randomly assigned. Group HIGH received the conventional injection dose of 30 mL of 1.5% Mepivacaine. Group LOW received the reduced volume dose of 15 mL. An ultrasound-guided supraclavicular nerve block was performed on each patient. Motor block and sensory perception to pin-prick were assessed in the nerve distributions for the ulnar, median, radial, and musculocutaneous branches at 5, 10, 15, 20, and 30 minutes post-injection. Results: Complete motor block in the radial, ulnar, musculocutaneous and median nerve distributions at 30 minutes, was present in 55% of patients in Group HIGH versus 10% in Group LOW and was statistically significant between both groups (p<0.01). The anatomic distribution of the observed motor-sparing was statistically significant in the median (p<0.01) and ulnar (p<0.05) nerve branches among those patients who received 15 mL LA boluses. Conclusions: Our study demonstrated that 15 mL vs. 30 mL injections of mepivacaine 1.5% at the supraclavicular approach provide equivalent surgical anesthesia, while reducing the incidence of motor block. These findings may have implications on early postoperative physical therapy for the subset of patients that present with Galeazzi-type fractures, carpal tunnel syndrome, and minimally-displaced distal radius fractures.

Early Postoperative Chest Physical Therapy Effects on Respiratory Function in Patients With Lung Transplantation

Early Postoperative Chest Physical Therapy Effects on Respiratory Function in Patients With Lung Transplantation

Mandibular hypomobility secondary to bilateral coronoid hyperplasia

Coronoid process hyperplasia is one of a large number of disorders affecting the stomatognathic system and causing mandibular hypomobility. It is characterized by an excessive coronoid process growing to such an extent that it impinges on the posterior portion of the zygomatic bones. Despite the low prevalence of this condition, it should be considered as a possible diagnosis in patients with painless, progressive, and chronic restriction of mouth opening. The diagnosis is based on clinical signs in association with radiographic examinations. Coronoidectomy is the only treatment option for this condition along with early postoperative physical therapy. This article presents the case of a patient with bilateral coronoid process hyperplasia, who was initially diagnosed as having bilateral temporomandibular joint disorders. The patient underwent months of physiotherapy and bite-appliance therapy without any improvement in mouth opening. FinalIy, he was referred to La Timone Hospital for a proper diagnosis and, consequently, effective treatment.

Retraction Note: Graft fixation alternatives in anterior cruciate ligament reconstruction

Reconstruction of the anterior cruciate ligament is a frequently performed procedure that has had outstanding results. Outcomes are dependent upon an early postoperative physical therapy program that stresses early motion. Early rehabilitation demands rigid intraoperative mechanical fixation of the graft since therapy begins before biologic incorporation of the graft in the bone tunnels. Regardless of the graft substitute chosen, many methods of fixation are available. The best fixation technique depends on several factors, including graft choice and surgeon comfort. The figures are not documented in this paper. We review current methods available for graft fixation in anterior cruciate ligament surgery.

RETRACTED ARTICLE: Graft fixation alternatives in anterior cruciate ligament reconstruction

Reconstruction of the anterior cruciate ligament is a frequently performed procedure that has had outstanding results. Outcomes are dependent upon an early postoperative physical therapy program that stresses early motion. Early rehabilitation demands rigid intraoperative mechanical fixation of the graft since therapy begins before biologic incorporation of the graft in the bone tunnels. Regardless of the graft substitute chosen, many methods of fixation are available. The best fixation technique depends on several factors, including graft choice and surgeon comfort. The figures are not documented in this paper. We review current methods available for graft fixation in anterior cruciate ligament surgery.

Patients’ reasons for electing to undergo total knee arthroplasty impact post-operative pain severity and range of motion

The present study examines the reasons cited by 103 patients for their electing to undergo total knee arthroplastic surgery and the relationship between these reasons and their post-operative pain and range of motion. Results suggest that individuals who describe different reasons for undergoing surgery vary in their post-operative recovery. Specifically, patients who cite pain as the reason they are undergoing surgery report greater levels of pain during the early post-operative period. In contrast, patients who describe goals of regaining mobility or a specific activity as their reason for undergoing surgery achieve a greater range of motion during early post-operative physical therapy. Individuals who express avoidance goals for undergoing total knee arthroplasty report more severe post-operative pain at 1 and 3 months following surgery compared to patients who express approach goals. Interventions targeted towards patients reporting pre-operative pain or avoidance goals may decrease subsequent post-operative pain and increase mobility.

Soft-tissue graft fixation in anterior cruciate ligament reconstruction

Reconstruction of the anterior cruciate ligament (ACL) is performed frequently in the United States with predictably good results. Results are dependent on an early postoperative physical therapy program that stresses early motion. Early rehabilitation demands rigid intraoperative mechanical fixation of the graft allowing aggressive physical therapy to begin before biologic incorporation of the graft in the bone tunnels. Many patients and surgeons choose to use a soft-tissue graft, usually a hamstring autograft, for the reconstruction. Many fixation options exist today for fixation of this graft. The “best” fixation technique depends on several factors including graft choice and surgeon comfort. In this article, we review noninterference screw devices available for fixation of soft-tissue grafts in ACL surgery.