Postoperative Anterior Cruciate Ligament Reconstruction Research Articles

Effects of combining rehabilitation training on the recovery of athletic ability after reconstruction of injured ligament

This paper aims to investigate the impact of conventional rehabilitation training and neuromuscular electrical stimulation (NMES) on the recovery of motor abilities in patients following ligament injury reconstruction. Forty postoperative patients who underwent surgery for anterior cruciate ligament reconstruction (ACLR) were randomly allocated to either the conventional rehabilitation group or the NMES group. The NMES group received NMES treatment in addition to the conventional rehabilitation program starting from eight weeks postoperatively. Various parameters, including knee joint function, stability, and balance, were compared between the two groups at eight weeks and 12 weeks postoperatively. Compared to the data at eight weeks postoperatively, both groups exhibited significant improvements in all measured indicators at 12 weeks postoperatively (p < 0.05). In the 12th week after the surgery, the NMES group demonstrated a Lysholm score of 93.18 ± 3.67 points, an IKDC score of 84.65 ± 2.33 points, a KT-2000 measurement of 0.88 ± 0.45 mm, a thigh circumference difference of −1.33 ± 0.55 cm, a knee flexion angle of 130.12 ± 4.21°, a single-leg standing time of 60.12 ± 9.33 s, a YBT score of 70.26 ± 2.68 points, and a Bulgarian split squat 1RM size of 58.07 ± 6.85 kg; all of these results were significantly superior to those observed in the conventional group (p < 0.05). NMES significantly enhances the recovery of athletic ability in patients following postoperative ACLR and can be effectively applied in clinical practice.

Physiotherapy management of functional activity disorders of knee dekstra et cause post-op anterior cruciate ligament reconstruction

Introduction: anterior cruciate ligament injury is one of the common knee injuries among athletes, which can cause functional activity impairment of the knee, such as pain, edema, range of motion limitation, contracture, and anxiety. Anterior cruciate ligament reconstruction is a surgical procedure that aims to restore the stability and function of the knee. Patients who undergo Anterior cruciate ligament reconstruction require appropriate physiotherapy management to accelerate the healing and recovery process. Aim: this study aims to determine the physiotherapy management of functional activity disorders of the knee joints and the causes of postoperative anterior cruciate ligament reconstruction. Methods: this study used a case study method with a research subject of a 24-year-old male who suffered an anterior cruciate ligament injury on the right knee and underwent Anterior cruciate ligament reconstruction. Data were collected using instruments such as the VAS pain scale, goniometer to measure a range of motion, MMT to measure muscle strength, and international knee documentation committee questionnaire to measure functional activity. Results: showed a decrease in pain, an increase in range of motion, an increase in muscle strength, and an increase in functional activity on the right knee caused post-op Anterior cruciate ligament reconstruction after receiving physiotherapy intervention for 9 sessions. Conclusion: physiotherapy management given in the form of electrical muscle stimulation, prone hang, passive range of motion exercise, patella mobilization, isotonic &amp; isometric strengthening, and walking exercise, as well as education, can help overcome functional activity impairment on the right knee et cause post-op anterior cruciate ligament reconstruction.

Changes in proprioception at different time points following anterior cruciate ligament injury or reconstruction

PurposeTo investigate the changes in 30° and 60° position sense in patients with anterior cruciate ligament (ACL) injury at different time points after injury and reconstruction.MethodsPatients were divided into six groups according to time after ACL injury and reconstruction: group A (ACL injury 1.5–6 months), group B (ACL injury 6–12 months), group C (ACL injury > 12 months), group D (postoperative ACL reconstruction 1–6 months), group E (postoperative ACL reconstruction > 6 months), and group F consisting of 14 healthy adults (control group). The ability of the affected leg to reproduce the same joint position during knee flexion was tested using active joint position sense assays to assess proprioception in both the lower extremities of the patient or between groups.ResultsProprioception decreased rapidly during the early stages of ACL injury. Significant difference in the affected side at 30° compared to the healthy side (Group A: 4.70 (4.78, 9.00) vs 4.15 (3.35, 6.13), P = 0.03; Group B: 2.90 (0.48, 4.56) vs 8.30 (4.18, 10.43), P = 0.001; Group E: 6.25 (2.55, 11.60) vs 9.60 (3.90, 12.73), P = 0.009). However, no significant differences were detected for a double lower limb contrast of 60° (Group A: 5.1 (1.00, 8.00) vs 3.00 (0.75, 3.55), P = 0.044). Finally, the affected side of patients in groups C, D and E had significant differences in position perception at 30° compared with healthy subjects (P < 0.01), and the affected side of patients in groups C and E had significant differences in position sense at 60° compared with healthy subjects (P < 0.01).ConclusionACL injury had a greater impact on the patient's 30° position sense, with only a small impact for 60°. Further, the early and middle proprioception recovery stages after ACL injury were the best before surgery. Finally, proprioception recovery training should be performed soon after injury.

Role Of Magnetic Resonance Imaging In Evaluation Of Post-Operative Anterior Cruciate Ligament Reconstruction

Objectives: This study aimed to spotlight on the diagnostic value of magnetic resonance imaging (MRI) in the assessment of anterior cruciate ligament (ACL) reconstruction graft & detection of its complications.

NEUROMUSCULAR ELECTRICAL STIMULATION IS BENEFICIAL FOR EARLY REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

The principal of “function priority, early rehabilitation, and return to sports” is now the goal for sports injury rehabilitation. Neuromuscular electrical stimulation for anterior cruciate ligament (ACL) reconstruction is a rising procedure for early rehabilitation. This paper systematically assessed the effects of neuromuscular electrical stimulation on postoperative ACL reconstruction to provide guidance for physiotherapist and patient when designing a suitable rehabilitation protocol.To evaluate the interventional outcomes of neuromuscular electrical stimulation following ACL reconstruction, we searched PubMed, EMbase, the Cochrane Library, Web of Science and CNKI to collect all randomized controlled trials (RCTs) comparing the effects with neuromuscular electrical stimulation and without intervention on rehabilitation after ACL reconstruction up to January 30, 2022. Two investigators independently performed literature screening, data extraction, bias assessment of risk, and used RevMan 5.3 software to conduct a meta-analysis.A total of six RCTs were included, and the results showed that the use of neuromuscular electrical stimulation after anterior cruciate ligament reconstruction significantly improved the International Knee Documentation Committee (IKDC) scores (MD 6.33, 95% CI [-0.43, 12.22]; I2 = 66%; p = 0.040), the Lysholm score (MD 7.94, 95% CI [6.49, 9.39]; I2 = 89%; p &lt; 0.001), and the range of motion (ROM) (MD 9.99, 95% CI [7.97, 12.02]; I2 = 81%; p &lt; 0.001) in the knees when compared to the control group without using neuromuscular electrical stimulation.Existing evidence show that neuromuscular electrical stimulation is beneficial for early rehabilitation after ACL reconstruction. The use of neuromuscular electrical stimulation is encouraged in the design of rehabilitation protocol. However, due to the limited number of RCT studies and the small sample size, further multi-center RCTs with more participants are needed for a higher-level evidence.

Physiotherapy rehabilitation management on phase III of post-operative anterior cruciate ligament reconstruction with partial lateral meniscectomy: a case report

BACKGROUND/LATAR BELAKANG:&#x0D; Angka kejadian cedera pada lower esxtremity saat aktivitas olahraga menacapai 40-60% diseluruh dunia dan 16%nya menyebabkan cedera pada ligament ACL, dimana ligament ACL mengalami peregangan hingga rupture, cedera ACL dapat terjadi karena adanya mekanisme trauma, dimana posisi lutut rotasi, dan hiperekstensi atau disebabkan adanya kontraksi tiba-tiba dari otot quadricep femoris1. Cedera pada ACL dan juga disertai dengan meniscus tear dapat menimbulkan gangguan fungsi gerak tubuh sehingga dapat menganggu aktivitas sehari-hari 2.&#x0D; Rekonstruksi ACL adalah prosedur bedah untuk mencangkok ACL dengan menggunakan jaringan tendon untuk mengembalikan fungsi fiksasi dan stabilisasi sendi. Tendon yang diambil untuk cangkok ACL berasal dari tendon hamstring, quadriceps, pattelar, maupun tendon otot ekstremitas bawah lainnya yang dinilai kuat dan panjang, Pada kondisi meniskus yang mengalami kerobekan dapat dilakukan Tindakan menisektomi. Menisektomi parsial melibatkan mengeluarkan bagian yang robek dari meniscus dan biasanya dilakukan untuk robekan yang memiliki kemungkinan penyembuhan sangat rendah setelah perbaikan. Prosedur ini akan mengangkat sepotong meniskus yang robek sehingga lutut dapat berfungsi secara normal kembali 3.&#x0D; Penatalaksanaan rehabilitasi yang dilakukan oleh fisioterapi pada pasien ACL-R fase III untuk meningkatkan strength, balance dan kontrol gerak fungsional pasien dengan intervensi adaptasi rehabilitasi dan latihan dengan tujuan untuk mencegah cedera, mengembalikan fungsi optimal serta berkontribusi dalam meningkatkan performa olahraga atlet atau pemain dari segala usia dan kemampuan dengan menjamin standar profesionalitas yang tinggi.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; CASE DESCRIPTION/DESKRIPSI KASUS :&#x0D; Pada tanggal 09 Juni 2022 pasien bermain basket, lalu pasien mendengar kakinya berbunyi “pop” akibat gerakan berhenti dan berputar secara mendadak pada saat bermain basket. Pasien berinisiatif pergi kerumah sakit karena kakinya terasa nyeri dan disarankan untuk melakukan MRI, hasil pemeriksaan MRI menyatakan pasien mengalami rupture ACL dan Meniscus. Pasien telah menjalani operasi rekonstruksi ACL dan partial lateral menisectomy pada 20 Juli 2022, pasien telah melakukan fisioterapi sejak hari pertama pasca operasi hingaa saat ini memasuki minggu ke 10, pasien masih merasa ada yang mengganjal di bagian lutut, dan merasa kaki kirinya kaku dan lemah pada saat digerakkan.&#x0D; CONCLUSION/KESIMPULAN :&#x0D; Pemberian asuhan fisioterapi pada kasus ini bertujuan untuk mengurangi nyeri pada knee sinistra, rasa menganjal pada lutut, meningkatkan ROM khususnya pada flexi knee, meningkatkan kekuatan, endurance dan massa otot quadriceps &amp; hamstring agar kemampuan fungsional knee sinistra pasien bisa kembali ke kondisi optinal sehingga pasien bisa menjalani kehidupan sehari-harinya tanpa gangguan kemudian return to sport.

Physiotherapy rehabilitation management on phase IV of post-operative anterior cruciate ligament reconstruction with medial meniscus repair : a case report

Background: Sports injuries are injuries that arise as a result of sporting activities or activities. 60% of sports-related injuries occur in the lower limbs, including the knee's anterior cruciate ligament (ACL). This study aims to evaluate the physiotherapy interventions to improve ROM, balance, and knee function following ACLR with medial meniscus repair phase IV. Case Description: The patient complained of pain and stiffness in the popliteal area. The pain was felt when driving a car and squatting. The injury occurred when playing futsal, and the patient made a zigzag while trying to win the ball. The patient took the wrong footing. Namely, the body turned while the left leg was left behind, and the knee joint suddenly rotated or twisted. Before surgery, the patient had carried out physiotherapy for six meetings. The operation was carried out on 11 May 2022 at the Royal Progress Hospital with three-day hospitalisation. The patient has been doing physiotherapy since the first day after surgery. Currently, the patient has entered week 19 (Phase IV). Conclusion: The physiotherapy rehabilitation process, in this case, focuses on maintaining and increasing the strength of the core muscles and lower extremities, preparing the patient to jog, and training the patient's brain coordination through agility training. Returning to futsal is the ultimate goal of physiotherapy rehabilitation in this case.

The Seated Trunk Control Test: Investigation of Reliability and Known-Groups Validity Using Individuals Post-Anterior Cruciate Ligament Reconstruction.

Decreased trunk neuromuscular control is a risk factor for both upper- and lower-extremity injuries, yet there are few reliable and valid clinical tests to identify deficits. The purpose of this study was to determine the reliability and known-groups validity of a novel clinical test, the seated trunk control test (STCT). Cross-sectional reliability and known-groups validity study. Laboratory. 89 unique participants: 34 were 3months postoperative anterior cruciate ligament reconstruction (ACLR) and 55 healthy controls. For the STCT, participants sat on a balance board with their eyes closed for three 30-second trials while investigators counted balance errors. Intraclass correlations (ICCs) were used to assess interrater reliability (N = 20) and test-retest reliability (N = 40). To assess known-groups validity, independent t tests were used to compare STCT errors at 3 months post-ACLR with healthy matched controls (N = 34/group). Area under a receiver operating characteristic curve identified an optimal cutoff for distinguishing between groups. The STCT had perfect interrater reliability (ICC2,3 = 1.00) and good test-retest reliability (ICC3,3 = .79; 95% confidence interval = .61-.89). The ACLR group made significantly more errors on the STCT (mean [SD] = 15.5 [5.4]) than controls (mean [SD] = 8.2 [4.1]; P < .001, Cohen d = 1.52). The STCT's ability to distinguish between groups was excellent (area under a ROC curve = 0.86). A cutoff of 12 errors maximized sensitivity (76%) and specificity (85%). The STCT is reliable between raters and across days. It also has excellent ability to distinguish between individuals with a recent ACLR and healthy matched controls, which provides initial evidence to suggest that the STCT may be clinically useful for identifying deficits in trunk neuromuscular control.

The relationship between thigh and leg circumferences and proprioceptive sense: results of postoperative anterior cruciate ligament reconstruction

The relationship between thigh and leg circumferences and proprioceptive sense: results of postoperative anterior cruciate ligament reconstruction

The Effects of a Combined Pre- and Post-Operative Anterior Cruciate Ligament Reconstruction Rehabilitation Program on Lower Extremity Muscle Imbalance

This study examined whether the 5-week pre-operative progressive exercise rehabilitation program with weekly monitoring contributed to a significantly lower muscle activity imbalance in the treatment group, both before and immediately after anterior cruciate ligament reconstruction (ACLR), as well as during the next 5 weeks in comparison to the control group. Twelve professional soccer players took part in the study (from among the top three Polish levels of competition) (age: 26 ± 5 years, body mass: 73 ± 7 kg, stature: 180 ± 6 cm, training experience: 15 ± 4 years). The participants were randomly assigned to the treatment group (n = 6) or to the control group (n = 6). Both groups performed the same pre- and post-operative progressive exercise rehabilitation program, while the rehabilitation of the treatment group was extended by supplementary body-weight functional stabilization training. The three-way repeated-measures ANOVA revealed a statistically significant interaction for muscle × group × time (p &lt; 0.0001; F = 24.897; η2 = 0.806). The post-hoc analysis for the interaction effect of muscle × group × time indicated a significantly higher muscle activity imbalance for every measured muscle in the control group at any time point than in the treatment group (from p = 0.036 to p &lt; 0.0001). The muscle activity imbalance was significantly higher from the 1st to 4th weeks than in the last week before surgery for quadriceps (p &lt; 0.016 for all) and hamstrings (p &lt; 0.001). However, in the case of gluteal muscles’ activity imbalance, it was significantly higher at every time point of the post-operative phase than in the last week before surgery (p &lt; 0.001). The results of this study showed that the 5-week pre-operative rehabilitation program with weekly monitoring influenced outcomes of the post-operative phase. Nevertheless, performing both pre- and post-ACLR rehabilitation significantly reduced the muscle activity imbalance of lower limbs, but in the case of the quadriceps muscles, not to a sufficient level.

Postoperative Anterior Cruciate Ligament Reconstruction Quadricep and Patella Tendon Rupture, Infection, and Lysis of Adhesions Decreased Despite Changing Graft Trends Over the Past Decade

PurposeTo investigate recent trends in postoperative complications following anterior cruciate ligament (ACL) reconstruction.MethodsPatients who underwent ACL reconstruction surgery were identified in a national insurance database and separated into 2 cohorts based on the date of their initial surgery comprising the years 2010 to 2012 and 2016 to 2018, respectively. Patients were matched 1:1 based on comorbidities and Elixhauser Comorbidity Index. All patients were assessed for postoperative complications within 18 months of surgery. Rate of complication was compared between cohorts.ResultsOverall, the all-cause complication rate was 2%. There were significantly more quadriceps tendon rupture, patella tendon rupture, lysis of adhesion, and infection in the early cohort. There were significantly more instances of deep vein thrombosis in the late cohort. We found no significant difference in manipulations under anesthesia between the 2 cohorts.ConclusionsPatients who underwent surgery in the late cohort had lower rates of postoperative complications, except for deep vein thrombosis. The rate of postoperative quadriceps tendon rupture decreased despite considerable increase in the use of quadriceps tendon autograft.Clinical RelevanceAs there has been an increased use of quadriceps tendon autografts, but little is known about the postoperative complications after ACL reconstruction with these grafts. This information has the potential to improve patient outcomes.

Assessment of the Complications and Associated Findings by Conventional MRI in Post-Operative ACL Reconstruction

Background: The anterior cruciate ligament (ACL) runs from the femur to the tibia in the knee joint and is a thick band of connective tissue that may be exposed to tears. Accurate MR imaging evaluation of these patients requires an understanding of the usual postoperative MR imaging appearance of postoperative ACL graft and any abnormalities. Objective: To assess the complications and associated findings by conventional MRI in post-operative ACL reconstruction. Patients and methods: This study included 27 symptomatic patients (23 males and 4 females). The study was carried out at the Radiology Department at Zagazig University Hospitals. They were assessed by conventional MRI after the ACL operations. Results: The mean age of the studied patients was 29.26 ± 7.79 years old. Most of the studied patients were males (85.2 %). 14.8% of the studied patients had anterior tibial translation, graft impingement in 2/27 (7.4 %) of patients and anteriorly displaced tibial hardware was found in 3/27 (11.1 %) of the studied patients. 18.5% of the studied patients had joint effusion. PCL buckling and bone marrow edema were found in 7.4% of the studied patients and PHMM degeneration was found in 11.1% of the studied patients. Conclusion: In order to properly evaluate the post-operative knee, particularly in patients who had cruciate ligament repair, magnetic resonance imaging (MRI) of the knee is required.

Blood Flow Restriction and Its Function in Post-Operative Anterior Cruciate Ligament Reconstruction Therapy: Expert Opinion.

An increasingly popular method for post-operative rehabilitation of an ACL reconstruction, as a substitute for traditional therapy, is blood flow restriction therapy (BFR). BFR therapy utilizes a pneumatic cuff to simulate strenuous exercise in an effort to stimulate muscle recruitment, mitigate atrophy, and promote hypertrophy in patients with load-bearing limitations. Because this is a relatively new form of therapy, there is a lack of established literature and protocol that is preventing widespread use of the therapy. This article will seek to confirm the value and validity of the utilization of BFR therapy.In order to validate the utilization of BFR, an evaluation of the science underlying BFR will be discussed as well as the technique and exercises preformed during therapy. Furthermore, analysis of other BFR literature will be utilized to lend further credence to the obtained conclusions. Based on the literature, BFR therapy mitigates atrophy through type II muscle recruitment while also stimulating hypertrophy in patients, supporting its use post-operatively. Moreover, positive results from BFR case series also lend credence to its value as a substitute for traditional therapy in patients who have weight-bearing limitations, specifically those who are recovering from anterior cruciate ligament reconstructions.

The Effect of Allogenic Bone Marrow on Integration Dev-Mesenchymal Stem Cell And Vascular Endothelial Growth Factor

Background: The integration of the tendon graft within the bone tunnel is one of the decisive success factors of the Anterior Cruciate Ligament (ACL) reconstruction. In ACL reconstruction that uses tendons as graft, the healing process that occurs in the bone tunnel is healing with fibrotic tissue. Aim: This study aims to determine the role of bone marrow mesenchymal stem cells and vascular endothelial growth factor intraarticularly in improving the biomechanical strength. Methods: This study uses experimental research design by using animal as a testing tool. The animals used in this study are male New Zealand white rabbits (Oryctolagus cuniculus), with the weight ranging of 2000 grams up to 3000 grams. Results: From the experiment, all samples from both treatment and control groups were all evaluated and no post-operative complication was found. At the evaluation time of 3 weeks, the difference between the mean of maximum strain rate between the treatment group and the control group was not statistically significant (p &gt;0.05). At the evaluation time of 6 weeks, it was found that the difference in mean value of the maximum strain load force between the treatment groups versus the group was statistically significant. Conclusions: From this study, it can be concluded that intraarticular BM-MSC and VEGF administration can increase the ultimate tension strength of postoperative graft tendon rosary ACL reconstruction.

Conventional Follow-up Versus Mobile Application Home Monitoring for Postoperative Anterior Cruciate Ligament Reconstruction Patients: A Randomized Controlled Trial

To determine whether a mobile app can reduce the need for in-person visits and examine the resulting societal cost differences between mobile and conventional follow-up for postoperative anterior cruciate ligament (ACL) reconstruction patients. Study design was a single-center, 2-arm parallel group randomized controlled trial. All patients undergoing ACL reconstruction aged 16 to 70 years were screened for inclusion in the study. Competent use of a mobile device and ability to communicate in English was required. Patients were randomly assigned to receive follow-up via a mobile app or conventional appointments. Analysis was intention-to-treat. The primary outcome was the number of in-person visits to any health care professional during the first 6 postoperative weeks. Secondary outcomes included analysis of costs incurred by the health care system and personal patient costs related to both methods of follow-up. Patient-reported satisfaction and convenience scores, rates of complications, and clinical outcomes were also analyzed. Sixty patients were analyzed. Participants in the app group attended a mean of 0.36 in-person visits versus 2.44 in-person visits in the conventional group (95% confidence interval 0.08-0.28; P < .0001). On average, patients in the app group spent $211 (Canadian dollars) less than the conventional group over 6 weeks (P < .0001) on personal costs related to follow-up. Health care system costs were also significantly less in the app group ($157.5 vs CAD $202.2; P < .0001). There was no difference between groups in patient satisfaction, convenience, complication rates, or clinical outcome measures. Mobile follow-up can eliminate a significant number of in-person visits during the first 6 postoperative weeks in patients undergoing ACL reconstruction with cost savings to both the patient and health care system. This method should be considered for dissemination among similar orthopaedic procedures during early postoperative care. I: Prospective randomized controlled trial.

How to repair an immediately post-operative anterior cruciate ligament reconstruction failure? About a clinical case

&lt;p class="abstract"&gt;We present a 23-year-old male with an early anterior cruciate ligament (ACL) reconstruction failure due to lateral wall blow-out, diagnosed on day one post-op. We were able to perform the revision using the original graft, and maintaining the initial tibial fixation, revising only the femoral fixation. At 1-year follow-up the patient is asymptomatic. In the early ACL reconstruction failures due to femoral wall blowout, it is possible to perform the revision surgery using the same graft and maintaining the same tibial fixation. This avoids de morbidity of a new graft harvest and the need for a new tibial tunnel.&lt;/p&gt;

Participants at three months post-operative anterior cruciate ligament reconstruction (ACL-R) demonstrate differences in lower extremity energy absorption contribution and quadriceps strength compared to healthy controls

BackgroundThe purpose of this study was to compare hip and knee energy absorption contribution (EAC) during a double limb squat (DLS) and quadriceps strength in patients three months post-operative ACL-R versus matched healthy controls. MethodsTwenty-four ACL-R participants (Age = 15.5 ± 1.3 yrs; Ht = 1.66 ± .07 m; Mass = 66.3 ± 15.5 kg) were compared to 24 age, sex, limb, and activity-matched healthy controls (Age = 15.5 ± 1.2 yrs; Ht = 1.65 ± .08 m; Mass = 59.0 ± 9.8 kg). Lower extremity biomechanical data was collected at three months post-operative ACL-R during five consecutive DLS. EAC was calculated during DLS descent. Isokinetic quadriceps strength was collected at 60°/s. Normalized quadriceps peak torque (QUADS) was averaged across five trials. Independent t-tests examined differences in group hip and knee EAC during each task. Separate Pearson product–moment correlations examined the relationship between QUADS and hip and knee EAC during the DLS. ResultsACL-R demonstrated greater injured limb hip EAC (46.4 ± 16.0) than Healthy (31.7 ± 11.0) during a DLS (p = 0.001). ACL-R demonstrated less injured limb knee EAC (42.7 ± 14.6) than Healthy (60.6 ± 8.9) during DLS (p < 0.001). No differences were seen between uninjured limb hip (ACL-R = 0.0 ± 14.2; Healthy = 33.4 ± 9.1, p = 0.629) or knee (ACL-R = 56.9 ± 15.6; Healthy = 59.1 ± 9.8, p = 0.561) EAC and matched limbs. ACL-R injured limb QUADS was decreased compared to Healthy (ACL-R = 1.1 ± 0.5; Healthy = 2.0 ± 0.5, p < 0.001). No differences were seen in QUADS on the uninjured and matched limbs (ACL-R = 2.0 ± 0.6; Healthy = 1.9 ± 0.5, p = 0.894). There was a weak, negative correlation between injured limb QUADS and hip EAC (r = −0.471, p = 0.001) and moderate, positive correlation between injured limb QUADS and knee EAC (r = 0.615, p < 0.001). ConclusionsACL-R participants demonstrate different eccentric loading strategies during a DLS at three months postoperative compared to matched healthy controls.

Continued Improvements in Quadriceps Strength and Biomechanical Symmetry of the Knee After Postoperative Anterior Cruciate Ligament Reconstruction Rehabilitation: Is It Time to Reconsider the 6-Month Return-to-Activity Criteria?

Patients who undergo anterior cruciate ligament reconstruction (ACLR) present with strength and biomechanical deficits at return to activity (RTA). Deficits in strength and biomechanical symmetry impair function during activity and may predispose patients to subsequent injury. To compare strength and biomechanical function in patients with ACLR at RTA and more than 12 months post-ACLR. Descriptive laboratory study. Research laboratory. A total of 20 participants (12 females, 8 males; age = 21.40 ± 5.60 years, height = 171.3 ± 10.2 cm, mass = 73.21 ± 19.41 kg) who had undergone ACLR and were cleared to RTA were recruited. Strength was measured during knee extension and evaluated by the isometric and isokinetic quadriceps index. Biomechanical function was evaluated using symmetry values for sagittal-plane knee-joint rotations, changes in sagittal-plane knee-joint rotation, knee-extension moments, and changes in knee-extension moment that were recorded during a single-legged forward hop. Self-reported function was measured using the International Knee Documentation Committee Subjective Knee Evaluation Form. Participants were assessed at RTA (212.25 ± 28.11 days) and more than 12 months post-ACLR (556.25 ± 230.89 days). At RTA, strength and biomechanical values were less than 80% symmetric. We observed improvements from RTA to more than 12 months post-ACLR for the isometric quadriceps index ( F1,18 = 29.22, P < .001), isokinetic quadriceps index ( F1,18 = 10.88, P = .004), sagittal-plane knee-joint rotations ( F1,19 = 9.58, P = .006), change in sagittal-plane knee-joint rotations ( F1,19 = 7.83, P = .01), knee-extension moments ( F1,19 = 5.73, P = .03), change in knee-extension moments ( F1,19 = 21.10, P < .001), and self-perceived function ( F1,19 = 11.50, P = .003). Of the 7 variables that showed improvement at more than 12 months post-ACLR, only 3 met the recommended criteria (≥90%). Patients with ACLR showed asymmetry in strength and biomechanics at RTA. These asymmetries, along with self-perceived function, improved over time. However, despite improvements in strength and biomechanics at RTA, asymmetries of more than 10% were still present more than 12 months post-ACLR.

Relations Between Return to Play Unilateral Knee Extension Strength and Triple-Hop Tests

Unilateral assessments are used to monitor the restoration of strength and strength symmetry following unilateral injury, such as an anterior cruciate ligament (ACL) tear. PURPOSE: To assess the relation between unilateral isokinetic knee extension (KE) strength and triple hop distance in post-operative ACL reconstruction patients at the time of return to sport (RTS). METHODS: Thirty patients (15 male; 18 ± 6 y; 1.75 ± 0.13 m; 76 ± 19 kg) were assessed for unilateral isokinetic KE strength at 180° s-1 and triple hop distance. Peak KE strength on the involved leg (IL) and uninvolved leg (UIL) were averaged to obtain an overall strength value and strength asymmetry was calculated between legs as a percentage. Participants were stratified into four groups based on the cohort’s overall median strength and strength asymmetry values (low strength low asymmetry, low strength high asymmetry, high strength low asymmetry, and high strength high asymmetry). Pearson correlations were used to determine the relation between KE strength and triple hop distance. One-way analysis of variance was used to assess the effect of group on triple hop distance on IL and UIL. T-tests were used to determine the source of identified effects and to compare IL to UIL in each group. RESULTS: For all patients, the mean IL and UIL KE strength was 1.52 ± 0.59 Nm kg-1 and 1.68 ± 0.61 Nm kg-1, respectively, and the median KE strength asymmetry was 13.2%. The mean IL and UIL triple hop distance was 4.27 ± 1.09 m and 4.26 ± 1.27 m, respectively. No significant correlations were identified between UIL KE strength and triple hop distance (r = 0.34; p > 0.05), but were identified for IL KE strength and triple hop distance (r = 0.40; p = 0.03). No significant effect of group for IL was identified (p > 0.05) but was identified for UIL (p = 0.03), though individual comparisons were not significant (p > 0.05). Among all groups, triple hop distance was not significantly different between IL and UIL (p > 0.05). CONCLUSION: The low explained variance between KE strength and triple hop distance suggests these test shouldn’t be used in isolation during RTS testing. Groups may have demonstrated similar triple hop distance because demand may be shifted to proximal or distal joints during unilateral hopping, which masks unilateral KE strength deficits and results in symmetrical unilateral function.

Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery.

Background:In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation.Purpose:To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act.Study Design:Cross-sectional study.Methods:Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located.Results:Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients (P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted.Conclusion:The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.