Postoperative Rehabilitation Protocol Research Articles

The best time of weight bearing after ACL reconstruction, immediately or delayed? A randomized clinical trial

Objective: Postoperative rehabilitation protocols, such as immobilization and non-weight-bearing periods during the acute phase after ACL surgery, vary depending on the surgeon or the institution, and lack clear standardization. Weight bearing (WB) after anterior cruciate ligament reconstruction (ACL-R) is one of the important issues. This study aimed to compare the results of WB immediately after surgery and partial WB with a brace after ACL-R. Materials and Methods: In this randomized clinical trial (IRCT20110809007274N17), block random sampling was used to select 84 patients who were divided into two groups: group 1 who were allowed to have full WB after surgery, and group 2 who were asked to use braces after surgery, and they were divided into partial WB for one month and then full WB. Demographic information was recorded. Lachman test, anterior knee pain and kneeling pain before surgery and one months after surgery were also recorded. Knee function was evaluated using IKDC , KOOS and Lysholm scales before surgery and 1, 3, and 6 months after surgery. Data were analyzed in SPSS software using Fisher's exact, Chi-square, Friedman and repeated measures ANOVA. Results: Most of the patients were men under 30 years old. There was no statistically significant difference in the demographic information of the patients in the two groups. Kneeling pain, anterior knee pain and the Lachman test did not differ between the two groups one month after the surgery. There was no difference between the two groups in the scores of IKDC, KOOS and Lysholm in the 6-month follow-up. All the examined indicators in each group improved over time. Conclusion: It appears WB immediately after surgery compared to partial WB at 1, 3, 6 months after ACL-R do not differ from each other. Therefore, patients can bear full weight if they tolerate it.

A ‘STRONG REGIME’ FOR SAFE ANKLES: A PROSPECTIVE STUDY TO VALIDATE AN EARLY MOBILIZATION PROGRAMME AFTER A LATERAL ANKLE LIGAMENT REPAIR WITH SUTURE TAPE AUGMENTATION

ObjectiveTo evaluate early mobilization with the ‘STRONG regime’ is safe after lateral ankle ligament repair with suture tape augmentation.BackgroundThe ESSKA-AFAS ankle instability group presented in 2016 evidence-based guidelines for rehabilitation and return to activity after lateral ankle ligament repair. Early mobilization is considered an important element of postoperative rehabilitation. Patients have to be immobilized for approximately six weeks to protect the delicate repair. Lateral ankle ligament repair with suture tape augmentation results in greater strength compared with standard repairs and early mobilization proved to be successful in small sample size studies. Augmented surgery technique is getting increasingly popular. However, it is unknown which rehabilitation regimes are used. It is essential to establish a clear evidence-based guideline for rehabilitation after surgery.MethodsA systematic literature search was performed to obtain the best evidence research regarding this surgery. In cooperation between the orthopaedic- and physical therapy department a post-operative rehabilitation protocol with early mobilization was established. This STRONG protocol (figure 1) is based on milestones and three stages.ResultsIn February 2016 the first patients were selected for the early mobilization regime. In total 102 patients with a lateral ankle ligament repair were treated with the STRONG protocol. No re-ruptures were observed with a follow up of a year. In a subgroup of athletes hop tests showed a symmetry index of 100,5% for triple hop, 98,6 for side hop and 103,6 for figure of 8 hop. First return to sport was achieved between 9–12 weeks, with full return to competition after a mean of 4 months.ConclusionsAn early postoperative mobilization regime based on supervised exercises seems to be a safe intervention after a lateral ankle ligament reconstruction.Clinical implicationsAugmented ankle ligament surgery with early mobilization could be an important advancement in treating patients with chronic ankle injuries.For any figures or tables, please contact authors directly.

Blood Flow Restriction Therapy After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament reconstruction (ACLR) rehabilitation necessitates restoration of quadriceps strength to minimize reinjury and optimize return to sport (RTS). Patients recovering from ACLR are limited by pain and activity restrictions, resulting in quadriceps muscle atrophy. Blood flow restriction (BFR) therapy involves performing exercises while a specialized blood pressure cuff is applied to the proximal aspect of the operative extremity and inflated to 40% to 90% of the arterial occlusion pressure, as determined using Doppler ultrasonography. BFR is theorized to induce an anaerobic environment and metabolic stress during exercise, promoting muscle hypertrophy and strength gains. Although the physiological mechanism has not been fully elucidated, it is theorized that BFR combined with low-load resistance training could yield muscle adaptations comparable to those of high-load resistance training. For ACLR patients with pain and restrictions precluding high-intensity strength training, incorporation of BFR into postoperative rehabilitation protocols could help mitigate quadriceps weakness and promote RTS. Randomized controlled trials report a prolonged, dose-dependent relation between BFR use and quadriceps and hamstring strength gains, improved bone and muscle mass, and earlier RTS, whereas other studies report no significant difference in quadriceps size, strength, or patient satisfaction compared with controls. Furthermore, although generally considered safe, there are rare reports of associated adverse events such as rhabdomyolysis, and BFR should be avoided in patients with a history of thromboembolic disease or peripheral vasculopathy. The literature examining BFR after ACLR is heterogeneous; lacks standardization; and contains broad variation in reported cuff pressures, as well as timing and duration of BFR use, among protocols. Although the use of BFR after ACLR shows promise, further study is necessary to elucidate the efficacy, safety, and optimal protocols.

Cannulated screws fixation for nondisplaced femoral neck fractures: early versus late weight-bearing-a prospective analysis.

Nondisplaced intracapsular fractures (Garden I/II) are predominantly treated with an internal fixation technique. The purpose of the study is to identify the best rehabilitation protocol after internal fixation with 3 parallel cannulated screws. All patients operated on from 2016 to 2021 for femoral neck fractures by internal fixation with 3 cannulated screws were enrolled into this prospective study. The population was divided into two groups: Group A (n = 34) who followed a postoperative rehabilitation protocol involving full and immediate loading, and Group B (n = 22) who followed a postoperative rehabilitation protocol involving late full loading (after 30days). The two groups were compared with each other by mortality rate, postoperative complications and need for re-interventions. Functional outcome and quality of life were assessed at the minimum follow-up of 1year using the modified Harris Hip Score(HHS) and the Short form health survey (SF-12) questionnaire. Group A showed a lower complication rate (2.9% vs. 18.2%), a lower 1-year mortality rate (5.9% vs. 9.1%), a better perception of mental health status (SF12-MCS 56.2 vs. 51.4, p = 0.03) but a worse perception of one's physical health status (SF12-PCS 48.1 vs. 56.7, p < 0.01). The two groups were also statistically overlapping in terms of the functional outcome achieved after the intervention (HHS was 90.94 in Group A vs. 93.15 in Group B, p = 0.32). Postoperative complications, mortality and revision rate were higher in patients who followed a late-loaded rather than early loaded rehabilitation protocol. Functional outcome at 1-year survival is not significantly different. In nondisplaced intracapsular hip fractures treated with cannulated screws, an immediate full load should be preferred. Query.

Long Term Comparison of Hamstring Tendon Autograft and Tibialis Anterior Tendon Allograft Use in ACL Reconstruction

Aim: In the early 2000s, the optimal graft for anterior cruciate ligament (ACL) reconstruction was a subject of uncertainty. Today, autografts have become the gold standard in this procedure. Aim of this study is to contribute to the existing knowledge by conducting a comprehensive comparison of the long-term clinical outcomes between hamstring allografts and anterior tibialis tendon allografts (ATT) in the context of ACL reconstruction. Material and Method: This study was conducted based on individuals who were operated on with the diagnosis of symptomatic ACL rupture 10 years ago. Participants were randomly assigned to undergo ACL reconstruction using either hamstring autografts or anterior tibialis allografts. All allografts were procured from a single tissue bank, underwent aseptic processing, and were fresh-frozen without terminal irradiation. Patient assessments included questionnaires based on the Lysholm knee scoring scale (LKSS) and the International Knee Documentation Committee (IKDC) subjective knee score. Objective functional tests, such as the Lachman test and pivot-shift, were performed, accompanied by a comprehensive physical examination of the knee. Results: A total of 60 patients, comprising 58 males and 2 females, with a mean age of 29.48±6.2, were included in the study. Predominant symptoms reported were pain and giving-way phenomena. Significantly different LKSS values were observed between the preoperative and postoperative periods for both anterior tibialis allograft and hamstring autograft patients (p

Evaluation and Rehabilitation after Adult Lumbar Spine Surgery.

Purpose: With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. Materials and Methods: The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Results: Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Conclusions: Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.

New dynamic suture material for tendon transfer surgeries in the upper extremity - a biomechanical comparative analysis.

Early mobilization after tendon surgery is crucial to avoid commonly observed postoperative soft tissue adhesions. Recently, a new suture was introduced (DYNACORD; DC) with a salt-infused silicone core designed to minimize laxity and preserve consistent tissue approximation in order to avoid gap formation and allow early mobilization. To compare the biomechanical competence of DC against a conventional high strength suture (FiberWire; FW) in a human cadaveric tendon transfer model with an early rehabilitation protocol. Sixteen tendon transfers (flexor digitorum superficialis (FDS) IV to flexor pollicis longus (FPL)) were performed in 8 pairs human cadaveric forearms using either DC or FW. Markings were set 0.8cm proximally and 0.7cm distally to the level of the interweaving zone of the transfer. All specimens underwent repetitive thumb flexion against resistance in 9 intermittent series of 300 cycles each, simulating an aggressive postoperative rehabilitation protocol. After each series, the distance of the proximal marker to the interweaving zone (proximal), the length of the interweaving zone (intermediate) and the distance of the distal marker to the interweaving zone (distal) were measured. Pooled data over all nine series, normalized to the immediate postoperative status, demonstrated no significant differences between FW and DC (p ≥ 0.355) for the proximal and distal markers. However, at the intermediate zone, DC was associated with significant length shortening (p < 0.001)compared to FW without significant length changes (p = 0.351). Load to catastrophic failure demonstrated significant higher forces in FW (p = 0.011). Nevertheless, due to failure mainly proximal or distal of the transfer zone, these loads are not informative. From a biomechanical perspective, DC preserved tissue approximation and might be considered as a valid alternative to conventional high-strength sutures in tendon transfer surgery. DC might allow for a shorter interweaving zone and a more aggressive early postoperative rehabilitation program, possibly avoiding commonly observed postoperative soft tissue adhesions and stiffness.

'Real world' clinical implementation of blood flow restriction therapy does not increase quadriceps strength after quadriceps tendon autograft ACL reconstruction.

To retrospectively compare strength outcomes of individuals undergoing postoperative rehabilitation following quadriceps tendon (QT) autograft anterior cruciate ligament reconstruction (ACLR) with and without blood flow restriction therapy. A retrospective review of consecutive patients undergoing ACLR with QT autograft with a minimum of two quantitative postoperative isometric strength assessments via an electromechanical dynamometer (Biodex) was included. Demographics, surgical variables and strength measurement outcomes were compared between patients undergoing blood flow restriction therapy as part of postoperative rehabilitation versus those who did not. Eighty-one (81) patients met the inclusion criteria. No differences were found in demographic and surgical characteristics between those who received blood flow restriction compared with those who did not. While both groups had improvements in quadriceps peak torque and limb symmetry index (LSI; defined as peak torque of the operative limb divided by the peak torque of the nonoperative limb) over the study period, the blood flow restriction group had significantly lower mean peak torque of the operative limb at first Biodex strength measurement (95.6 vs. 111.2 Nm; p = 0.03). Additionally, the blood flow restriction group had a significantly lower mean LSI than those with no blood flow restriction at the second Biodex measurement timepoint (81% vs. 90%; p = 0.02). No other significant differences were found between the strength outcomes measured. Results of this study show that the 'real world' clinical implementation of blood flow restriction therapy to the postoperative rehabilitation protocol following QT autograft ACLR did not result in an increase in absolute or longitudinal changes in quadriceps strength measurements. A better understanding and standardisation of the use of blood flow restriction therapy in the rehabilitation setting is necessary to delineate the true effects of this modality on strength recovery after QT autograft ACLR. Level III.

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.

Management of Articular Cartilage Defects in the Knee: An Evidence-Based Algorithm

Focal articular cartilage lesions of the knee are a challenging disease entity due to the poor regenerative properties of hyaline cartilage that often lead to degenerative joint disease. Surgery is indicated to alleviate symptoms, restore function, and return to desired activities when conservative treatment fails. Providers must consider defect size and severity, compliance with the postoperative rehabilitation protocol including weight-bearing restrictions, and patient expectations in their clinical decision-making. Smaller defects may be treated with arthroscopic chondroplasty, bone marrow stimulation, and osteochondral autologous transfer. Alternative surgical options for larger defects include osteochondral restoration using fresh vs. cryopreserved allografts, autologous chondrocyte implantation, and particulated juvenile allograft cartilage. This article will review available treatment options and provide an evidence-based treatment algorithm to guide the orthopaedic clinician's clinical decision-making.

Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis.

Preoperative oral carbohydrate (CHO) is a rapid postoperative rehabilitation protocol that improves perioperative outcomes and is widely used in adult surgical patients. However, pregnant women are excluded because of the possibility of aspiration due to delayed gastric emptying. This meta-analysis was conducted to evaluate the efficacy of preoperative oral CHO in elective cesarean section. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to July 2023. Randomized controlled trials were included. The risk of bias was assessed using the Cochrane tool. Risk ratios and 95% confidence intervals were calculated. Meta-analysis was performed using random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The outcomes included thirst and hunger scores, incidence of vomiting and nausea, time to flatus, and homeostatic model assessment of insulin resistance (HOMA-IR). A total of nine studies with 1211 patients were included in the analysis. The levels of thirst and hunger were evaluated using a 10-point visual analog scale, with 0 representing the best and 10 representing the worst. The severity of hunger (weighted mean difference (WMD: -2.34, 95% CI: -3.13 to -1.54), time to flatus (WMD: -3.51 hours, 95% CI: -6.85 to -0.17), and HOMA-IR (WMD: -1.04, 95% CI: -1.31 to -0.77) were significantly lower in the CHO group compared to the control group. However, there were no significant differences in the severity of thirst or the incidence of vomiting and nausea between the CHO and control groups. Preoperative oral CHO during cesarean section alleviates thirst and hunger, shortens the time of postoperative flatus, and reduces HOMA-IR. However, the available evidence is insufficient to reach a clear consensus on the benefits or harms of preoperative oral CHO during cesarean section. Therefore, it is premature to make a definitive recommendation for or against its routine use.

Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review.

Cleft lip with or without cleft palate (CL/P) stands as the most common congenital facial anomaly, stemming from multifactorial causes. Our study aimed to ascertain the prevalence and characteristics of cleft palates, identify associated risk factors to inform prevention and prenatal detection for early intervention, and assess postoperative rehabilitation protocols for cleft palates. This study employs a retrospective descriptive and clinical approach. The study includes 103 children with cleft palates treated at the Department of Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury. We conducted a thorough evaluation of records, considering variables such as sex, cleft type, maternal occupation, parental education, and family history of clefts. Data analysis was carried out using R software version GPL-3 and ordinal logistic regression analyses. Notably, children born to mothers who experienced significant stress during pregnancy exhibited a 9.4-fold increase in the odds of having bilateral cleft palates. Conversely, no substantial evidence was found to support the influence of the child's sex, birth order, body mass, maternal exposure to workplace toxins, infections, or drug toxicity on the dependent variable. Our findings suggest that children with parents who have a history of clefts and those with less educated mothers are more likely to develop bilateral cleft palates. Additionally, children born to mothers experiencing stress during pregnancy face an increased risk of bilateral cleft palates. It is important to note that there is a paucity of literature on rehabilitation following various cleft palate surgical techniques in children.

Equino-plano-valgus foot in cerebral palsy – clinical principles and surgical techniques review (world perspective). Report from the 5th edition of the Transatlantic Orthopedic Surgery Webinar 2023

Introduction. The fifth edition of the Transatlantic Orthopedic Surgery Webinar 2023 occurred on December 4, 2023. The webinar’s main topic was treating equino-plano-valgus foot in children with cerebral palsy (CP). The event included speakers from Austria, Australia, China, India, Canada, Germany, Poland, Sweden, Turkey, the USA and the UK. Results. The first general session presented epidemiology, biomechanics, muscle function, equinoplano- valgus foot prevention options, and the Silverskiöld test in clinical assessment. It also discussed the principles of deformation treatment, options for orthotic treatment, and pathology treatment in adults suffering from CP. The surgical sessions presented comprehensive surgical techniques for the treatment of clubfoot equinus: sliding calcaneal osteotomy, lateral column lengthening with talonavicular arthrodesis, use of an expandable cage for the lateral column lengthening, double arthrodesis with the transfer of the peroneal muscles, percutaneous soft tissue release with/without arthroereisis, lateral column lengthening with arthroereisis, Grice procedure with talonavicular arthrodesis, lateral column lengthening with medial cuneiform bone plantarflexion osteotomy, lateral column lengthening with duplication of the talonavicular capsule, talonavicular and calcaneocuboid arthrodesis, transfer of the tibialis anterior muscle to the peroneal tertius muscle. The second general session presented methods of assessing the results of clubfoot treatment and postoperative rehabilitation protocols involving upright positioning and walking. Conclusion. The most important conclusions from the event are: clinical assessment and understanding the pathophysiology of the defect is crucial for its proper treatment; non-surgical treatment is recommended under the age of 6; between the ages of 6 and 14, surgical methods that preserve joint function predominate; after the age of 14 a large percentage of patients require performing joint arthrodesis. Nevertheless, arthrodesis should be avoided to correct flexible deformities and to treat patients with high functional requirements. The webinar audience included 583 people from 50 countries. Most participants came from Poland, Spain, Turkey, and Great Britain.

Accelerated versus Standard Rehabilitation after Meniscus Allograft Transplantation in the Knee.

Meniscus allograft transplantation (MAT) is a proven treatment option for patients with symptomatic irreparable meniscus deficiency. When patients are adherent to prescribed post-operative restriction and rehabilitation protocols, outcomes after MAT are considered good to excellent. However, nonadherence to standard protocols is common and can be associated with undesirable outcomes and patient dissatisfaction. Based on demonstrated safety for early weightbearing following MAT in conjunction with significant advances in graft preservation and surgical techniques, our joint preservation center implemented a shift in practice towards accelerated weightbearing following MAT and designed this study to test the hypothesis that accelerated rehabilitation would be associated with superior adherence, patient-reported outcomes, and patient satisfaction, without diminishing patient safety, when compared to standard rehabilitation. Patients were included for analyses when they had a undergone fresh or fresh-frozen MAT using a double bone plug technique for treatment of medial or lateral meniscus deficiency and at least 1-year treatment outcomes recorded. The results of this study revealed that patients who were prescribed accelerated rehabilitation after MAT were significantly more adherent than patients who were prescribed standard rehabilitation and reported statistically significant and clinically meaningful improvements in knee pain and function for at least 1-year following MAT, whereas those in the standard cohort did not. While not statistically different, treatment failure rate was lower in the accelerated rehabilitation cohort when compared to the standard rehabilitation cohort (11% vs 29%). Importantly, initial outcomes for revision MAT were associated with short-term success in all of the patients who opted for this option in the study population. These data suggest that accelerated weightbearing after meniscus allograft transplantation is safe, promotes patient adherence, and is associated with statistically significant and clinically meaningful improvements in patient-reported knee pain and function at early and mid-term follow-up.

Blood Flow Restriction Training for Meniscus Repair Surgery

Background: Blood flow restriction (BFR) is a training tool that involves wearing a tourniquet or occlusive device during exercise. Data support that low-load training with BFR may produce muscle hypertrophy similar to standard high-load training. Because of the weight-bearing and range of motion (ROM) restrictions after meniscal repair, patients encounter substantial atrophy of lower extremity musculature. We perform BFR for these patients to limit atrophy postoperatively with the goal of facilitating their return to prior function and sports. Indications: We incorporate BFR in the postoperative rehabilitation protocol for patients undergoing meniscal repair not involving the root. Patients with the following are excluded: acute or severe cardiac disease, peripheral vascular disease, blood pressure over systolic 180 mm Hg or diastolic 100 mm Hg, hemophilia, thrombophlebitis or history of deep vein thrombosis, severe anemia, and sickle cell disease. Technique Description: An automated BFR device calculates the patient’s limb occlusion pressure (LOP) and titrates to 50% to 80% of LOP for lower extremity exercises. Exercise parameters typically consist of 4 sets of each exercise, totaling 75 repetitions, with 30-second interset rest. Patients undergo a standard 3-phase postoperative rehabilitation protocol. Phase I (weeks 0-6): Patients are nonweightbearing, may be either footflat weightbearing or partial weightbearing at the surgeon’s, with ROM restricted 0 to 90 in a hinge knee brace throughout the phase. Exercises include quadriceps sets with neuromuscular electrical stimulation and straight leg raises and short/long arcs quadriceps. Phase II (weeks 7-8): Patients progress to weightbearing and ROM as tolerated and begin exercises including double mini squats, hamstring curls, double leg press, and double leg heel raises. Phase III: (weeks 9+): Patients perform double and single leg bridges, double leg bridges on ball with knee band, squats, single leg press, and single leg heel raises, all with the goal of returning to sports. Results: Prior systematic review data demonstrate low-load training with BFR increases muscle strength and induces hypertrophy relative to low-load training alone. No significant differences for Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales between BFR training group and control group. Discussion: BFR training may facilitate postoperative recovery in patients undergoing meniscal repair surgery by helping mitigate muscular atrophy. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

A Narrative Review Current Physical Therapy Management for Patellar Tendinopathy

Patellar tendinopathy, or jumper’s knee, is a common chronic musculoskeletal disease in the tendon that occurs in lower-extremities injuries. It is common in athletes, particularly sports that integrate frequent jumping and landing, such as volleyball (45%), basketball (32%), and distance running (14%), Patellar tendinopathy is usually difficult for such athletes to manage during the active sports season. This review article is recommended for physical therapists for the conservative treatment in competition season and post-operative rehabilitation of patellar tendon injuries. This review article discusses a new intervention for physiotherapy treatment for Patellar tendinopathy that can support a significant improvement in performance in sport and functional daily activity. The ultimate aim is to develop a clinical practice recommendation for physical therapists for the conservative treatment and post-operative rehabilitation of patellar tendon injuries. This review article found that physical therapy is popularly used to treat Patellar tendinopathy and effective interventions consist of exercise, extracorporeal shockwave therapy, high-energy laser therapy, elastic therapeutic taping, and education for prevention of issues. The post-operative rehabilitation protocol for patella tendon injuries aims to decrease pain, improve the range of motion, and ensure early ambulation and a quick return to sport, though in a time period that is decided on a case-by-case basis depending on the person and the sport. Post-operative rehabilitation is highly important for ensuring a safe return to sport and good quality of life.

Proximal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-operative Rehabilitation Protocol.

Reconstructions of the proximal femur after massive resections represent one of the main challenges in orthopedic oncology. Among the possible treatments, megaprostheses represent one of the most used and reliable reconstructive approaches. Although literature about their outcomes has flourished through the last decades, a consensus rehabilitative treatment is still far from being established. We evaluated the functional results of all our oncologic cases treated between 2016 and 2022 that could follow our standardized post-operative rehabilitative approach, consisting in progressive hip mobilization and early weight-bearing. Twenty-two cases were included in our study. On average, their hospitalization lasted 15.1days. The seated position was achieved on average within 3.7days after surgery, the standing position reached 5.4 after surgery, while assisted deambulation was started 6.4days after surgery. After a mean post-operative follow-up of 44.0months, our patients' mean MSTS score was 23.2 (10-30). Our data suggested a statistically significant inverse linear correlation between post-operative functionality and patients' age, resection length, and the start of deambulation. A correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximize patients' post-operative functional outcomes.

Systematic Review of Bracing After Proximal Hamstring Repair.

Traditionally, postoperative rehabilitation protocols after proximal hamstring repair (PHR) for avulsion of the proximal hamstring tendon from its ischial insertion recommend bracing the hip and/or knee to protect the fixation. However, because of the cumbersome nature of these orthoses, recent studies have investigated outcomes in patients with postoperative protocols that do not include any form of postoperative bracing. To synthesize the current body of evidence concerning bracing versus nonbracing postoperative management of PHR. Systematic review; level of evidence, 4. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a thorough search of the PubMed/Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase (OVID) databases on March 24, 2023. We analyzed complication rates, reoperation rates, patient satisfaction, return to sport, and patient-reported outcomes of studies that used postoperative bracing versus studies that used no postoperative bracing after PHR with at least 12 months of follow-up. A total of 308 articles were identified after initial search. In total, 25 studies were included in this review: 18 studies (905 patients) on bracing and 7 studies (291 patients) on nonbracing after PHR. The overall complication rate in the braced patients was found to be 10.9%, compared with 12.7% in nonbraced patients. The rate of reoperation due to retear of the proximal hamstring was found to be 0.05% in braced patients and 3.1% in nonbraced patients. Patient-reported outcome measures were found to be higher at the final follow-up in braced versus nonbraced patients, and patient satisfaction was found to be 94.7% in braced studies compared with 88.9% in nonbraced studies. The rate of 12-month return to sport in athletic patients was 88.4% with bracing and 82.7% without bracing. The findings of this review demonstrated lower complication and reoperation rates, higher patient-reported outcome scores, higher patient satisfaction, and a higher rate of return to sport in braced patients compared with nonbraced patients.

Large variation in postoperative rehabilitation protocols following operative treatment of osteochondral lesions of the talus: A systematic review and meta-analysis on >200 studies.

A treatment-specific rehabilitation protocol and well-defined return-to-play criteria guide clinical decision-making on return to normal function, activity, sports and performance after surgical treatment for osteochondral lesionof the talus (OLT). The optimal rehabilitation protocols in the current literature remain unclear. The purpose of this study was to explore the existing literature on rehabilitation protocols from the early postoperative phase to return to sport onwards after different types of surgical treatment of OLTs. PubMed, Embase, CDSR, DARE and Central were searched systematically from inception to February 2023 according to the PRISMA 2020 guidelines. All clinical studies with a description of postoperative rehabilitation criteria after surgical treatment of OLTs were included. The primary outcome of this study is the extent of reportage for each rehabilitation parameter expressed in percentage. The secondary outcome is the reported median time for each parameter in rehabilitation protocols for all different treatment modalities (type of surgery). The median time, expressed as number of weeks, for each parameter was compared between different types of surgery. A total of 227 articles were included reporting on 255 different rehabilitation protocols from seven different types of surgery. Weight-bearing instructions were reported in 84%-100% and the use of a cast or walker was prescribed in 27%-100%. Range of motion exercises were described in 54%-100% whereas physical therapy was advised in 21%-67% of the protocols. Any advice on return to sport was described in 0%-67% protocols. A nonparametric analysis of variance showed significant differences between the different surgical treatment modalities for the following parameters between the treatment groups: time to full weight-bearing (p < 0.0003) and return to high impact level of sports (p < 0.0003). Subjective or objective criteria for progression during rehabilitation were reported in only 24% of the studies. An in-depth exploration of the current literature showed substantial variation in postoperative rehabilitation guidelines with an associated underreporting of the most important rehabilitation parameters in postoperative protocols after surgical treatment of OLTs. Furthermore, nearly all rehabilitation protocols were constructed according to a time-based approach. Only one out of four reported either objective or subjective criteria. Level IV, systematic review.

IS THERE A CLINICAL AND FUNCTIONAL DIFFERENCE BETWEEN USING A QUADRICEPS TENDON OR QUADRUPLED HAMSTRING GRAFT IN ACL RECONSTRUCTION?

IntroductionAnterior cruciate ligament (ACL) injuries represent a significant burden of disease to the orthopaedic surgeon and often necessitate surgical reconstruction in the presence of instability. The hamstring graft has traditionally been used to reconstruct the ACL but the quadriceps tendon (QT) graft has gained popularity due to its relatively low donor site morbidity.MethodsThis is a single centre comparative retrospective analysis of prospectively collected data of patients who had an ACL reconstruction (either with single tendon quadrupled hamstring graft or soft tissue quadriceps tendon graft). All surgeries were performed by a single surgeon using the All-inside technique. For this study, there were 20 patients in each group. All patients received the same post-operative rehabilitation protocol and were added to the National Ligament Registry to monitor their patient related outcome scores (PROM).ResultsThe average age of patients in the QT group was 29 years (16 males, 4 females) and in the hamstring group was 28 years (18 males, 2 females). The most common mechanism of injury in both groups was a contact twisting injury. There were no statistical differences between the two patient groups in regards to PROMS and need for further revision surgery as analysed on the National Ligament Registry.ConclusionsThe all soft tissue QT graft seems to be equivocal to quadrupled hamstring graft in terms of patient function and recovery graft characteristics. Further research may be needed to elucidate the long-term results of the all soft tissue QT graft given its recent increase in use.