Post-operative use of knee brace in bone-tendon-bone patellar tendon anterior cruciate ligament reconstruction: 5-year follow-up results of a randomized prospective study

Sixty patients were prospectively randomized to brace and no-brace groups after bone-tendon-bone patellar tendon anterior cruciate ligament (ACL) reconstruction. The brace group wore a rehabilitation knee brace for 12 weeks post-operatively, while the no-brace group was mobilized immediately, and crutches were discarded 2 weeks post-operatively. The groups were comparable with respect to age, gender, time from injury to surgery and concomitant injuries. There were no differences either pre-operatively or 5 years post-operatively (80% of patients reviewed) between the groups in terms of the knee score (Lysholm), activity level (Tegner), degree of laxity or isokinetic peak muscle torque. Thus it appears that knee braces are not needed in the post-operative rehabilitation after ACL reconstruction with the patellar tendon graft.     

Knee brace after bone-tendon-bone anterior cruciate ligament reconstruction Randomized, prospective study with 2-year follow-up

In a prospective study 60 patients were randomized to brace and no-brace groups after bone-tendon-bone anterior cruciate ligament reconstruction. The brace group wore a rehabilitation orthosis for 12 weeks postoperatively, while the no-brace group was mobilized immediately, and crutches were discarded 2 weeks postoperatively. The groups were comparable with respect to age, gender, time from injury to surgery, knee score (Lysholm), activity level (Tegner), degree of laxity and isokinetic muscle torque. Although compared with the preoperative situation patients in both groups had significantly improved, there were no differences between the groups 1 and 2 years postoperatively in terms of functional outcome (Lysholm and Tegner scores), stability of the knee or isokinetic muscle torque. Received: 13 June 1996 Accepted: 23 November 1996     

Is bracing after anterior cruciate ligament reconstruction necessary? A 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace

The aim of this study was to evaluate the effect of a standard postoperative rehabilitation knee brace on function, stability and postoperative complications at the 2-year follow-up after anterior cruciate ligament (ACL) reconstructive surgery. Seventy-eight consecutive patients with a unilateral chronic ACL rupture reconstructed by the same surgeon using the endoscopic “all-inside” technique, patellar tendon autograft and interference screw fixation were included in the study. The rehabilitation followed a standard protocol. Group A included 39 patients who were supplied postoperatively with a knee brace for 4 (range 3–6) weeks. Group B included 39 patients for whom a brace was not used. The median age was 27 (range 16–48) years in group A and 26 (range 14–51) years in group B. The median time period between the injury and the index operation was 24 (range 3–150) months in group A and 18 (range 3–360) months in group B. All 78 patients were re-examined by two independent observers after a median follow-up period of 25 (range 23–28) months in group A and 24 (range 22– 27) months in group B. The median KT-1000 total side-to-side difference between the reconstructed and the uninjured knees at 89 N was 3 (range –5.5–11) mm in group A and 3 (range –7–10) mm in group B (NS). When the anterior translation was tested separately at 89 N, the corresponding values were 3 (range –4–13) mm in group A and 3 (range –5–10) mm in group B (NS). The median one-leg hop quotient was 95% (range 50%–167%) of the uninjured leg in group A and 92% (range 64%–119%) in group B (NS). The median Lysholm score was 89 (range 39–100) points in group A and 85 (range 37–100) points in group B (NS). In group A, 27/39 (69%) patients and in group B 21/39 (54%) patients were classified as excellent or good (NS). The median Tegner activity level was 7 (range 3–9) in group A and 6 (range 3–9) in group B (NS). Using the IKDC scale, 27/39 (69%) in group A and 24/39 (62%) in group B were classified as normal or nearly normal (NS). The median sick leave in group A was 62 (range 0–357) days and 59 (range 0–243) days in group B (NS). No serious complications occurred during the first 6 postoperative weeks. Two serious complications were, however, registered after the 6th postoperative week. One patient in group A sustained a rupture of the reconstructed ACL 8 weeks postoperatively (3 weeks after removing the brace), and one patient in group B sustained an undislocated patellar fracture during the 7th postoperative week after a fall. This study indicates that the use of a postoperative rehabilitation brace after an arthroscopic ACL reconstruction did not appear to influence either objective stability or subjective function by the 2-year follow-up. Received: 23 December 1996 Accepted: 15 April 1997     

前交叉韧带重建军人患者快速康复与传统康复对术后功能恢复的影响

目的 比较快速康复训练与传统康复训练对军人患者前交叉韧带重建术后膝关节功能及运动恢复的影响.方法 回顾性分析2018-06至2019-06在东部战区总医院骨科行关节镜下前交叉韧带重建术的102例军人患者资料,分为快速康复组(51例)和传统康复组(51例).分别记录两组患者术前、术后疼痛视觉模拟量表(VAS)评分、Lys...     

Isokinetic muscle strength after anterior cruciate ligament reconstruction

The purpose of the present study was to investigate the isokinetic muscle strength 6 months after reconstruction of the anterior cruciate ligament (ACL). In order to recommend full-load come-back in sport, sufficient muscle strength may be important. Ninety female elite team handball players (mean 24.1 years) were postoperatively tested with Biodex. The operated limb was compared with the contralateral limb: 82.2% had a hamstring strength of a minimum of 49.6 Nm, corresponding to at least 90% of the non-operated limb, while only 12.2% fulfilled the recommended strength of 117.7 Nm for quadriceps femoris. Patients over 26 years showed significantly lower muscle strength in the operated limb than their younger counterparts. Increased focus on quadriceps femoris muscle strength during rehabilitation may improve the knee function faster after ACL reconstruction.     

Revision of failed gore-tex anterior cruciate ligament reconstruction

The Gore-Tex synthetic knee ligament was widely used in the early 1980s because of encouraging early results. However, the long-term failure rate is unfavorable. Gore-Tex failures are divided into four categories: effusion, graft rupture, loosening/ osteolysis, and infection. Revision surgery is challenging and requires a systematic approach to achieve optimal results.     

Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six-year follow-up

The aim of this study was to investigate whether gender, age, stable personality traits, associated meniscus and/or articular cartilage injuries, treatment (non-operative or reconstructive surgery), additional subsequent trauma to the anterior cruciate ligament (ACL)-injured knee and activity level before injury affect the intermediate outcome after ACL injury. The primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS). Fifty-seven patients, 18-50 years old with an acute, unilateral ACL tear were included in the study. At the time of inclusion, the patients completed the Tegner score, regarding activity level before injury, and Swedish universities Scales of Personality (SSP). At follow-up, after 5.6 years they completed the KOOS, the Tegner score and a general questionnaire concerning ACL reconstruction and subsequent knee trauma. The subjects who had sustained additional trauma subsequent to their ACL injury had a significantly worse outcome according to the KOOS than those who had not. Furthermore, low ratings in the embitterment scale in the SSP were correlated to a better outcome in the KOOS. Treatment did not affect the KOOS total score. However, the non-operatively treated subjects had a significantly better outcome according to the knee-related quality-of-life domain in the KOOS.     

Post-operative problems following anterior cruciate ligament reconstruction

Seventy adult patients were studied during the postoperative rehabilitation period following anterior cruciate ligament reconstruction in order to investigate the role of pre-, intra-, and postoperative factors in range of motion and graft problems. A standard bone-patellar tendon-bone autograft was used for the reconstruction. Pre-and intraoperative factors such as concomitant injuries, time from injury to surgery, age, sex, and tunnel placement were recorded. Tunnel placement was recorded on intraoperative radiographs of the final guide pin placement and compared to pin placement on cadaver knees. The results indicated a significant relation between early reconstruction (<1 month) following the injury and range of motion problems during the early rehabilitation period (P<0.001). This relation disappeared by the end of the first postoperative year. Prolonged surgery was also associated with early motion problems (P<0.05). Graft laxity or failure was correlated with an earlier return of range of motion (P<0.05). We hypothesized that graft failure can have a biologic cause rather than a mechanical one since intraoperative X-rays indicated a near-anatomic tunnel placement in this patient group when compared to ideal placement in the cadaver knees.     

Treatment of limited motion after anterior cruciate ligament reconstruction

Limited motion or arthrofibrosis after anterior cruciate ligament (ACL) reconstruction causes significant pain and functional impairment. Based on physical findings and loss of motion compared with the opposite normal knee, classification systems for the diagnosis and treatment of arthrofibrosis have been developed. The operative techniques and preoperative and postoperative rehabilitation and management are discussed. Range of motion (ROM) problems after ACL reconstruction have been minimized by improved surgical techniques and perioperative rehabilitation programs. The most effective treatment for arthrofibrosis is prevention by delaying ACL reconstruction until the patient has a normal gait and full ROM and minimal swelling in the injured knee and by appropriate ROM exercises after surgery. Received: 13 October 1997 Accepted: 23 June 1998     

Rehabilitation after revision anterior cruciate ligament reconstruction: Practice guidelines and procedure-modified, criterion-based progression

Reconstructive surgery has become a more common solution for patients after rupture of the anterior cruciateligament (ACL) as a result of better surgical technique and more efficient and effective rehabilitation. As the incidence of ACL reconstruction surgery increases, the number of reconstructions that ultimately fail also increases. Failure of the primary reconstruction, whether caused by technical error during the surgery or an outside factor such as traumatic rerupture, often necessitates revision of the ACL reconstruction to restore joint integrity and optimize function. We have previously described criterion-based and procedure-modified rehabilitation after primary ACL reconstruction. The same principles that drive rehabilitation after primary reconstruction are factors after revision surgery; however, the progression must be modified. The major difference between the two surgeries lies in the ability of the surgeon to achieve adequate fixation of the new graft within the joint during a revision reconstruction. The second controlled trauma of revision surgery further compromises the bony structures that serve as the foundation for the new graft. Therefore, less rigid fixation after revision ACL reconstruction must be assumed. This necessitates a longer period of controlled weight bearing for every-day activities and slower progression of weight-bearing exercise during rehabilitation to ensure that biological healing can proceed without being compromised by the presence of forces that exceed the strength of the new graft fixation. Other factors such as staging of the revision surgery and concurrent bony procedures will also require modification of the rehabilitation. Understanding these factors and implementing the modifications that they necessitate into rehabilitation should lead to a more predictable return to high functional levels after revision ACL reconstruction.     

Experience with the Leeds-Keio artificial ligament for anterior cruciate ligament reconstruction

Artificial anterior ligament reconstruction was very popular between 1975 and 1990. Recently, disappointing results have been published. We reviewed 68 patients who had received an artificial anterior cruciate ligament reconstruction 1 year and 5 years after their operation. The Leeds-Keio device was used as a scaffold. The ligament failed in 32 knees. This was arthroscopically confirmed in 20 cases. The other 12 knees were grossly unstable, with a reappearance of pivot shift, anterior drawer sign and high KT 1000. Generally, we found a marked increase in laxity over the period of investigation. Several biopsies were taken during arthroscopic examination of suspected ruptures. They showed lack of collagenisation and ingrowth.     

Double semitendinosus anterior cruciate ligament reconstruction: 10-year results

In a series of 30 consecutive patients who suffered from chronic instability of the knee joint, reconstruction of the torn anterior cruciate ligament was performed with a looped semitendinosus tendon, reinforced by an extra-articular anterolateral procedure. Of these 30, 27 could be followed up 9–11 years after the operation. The evaluation included the International Knee Documentation Committee (IKDC) questionnaire and was completed by testing with a Kneelax arthrometer at 132 N and by anteroposterior standing X-ray, in order to evaluate the degenerative changes. At the time of the check-up: 96% of the study group considered that they had normal or nearly normal knees, and 81% had recovered to the same sports activity level as before their injury. The degenerative changes noted at the index operation did not progress notably, except in two cases. Laxities of 7 knees were normal, with a side-to-side difference of less than 2 mm; 15 were nearly normal, with a mean difference of 3.45 mm; and 5 were abnormal, with a mean difference of 6.2 mm. The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. Received: 30 December 1996 Accepted: 25 July 1997     

Early rehabilitation of acute anterior cruciate ligament injury—a randomized clinical trial

The efficacy of a 6-week rehabilitation program was evaluated in 100 consecutive patients, age 15–42 years, with acute anterior cruciate ligament (ACL) injury. Arthroscopy revealed associated lesions in 82% of the patients. Except for resections on menisci with large and unstable lesions, no surgery was performed. The patients were randomly assigned to supervised training or self-monitored training after instruction. Results: At the 6-week follow-up there was no difference between the groups with regard to pain at rest, pain during walking, or experience of giving-way episodes, Tegner activity level or Lysholm knee score. Only 2 of the 100 patients were observed without joint mobility restriction. The only significant difference between the groups was the improvement of muscle function in men in the supervised training group. Conclusion: Six weeks' rehabilitation is too short a time period from original injury to obtain normal mobility and restored knee function.     

Complications of anterior cruciate ligament reconstruction: MR imaging

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. Electronic Publication     

关节镜下钮扣钢板固定四股半腱肌重建膝关节前交叉韧带

目的 探讨关节镜下钮扣钢板固定四股半腱肌重建膝关节前交叉韧带的治疗效果。方法 关节镜下四股半腱肌重建膝关节前交叉韧带20例。术前MRI证实膝关节前交叉韧带断裂,术中关节镜下均证实膝关节前交叉韧带断裂,四股半腱肌重建者用钮扣钢板固定。结果 平均随访7个月,无1例打软腿,假交锁症状消失,关节痛消失。X线见内固定物与术后一致,无移位。Lysholm膝关节功能评分：术前平均54.5,随访评分95.6。结论 关节镜下四股半腱肌重建膝关节前交叉韧带临床效果好,并发症少,手术时间短。     

Anatomic anterior cruciate ligament reconstruction: the two-incision technique

This article describes the anatomical two-incision reconstruction of anterior cruciate ligament (ACL) of knee. The major part of currently single incision tibial endoscopic techniques attempts to reproduce the most isometric anteromedial bundle of ACL. Often a relatively vertical femoral tunnel, respect to the notch, is drilled, which is not really efficacious in providing rotatory stability. The single incision technique was developed to obviate the necessity of the lateral femoral incision and dissection. This technical note describes a two-incision ACL reconstruction using an instrumentation, which avoids a large lateral femoral soft tissue dissection, and discusses the rational use of the two-incision ACL reconstruction technique.     

Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction

In a prospective, randomized study, 34 patients (25 male, 9 female; mean age 27±8 years) with unilateral anterior cruciate ligament ruptures and arthroscopic reconstruction with patellar tendon grafts were allocated at random to either early active motion only (AM;n=17) or active motion in combination with continuous passive motion (CPM;n=17). Range of motion was measured with a goniometer and joint swelling with a tape measure, preoperatively and at 6 weeks postoperatively. Neither associated injuries nor the age of the aptients differed in the two groups. There was no difference in the range of motion between the two groups at 6 weeks' follow-up. Joint swelling was more pronounced in the AM group both preoperatively and at 6 weeks' follow-up. In this investigation the range of motion was not improved by CPM. The difference in joint swelling between the two groups may be explained by a persistent preoperative variation in joint effusion due to an imbalanced distribution of acute and chronic cases.     

Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up

The aim of the present investigation was to study patient-reported long-term outcome after anterior cruciate ligament (ACL) reconstruction. On an average 11.5 years after ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft 56 patients were asked to answer four different questionnaires about their knee function and knee-related quality of life. Another aim was to study whether there were any correlations between clinical tests, commonly used for evaluating patients with ACL injuries, which were performed 2 years after ACL reconstruction, and patient-reported outcome in terms of knee function and knee-related quality of life on an average 9.5 years later. All patients who had unilateral BPTB ACL reconstructions were examined at 2 years and on an average 11.5 years after surgery. At 2 years one-leg hop test for distance, isokinetic muscle torque measurement, sagittal knee laxity, Lysholm knee scoring scale and Tegner activity scale were used for clinical evaluation. At the follow-up on an average 9.5 years later the patients were evaluated with knee injury osteoarthritis outcome score (KOOS), short form health survey (SF 36), Lysholm knee scoring scale and Tegner activity scale. The SF-36 showed that the patients had a similar health condition as an age- and gender-matched normal population in Sweden on an average 11.5 years after ACL reconstruction. There was no correlation between the results of one-leg hop test for distance, isokinetic muscle torque measurement, sagittal knee laxity evaluated 2 years after surgery and the result of KOOS (function in sport and recreation, knee-related quality of life) and SF-36 evaluated on an average 11.5 years after surgery. We also compared patients that 2 years after surgery demonstrated a side-to-side difference in anterior–posterior knee laxity of more than 3 mm with those with 3 mm or less and found no significant group differences in terms of knee function as determined with KOOS. We found no correlation between the results of KOOS and SF-36 at the long-term follow-up and the time between injury and surgery, age at surgery or gender, respectively. We conclude that there is no correlation between patient-reported knee function in sport and recreation and knee-related quality of life on an average 11.5 years after BPTP ACL reconstruction and the evaluation methods used 2 years after surgery.     

Rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament reconstruction: An online survey

ObjectivesThe primary objective of the study was to investigate rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament (ACL) reconstruction. Secondly, we aimed to investigate physical therapists’ preferences on continuing education and evaluate their self-rated confidence and competence when treating patients before and after ACL reconstruction.DesignSurvey-based study.SettingOnline survey platform.ParticipantsFlemish physical therapists (n = 283).Main outcome measuresThe online survey consisted of a combination of 40 open- and closed-ended questions, divided across 5 sections: (1) participant demographics and clinical practice information, (2) patient population information, (3) continued education practices, (4) rehabilitation strategies, and (5) physical therapist self-rated confidence and competence to treat patients with ACL reconstruction.ResultsA wide variability in rehabilitation strategies were found across the whole ACL rehabilitation continuum, which were in general not in line with best available evidence. Nevertheless, the overall self-rated confidence and competence of physical therapists treating patients before and after ACL reconstruction were high.ConclusionOur findings indicate a need to improve rehabilitation practices before and after ACL reconstruction. Advanced research dissemination and implementation are required to achieve better rehabilitation outcomes.