The effect of accelerated rehabilitation on the prevention of residual post operative disabilty in acl injured patients

Abstract EN

Purpose: Assessing the outcome of anterior cruciate ligament(ACL) reconstruction and to compare results of modern method of rehabilitation against results of standard method of rehabilitation using IKDC, Tegret and Lysholm scores and clinical indicators post operatively and to identify prognostic factors.

Type of study: Retrospective study with statistical analysis.

Methods: Eighty five patients who were admitted as a planned admission underwent reconstruction using the autogenous patellar tendon, which was fixed arthroscopically using tibial and femoral tunnels according to the harvested graft dimensions.

The patients were allocated into two groups.

Group A constituted 32 patients who underwent the standard rehabilitation programme according to established braced proceedures.

The following 53 patients (Group B) were subjected to vigorous brace-free rehabilitation programme.

The mean age at the ACL reconstruction was 26 (±7) years, the mean weight was 71 (±14) kg, The mean height 167 (±9) cm and the mean body mass index (BMI) 26 (±3).

The cause of trauma was athletic activity in 82% (N: 71) of the patients.

76 % (N: 66) were sustained at football, 9% (N: 7) from car accidents 7 % (N:6) from a domestic accident, the remainder from other accident.

The two-year evaluation point was adopted, with the four months evaluation point as the secondary indicator.

All knees were measured for Tegner and Lysholm scores as the main variable for assessment, and all knees were assessed for IKDC in the pre-rupture hindsight appraisal.

This data was augmented by the One Leg Hop test and the clinical postoperative stability.

The complications were monitored along the time of follow up.

Results: The four months IKDC values for all the patients were 35.2%A (N:30), 54%B (N:46), 7% C (N:6) and 3.5%D (N: 3).

the two years follow up IKDC values for all patients was 89.4%A (N: 76), 9.4%B (N: 8), 1.1% C (N: 1), and none at D.

When comparing the four months values to the two years post operative values the gain was 54.2% A (P = .001), -44.6% B (P = .008), -5.9%C ( P = .09) and 3.5%D (P = .11).

C and D values are insignificant.

90.5% of patients (N:77) have successfully achieved the One Leg Hop for distance test at two years, as compared with 35.2% (N: 30) at 4 month follow up (P= 000.7).

When comparing the preinjury Tegret and Lysholm scores to the two years follow up scores for group A, there was a mean loss of 1.0 and 8.0 respectively constituting 13.6% and 11.6% (p = .024), range 0.67 to 3.5 and 6.8 to 13.5.

When comparing the preinjury Tegret and Lysholm scores to the two years follow up scores for group B, there was a mean loss of 0.4 and 1.0 respectively constituting 5.5% and 1.5% (p = .015), range 0.1 to 1.5 and 6.8 to 13.5.

The complications were seven cases of anterior knee pain and one case of limited range of movement.

Conclusion: Results of aggressive rehabilitation after Anterior Cruciate ligament reconstruction both subjectively and clinically are superior to that of the standard braced rehabilitation.

A better prognostic result with aggressive rehabilitation can be predicted for patients with high preinjury scores than for patients with a low preinjury score.

The result of this study support the use of accelerated brace free rehabilitation in autogenous patellar tendon graft..