Protocolo de reabilitação acelerada precoce versus conservadora retardada após reconstrução do ligamento cruzado anterior: Um ensaio prospectivo randomizado

Patra, Saroj Kumar; Nanda, Saurav Narayan; Patro, Bishnu Prasad; Sahu, Nabin Kumar; Mohanty, ChittaRanjan; Jain, Mantu

doi:10.1055/s-0042-1748970

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…Todos os pacientes de ambos os grupos haviam sido submetidos a uma reabilitação acelerada. 23 As limitações deste estudo são o tamanho relativamente pequeno da amostra e o seguimento de apenas um ano, o que pode explicar a ausência de casos de falha do enxerto nos nossos pacientes.…”

Section: Discussionunclassified

Comparação dos resultados funcionais da reconstrução artroscópica do ligamento cruzado anterior pelas técnicas all-inside e outside-in: Um ensaio clínico controlado, randomizado e duplo-cego

Varghese,

Patra,

Das

et al. 2024

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Comparar os resultados funcionais da reconstrução do ligamento cruzado anterior (LCA) com autoenxerto de isquiotibiais pela técnica all-inside (AI) com Endobutton (Smith & Nephew, Watford, Hertfordshire, Inglaterra) cortical de alça ajustável nos lados do fêmur e da tíbia e pela técnica outside-in (OI) com parafuso de interferência no lado tibial e Endobutton cortical no lado femoral. Métodos Trata-se de um ensaio clínico controlado, randomizado e duplo-cego com 44 pacientes submetidos à reconstrução artroscópica do LCA de fevereiro de 2019 a fevereiro de 2022 em um hospital de cuidados terciários. De acordo com a randomização por computador, os pacientes foram distribuídos em dois grupos: AI e OI. Ambos os grupos foram avaliados durante 12 meses pela Escala Visual Analógica (EVA), a Escala de Pontuação do Joelho de Lysholm e pela parte I (pontuação de dor) e a parte II (pontuação de função) da escala Knee Society Score (KSS). Resultados No segundo dia de pós-operatório, a pontuação média na EVA foi significativamente maior no grupo OI (p = 0,0001), mas insignificante (p 0,807) às 6 semanas. Aos 3, 6 e 12 meses de acompanhamento, a pontuação na Escala de Lysholm (p = 0,001) foi significativamente maior no grupo AI. Aos 6 meses, ambas as partes da KSS apresentam uma diferença significativa, com o grupo AI apresentando um desfecho melhor (p = 0,04). No entanto, aos 12 meses, o grupo AI apresentou uma pontuação melhor na parte I da KSS, mas não foram observadas diferenças na parte II. Conclusão Em um acompanhamento de 12 meses, os pacientes submetidos à técnica AI apresentaram melhores pontuações de desfecho e alívio da dor do que aqueles submetidos à técnica OI.

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Section: Discussionunclassified

Comparação dos resultados funcionais da reconstrução artroscópica do ligamento cruzado anterior pelas técnicas all-inside e outside-in: Um ensaio clínico controlado, randomizado e duplo-cego

Varghese,

Patra,

Das

et al. 2024

Rev Bras Ortop (Sao Paulo)

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“…Анализ медиан антропометрических параметров не выявил значимых статистически достоверных различий между группами (р > 0,05). По возрасту в 1-й группе основной подгруппы медиана составила 29 лет (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)…”

Section: результаты участники исследованияunclassified

Efficacy of Physical Rehabilitation after Anterior Cruciate Ligament Reconstruction: Non-Randomized Trial

Radysh

Круглова

Boyarintsev

et al. 2023

Kuban. nauсh. med. vestnik

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Background. Anterior cruciate ligament rupture is the most common knee joint injury, especially in young people with a healthy and active lifestyle. The concept of quality of life has been dynamically developing. The scope of its application is expanding in various fields of medicine to provide a comprehensive assessment of treatment and rehabilitation efficacy.Objective — to assess the feasibility of complex individual physical rehabilitation of patients after early and delayed arthroscopic reconstruction of the anterior cruciate ligament (ACL).Methods. Open simple non-randomized trial enrolled 834 patients with the anterior cruciate ligament rupture of the knee joint. In the first group (431 patients), ACL plastic surgery was performed in the early stages — between weeks 2 and 6. In the second group (403 patients), ACL reconstruction was performed in the later stages — from week 7 to 1 year, inclusive. Each group was divided into two subgroups — the main one, in which restorative treatment and comprehensive individual rehabilitation were carried out, and the control group, with rehabilitation treatment in accordance with the standards of postoperative treatment. The study was conducted in Traumatology, Orthopedics and Medical Rehabilitation Unit of Clinical Hospital No. 1. Patients were included in the trial from 2016 to 2021. The follow-up period for each patient was one year. Statistical data processing was performed by means of Statistica 12.0 (StatSoft, Inc., USA). Independent samples were compared using non-parametric criteria: Mann — Whitney U-test and Wilcoxon T-test.Results. No statistical differences were found in the distribution according to gender, age and body mass index. A comparative analysis of scale medians of Medical Outcomes Study 36Item Short-Form Health Survey (MOSSF-36), conducted in patients before surgery, revealed no statistically significant differences ( p>0.05) between the main and control subgroups in both groups. Analyzing medians before ACL reconstruction showed a significant decrease in comparison with population studies ( p < 0.0001, Mann — Whitney U-test). The analysis of physical and mental component summaries via MOSSF-36 revealed statistically significant differences in the effectiveness of treatment of patients in 1 year after ACL plastic surgery and complex individual rehabilitation. Thus, in the main subgroups, the values of treatment efficacy medians were significantly higher than in the control ones, regardless of the timing of ACL plastic surgery ( p < 0.001, Mann — Whitney U-test). The results testify to higher median efficacy values in patients of the main subgroup of group 1 than in other subgroups ( p < 0.001, Mann — Whitney U-test). The study of correlative relationships demonstrated a stronger relationship between the medians of physical and mental component summaries in the main subgroup of the first group (correlation coefficient = 0.76), if compared to the main subgroup of the second group (coefficient = 0.67).Conclusion. The study testified to the treatment efficacy proved using the scales of physical and mental component summaries. They demonstrated more significant treatment efficacy one year after arthroscopic ACL reconstruction and individual rehabilitation in the main subgroup of group 1 than in the other subgroups.

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“…Показники повернення до спорту після ревізійної реконструкції нижчі, ніж після первинної реконструкції. Майбутні дослідження мають бути зосереджені на вдосконаленні як техніки ревізійних втручань, так і реабілітації [15,16,37,38].…”

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“…Продовження ж базування програм реабілітації переважно на рівні функціональної здатності пацієнта без достатнього врахування його анатомічних особливостей, особливостей операції та інших параметрів є хибним шляхом та напрямком досліджень. Чудові результати надто ранньої реабі літації одних досліджень [34], [35], [36], [37] часто розходяться з менш райдужними результатами досліджень стосовно стабільності колінного суглоба [38], [39], [40] та ревізійних операції на ПХЗ [5]. А програми реабілітації після пластики ПХЗ в реабілітаційних центрах частіше відповідають більш прискореним протоколам реабілітації, ніж більш обережним.…”

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Reasons for the Variability of Rehabilitation Programs and the Perspective of the Standardized Guidelines Development for Patients after Anterior Cruciate Ligament Reconstruction

Kotiuk,

Kostrub,

Zasadniuk

et al. 2023

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Summary. The following factors influence the choice of rehabilitation program after anterior cruciate ligament (ACL) reconstruction. Surgical factors: peculiarities of the tunnels drilling, method and quality of graft fixation, presence and type of additional distal fixation, as well as the presence or absence of additional reinforcement, graft diameter, graft material and quality, graft suturing method, type of ACL repair (single- or double-bundle), and other elements of the surgery. Patient factors: compliance, psychological readiness to move on to the next phase of rehabilitation, goals and objectives set by the patient; age, type, and level of activity and physical condition of the patient; motivation, expectations of the patient, the preoperative experience of the patient in performing rehabilitation exercises, weight and height of the patient, body proportions, in particular of the lower limb segments (different lever lengths), rotational and axial allignment of the lower limb bones, posterior tibial plateau slope, intercondylar notch width and notch roof slope, condition of the anterolateral ligament and other knee joint stabilizers, muscle tone and strength in general and at the time of surgery in particular, range of motion in the knee and adjacent joints. Given the need to consider at least the above factors, there should not be a single rehabilitation protocol for ACL reconstruction. Only close cooperation between the surgeon, rehabilitologist and physical therapist allows for the fastest and safest rehabilitation of such patients. The patient's subjective feelings and their ability to perform specific exercises are not the criteria for deciding to proceed to the next rehabilitation phase. There is a certain limit, determined by the speed of biological processes in the body, which we cannot yet overcome. It is a good practice for the surgeon to fill out a patient's rehabilitation card immediately after the surgery, indicating the exercises, the time they should start, and the allowed loads.

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Protocolo de reabilitação acelerada precoce versus conservadora retardada após reconstrução do ligamento cruzado anterior: Um ensaio prospectivo randomizado

Cited by 6 publications

References 27 publications

Comparação dos resultados funcionais da reconstrução artroscópica do ligamento cruzado anterior pelas técnicas all-inside e outside-in: Um ensaio clínico controlado, randomizado e duplo-cego

Comparação dos resultados funcionais da reconstrução artroscópica do ligamento cruzado anterior pelas técnicas all-inside e outside-in: Um ensaio clínico controlado, randomizado e duplo-cego

Efficacy of Physical Rehabilitation after Anterior Cruciate Ligament Reconstruction: Non-Randomized Trial

Reasons for the Variability of Rehabilitation Programs and the Perspective of the Standardized Guidelines Development for Patients after Anterior Cruciate Ligament Reconstruction

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