A Perioperative Rehabilitation Program for Anterior Cruciate Ligament Surgery

Arnold, Thomas; Kd, Shelbourne

doi:10.3810/psm.2000.01.621

Cited by 15 publications

(6 citation statements)

References 11 publications

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“…Upon screening of the title and abstract, 2256 were excluded as they did not meet the eligibility criteria. The remaining 71 full texts were reviewed and 21 were excluded . Additionally, authors of 2 conference proceedings were contacted on 2 separate occasions with no response and therefore were excluded at the full text stage .…”

Section: Resultsmentioning

confidence: 99%

Prehabilitation for Patients Undergoing Orthopedic Surgery

et al. 2023

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ImportancePrehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results.ObjectiveTo evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery.Data SourcesBibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022.Study SelectionRandomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included.Data Extraction and SynthesisTwo independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresPain, function, muscle strength, and health-related quality of life (HRQOL).ResultsForty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], −0.70 [95% CI, −1.08 to −0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, –8.20 [95% CI, −8.85 to −7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, −0.51 [95% CI, −0.85 to −0.17]) and at 6 months in those undergoing lumbar surgery (SMD, −2.35 [95% CI, −3.92 to −0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence.Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.

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Section: Resultsmentioning

confidence: 99%

Prehabilitation for Patients Undergoing Orthopedic Surgery

et al. 2023

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“…12 , 15 Each patient then underwent an ACL rehabilitation program, also as previously described. 2 , 14 The rehabilitation program was designed to take patients through a progression of steps that were not defined by time but, instead, by each patient's ability to achieve rehabilitation goals. The progression of rehabilitation postoperatively was as follows: (1) obtain full knee extension and flexion while limiting swelling, (2) increase leg strength, (3) perform sport-specific drills individually, (4) perform controlled team drills, (5) participate part-time in competition while monitoring swelling and knee range of motion, and (6) participate full-time in competition.…”

Section: Methodsmentioning

confidence: 99%

Incidence of Subsequent Injury to Either Knee within 5 Years after Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft

Shelbourne¹,

Gray²,

Haro³

2008

Am J Sports Med

Self Cite

408

435

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“…The immediate and long-term benefits of presurgical rehabilitation has been repeatedly described in the ACL literature. 4,21,25,55,66 The restoration of a “quiet” knee after an acute ACL injury includes return of full active and passive knee extension, knee flexion ROM, trace to zero effusion, no quadriceps lag with straight leg raise, and quadriceps strength index ≥80%. Meeting all presurgical milestones has been associated with improved long-term outcomes after ACL reconstruction.…”

Section: Presurgical Preparationmentioning

confidence: 99%

ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline

Brinlee

Dickenson

Hunter‐Giordano

et al. 2021

Sports Health: A Multidisciplinary Approach

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Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians’ current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. Evidence Acquisition: Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention. Study Design: Clinical review. Level of Evidence: Level 5. Results: Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey–Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. Conclusion: Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. Strength of Recommendation Taxonomy (SORT): B.

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A Perioperative Rehabilitation Program for Anterior Cruciate Ligament Surgery

Cited by 15 publications

References 11 publications

Prehabilitation for Patients Undergoing Orthopedic Surgery

Prehabilitation for Patients Undergoing Orthopedic Surgery

Incidence of Subsequent Injury to Either Knee within 5 Years after Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft

ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline

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