Effect of Graft Rupture Prevention Training on Young Athletes After Anterior Cruciate Ligament Reconstruction: An 8-Year Prospective Intervention Study

Abstract

Background: There is a lack of research on the effects of a postoperative rehabilitation program on anterior cruciate ligament (ACL) graft rupture. Hypothesis: We hypothesized that a hip-focused rehabilitation protocol with graft rupture education and avoidance training (HIP-GREAT program) would demonstrate lower ACL graft rupture rates compared with a traditional physical therapy (PT) program. Study Design: Cohort study; Level of evidence, 3. Methods: This study consisted of young athletes who had undergone ACL reconstruction at a single institution. Postoperatively, 136 participants (mean age, 16.9 ± 2.4 years) were enrolled in a traditional PT protocol between 2006 and 2010, and 153 participants (mean age, 17.0 ± 2.3 years) were enrolled in the HIP-GREAT protocol between 2011 and 2015. Follow-up rates were 31% (42/136) and 27% (41/153) in the traditional PT and HIP-GREAT groups, respectively, at 3 years postoperatively. The hazard ratio was calculated, and absolute risk reduction (ARR) and number-needed-to-treat (NNT) analyses were performed to compare the 2 protocols. Results: ACL graft rupture occurred in 10 patients (7.4%) in the traditional PT group and 5 patients (3.3%) in the HIP-GREAT group. This difference was not statistically significant (hazard ratio, 0.39; 95% CI, 0.14 to 1.16; P = .09). The ARR was 0.041 (95% CI, –0.011 to 0.093), and the NNT was 24.5. Conclusion: This study did not demonstrate a statistically significant reduction of ACL graft rupture in patients in the HIP-GREAT group. However, high ARR values and low NNT values were found, which suggests the possible effectiveness of the HIP-GREAT protocol to reduce ACL graft ruptures in young athletes.

Association of Remaining Anterior Knee Laxity With Inferior Outcomes After Revision ACL Reconstruction

“…10,32,33 Low rates of recurrent knee laxity and a significant increase in functional scores with good or excellent outcomes have been reported in 75% to 90% of patients after ACLR. 19,28 However, the reduced anterior knee laxity after ACLR is not necessarily associated with subjective symptoms or improved functional outcome as has been reported in the current literature. 7,20,23,32 A remaining increased Lachman grade or an elevated side-to-side difference (SSD) in anterior knee laxity therefore do not seem to be associated with inferior clinical outcome measures.…”

Pelvic Rotation Is Associated With Asymmetry in the Knee Extensor Moment During Double-Leg Squatting After Anterior Cruciate Ligament Reconstruction

“…Trunk and pelvic control have been areas of focus in ACL injury and reinjury prevention. [33][34][35] Jump-landing training with verbal instructions reduced the lateral trunk lean and knee abduction moment during single-leg landing. 36 Therefore, pelvic rotation might also be improved with movement training using verbal instructions.…”

Impact of Surgical Timing on Functional Outcomes after Anterior Cruciate Ligament Reconstruction

“…Graft rupture commonly occurs within the first year of surgery [12,13]. Additionally, there have been reports of graft ruptures after returning to sports without medical clearance [52]. Although a prolonged preoperative waiting period may result in a longer absence from sports and impatience in returning to sports, previous reports have not investigated the relationship between the preoperative waiting period and graft rupture.…”