Effectiveness of early quadriceps exercises after anterior cruciate ligament reconstruction

Abstract

Objective. To systematically review the published information regarding the effectiveness and safety of early postoperative quadriceps muscle exercise training on pain, joint laxity, function and range of motion in postoperative anterior cruciate ligament (ACL) reconstruction adult patients. Data sources.Five databases (CINAHL, PEDro, Pubmed, Science Direct and the Cochrane Library) were searched for studies published from January 1990 to May 2007. Study selection.Publications describing research into the effectiveness of early quadriceps exercises after ACL reconstruction were included. A total of three eligible articles met the inclusion criteria. Data extraction.A review of the three eligible studies was undertaken to describe the key study components. The PEDro Scale was used to determine the methodological quality of the selected trials and the level of evidence of all the eligible studies was categorised according to the evidence hierarchy by Lloyd-Smith. 24 Relevant data were extracted by the two reviewer groups to reduce bias.Data synthesis. Due to study heterogeneity a meta-analysis could not be conducted. Effect sizes were calculated provided that sufficient data were provided. Outcome measures included range of motion (ROM), functional performance, pain CORRESPONDENCE:Quinette Division of Physiotherapy, Stellenbosch University, South Africa and knee laxity. The methodological quality of the studies did not vary considerably across the studies and the average PEDro score was 66%. Marginal significant differences were noted in knee ROM at 1 month postoperatively, pain day 1 postoperatively, knee laxity and subjective evaluation of function at 6 months postoperatively. Conclusion.Early quadriceps exercises can be performed safely in the first 2 postoperative weeks, but clinically significant gains in ROM, function, pain and knee laxity were not evident. Further research should include standardised interventions, measurement time frames and outcome measurement tools to allow for a meta-analysis to be conducted. research has been published on rehabilitation protocols after ACL reconstruction. 34 Published research in the 1980s focused on the effectiveness of electrical stimulation of the quadriceps muscle in the acute postoperative stage to decrease the effect of muscle atrophy and weakness. 28 More recently, the focus of published research has been on accelerated versus non-accelerated rehabilitation programmes, as well as open-kinematic chain versus closed-kinematic chain exercises in early rehabilitation after ACL reconstruction. 5,9 Anecdotally, it is proposed that accelerated rehabilitation programmes that allow early range of motion (ROM), immediate weight-bearing and early return to previous functional level should be advocated as best practice. However, these recommendations for best practice are often based on clinical opinion and not on research evidence. 9 Clinical decision-making regarding the most appropriate exercises should be based on research evidence. 9Appropriate neuromuscular fu...