Effects of open versus closed kinetic chain training on knee laxity in the early period after anterior cruciate ligament reconstruction

Morrissey, Matthew C.; Hudson, Zoë; Drechsler, Wendy I; Coutts, Fiona; Knight, Philippa R.; King, John B.

doi:10.1007/s001670000161

Cited by 81 publications

(70 citation statements)

References 21 publications

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“…Several studies have compared the effect of open kinetic chain (OKC) and closed kinetic chain (CKC) [7,[23][24][25]42] and most of the post-operative rehabilitation protocols used today include a combination of both methods. However, only a few studies have addressed the question of whether early active and passive extension immediately after the ACL reconstruction [35] affects A-P laxity of the knee.…”

Section: Introductionmentioning

confidence: 99%

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Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee

Isberg

Faxén

Brandsson

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior-posterior knee laxity (A-P laxity). Our hypothesis was that full active and passive extension immediately after an ACL reconstruction would have no effect on the A-P laxity and clinical results up to 2 years after the operation. Twenty-two consecutive patients (14 men, 8 women, median age 21 years, range 17-41) were included. All the patients had a unilateral ACL rupture and no other ligament injuries or any other history of previous knee injuries. The surgical procedure was identical in all patients and one experienced surgeon operated on all the patients, using the bone-patellar tendon-bone autograft. The post-operative rehabilitation programme was identical in both groups, except for extension training during the first 4 weeks post-operatively. The patients were randomly allocated to post-operative rehabilitation programmes either allowing (Group A, n=11) or not allowing [Group B (30 to -10 degrees ), n=11] full active and passive extension immediately after the operation. They were evaluated pre-operatively and at 6 months and 2 years after the reconstruction. To evaluate the A-P knee laxity, radiostereometric analysis (RSA) and KT-1000 arthrometer (KT-1000) measurements were used, range of motion, Lysholm score, Tegner activity level, the International Knee Documentation Committee (IKDC) evaluation system and one-leg-hop test quotient were used. Pre-operatively, the RSA measurements revealed side-to-side differences in Group A of 8.6 mm (2.3-15.4), median (range) and in Group B of 7.2 mm (2.2-17.4) (n.s.). The corresponding KT-1000 values were for Group A, 2.0 mm (0-8.0) and Group B, 4.0 mm (0-10.0) (n.s.). At 2 years, the differences between the two groups were minimal, regardless of the method that had been used. The RSA measurements in Group A were 2.7 mm (0-10.7) and in Group B 2.8 (-1.8 to 9.5). The KT-1000 values were for Group A, 1.0 mm (-1.5 to 3.5), and for Group B, 0.5 mm (-1.0 to 4.0), without any significant differences between the groups. Nor did the Lysholm score, Tegner activity level, IKDC or one-leg-hop test differ. Early active and passive extension training, without any restrictions in extension, immediately after an ACL reconstruction using bone-patellar tendon-bone graft did not increase post-operative knee laxity up to 2 years after the ACL reconstruction.

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Section: Introductionmentioning

confidence: 99%

“…The first period starts immediately after the reconstruction [24][25][26]30], while the second begins when the graft becomes weaker due to graft revitalisation, until it reaches its weakest point, approximately 12 weeks after the reconstruction [26,30].…”

Section: Introductionmentioning

confidence: 99%

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee

Isberg

Faxén

Brandsson

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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“…Isotonic progressive resistive exercises can be performed in the ranges listed above for both open and closed chain strengthening. Contrary to popular belief there is some limited evidence that ranges of CKC 0-90, and OKC 90-0°may be safe without risk of graft laxity or elongation [73][74][75][76][77].…”

Section: Phase Ii: Postoperative Weeks 4-6mentioning

confidence: 83%

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

Manske

Prohaska

Lucas

2012

Curr Rev Musculoskelet Med

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Injuries to the anterior cruciate ligament are common. Surgical reconstruction is more prevalent than ever. This review article discusses treatment of the patient following surgical reconstruction of the anterior cruciate ligament. Various phases of rehabilitation are discussed with emphasis on early return of passive motion, early weight bearing, bracing, kinetic chain exercises, neuromuscular electrical stimulation and accelerated rehabilitation. Although evidence exists for the treatment of the surgically reconstructed cruciate ligament, more is needed to better define specific timeframes for advancement. Evidence exists that many of these young individuals are not fully returning to unlimited high level activities. This review article presents some of the latest evidence regarding anterior cruciate ligament rehabilitation in an attempt to help the busy clinician understand and relate basic and clinical research to rehabilitation of a patient following reconstruction.

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“…Each limb segment and joint undergoes a cyclic pattern of flexion, extension and to a lesser extent, rotation, abduction and adduction during each stride. Furthermore, the energetic cost of moving the limbs depends upon joint postures and segmental accelerations [42], so the movements or loads at one joint will have consequences both for the other joints of the ipsilateral limb as well as the motions and loads in the contralateral limb (i.e., physical therapists refer to such functional interdependence as the "kinetic chain" [43][44][45][46][47][48]). Most current tools for gait analysis are not designed to capture these complex and coupled behaviors.…”

Section: Need For New Analysis Toolsmentioning

confidence: 99%

A Review of New Analytic Techniques for Quantifying Symmetry in Locomotion

et al. 2010

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Abstract:We present a review of novel techniques developed by our research group to improve quantitative assessment of human movement, especially assessments related to symmetric and asymmetric gait patterns. These new methods use motion capture data of the lower limb joints (e.g., joint and body segment angular position and/or velocity, or joint center locations) and include: (1) Regions of Deviation (ROD) analysis, (2) complexity and variability of phase portraits, and (3) multivariate shape-alignment and decomposition. We provide example demonstrations of these techniques using data from infants, typical and atypically developing children, simulated injuries of a knee or ankle, and wheelchair propulsion.

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Effects of open versus closed kinetic chain training on knee laxity in the early period after anterior cruciate ligament reconstruction

Cited by 81 publications

References 21 publications

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

A Review of New Analytic Techniques for Quantifying Symmetry in Locomotion

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