Evaluation of Open and Closed Kinetic Chain Exercises in Rehabilitation Following Anterior Cruciate Ligament Reconstruction

Abstract

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction.

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

“…They included the RCTs of Bynum et al ,64 Mikkelsen et al ,67 Morrissey et al 68 and Perry et al 69. The recent RCT of Uçar et al 70 found no differences between CKC and OKC exercises, but they investigated a group of patients after ACLR with a HS graft.…”

“…The overall conclusions were as follows: Level 1 : CKC and OKC training can be used for regaining quadriceps strength 61 62 70

Level 2 : after ACLR, OKC exercises can be performed from week 4 postoperative in a restricted ROM of 90–45° 61 63 65 66

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Assessment of knee joint range of motion and the level of pain in patients after arthroscopic ACL reconstruction in the selected physiotherapy model

“…A similar opinion concerning pain intensity in a postsurgical period in patients after the ACL reconstruction was expressed by Yabroudi et al, who revealed high usefulness of controlling postsurgical pain and oedema in a knee join area [33]. While assessing the value of exercises in open and closed kinematic chains after the ACL reconstruction, Ucar et al also applied the Visual Analogue Scale [37].…”

“…Podobną opinię o wartości pomiaru natężenia bólu w okresie pooperacyjnym u chorych po rekonstrukcji ACL wyrażają Yabroudi i wsp., którzy w swoim badaniu wykazali dużą przydatność kontrolowania po zabiegowego bólu i obrzęku okolicy stawu kolanowego [33]. Ucar i wsp., oceniając wartość ćwiczeń w otwartych i zamkniętych łańcuchach kinematycznych po rekonstrukcji ACL, również wykorzystywali wizualno-analogową skalę bólu VAS [37].…”

Influencia de lesiones asociadas en la intervención de un protocolo de fuerza y propiocepción en cirugía de ligamento cruzado anterior

“…En la siguiente fase se pueden realizar ejercicios de propiocepción con apoyo unipodal y se pueden ir complicando progresivamente al pedir al paciente que cierre los ojos. En la fase final se realizan todos los ejercicios de las fases anteriores pero añadiendo complicaciones a la realización del ejercicio, combinando distintas superficies y solicitando al paciente movimientos rápido y explosivos, pero sin perder el equilibrio (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”