Role of accelerated rehabilitation versus standard rehabilitation following anterior cruciate ligament reconstruction using hamstring graft

Gupta, Prateek Ku; Acharya, Ashis; Mourya, Ankur; Ameriya, Deepesh

doi:10.1016/j.jajs.2017.08.003

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…The current data did not allow for differentiation of the type of tasks performed, but it is assumed that individuals performed tasks with greater demands than a sit-to-stand. For these participants, selfreported IKDC scores, similar to those previously reported, 16,20,21 indicate that on average individuals in the ACLr group were progressing typically. We do not know to what extent the activities performed exceeded the individuals' loading abilities; therefore, we cannot determine the degree to which underuse contributes to underloading in these data.…”

Section: Resultssupporting

confidence: 79%

Individuals following anterior cruciate ligament reconstruction practice underloading strategies during daily activity

Chan¹,

Sigward

2021

Journal Orthopaedic Research

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Underloading the surgical limb has been described in biomechanical studies across recovery time points following anterior cruciate ligament reconstruction (ACLr). This study aimed to examine the extent to which laboratory findings translate to daily activities.Limb loading was quantified during a sit-to-stand task in laboratory testing and throughout 2 days of daily activity in 15 individuals 114.8 (17.2) days post-ACLr and 15 controls. Vertical force impulse calculated from force platform (laboratory) and pressure insoles (daily) was used to quantify limb loading. Between-limb symmetry was calculated for limb loading and knee strength measures, 2 × 2 GLM repeated measures determined a significant group-by-limb interaction on daily limb loading. Surgical limb daily loading was lower compared to nonsurgical (p < .001; effect sizes [ES] = 0.63), and control matched limbs (surgical: p = .037, ES = 0.80 and nonsurgical: p = .02, ES = 0.89). No group differences were found in total daily loading (summed loading between limbs; p = .18; ES = 0.50) and time performing weight-bearing activities (p = .32; ES = 0.36).Pearson's correlation determined that between-limb symmetry in daily loading was related to sit-to-stand loading (r = .62; p = .01) and knee extensor strength symmetry (r = .6; p = .02) in the ACLr group. These data support the presence of underloading behaviors in individuals 10-14 weeks following ACLr that are consistent with previous biomechanical studies and current biomechanical data. Knee extensor weakness was related to greater underloading. Asymmetrical loading quantified in the laboratory is practiced throughout the day in individuals post-ACLr. Practice afforded by daily activities represents powerful contributors to learning of a pattern that contrasts the goal of rehabilitation exercises.

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Section: Resultssupporting

confidence: 79%

Individuals following anterior cruciate ligament reconstruction practice underloading strategies during daily activity

Chan¹,

Sigward

2021

Journal Orthopaedic Research

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“…Randomized controlled trials have shown no or only modest improvement with accelerated rehabilitation. 11 , 14 , 24 Others have suggested early aggressive rehabilitation to have a negative effect on final graft laxity. 21 , 34 , 41 The fear of the latter leads to surgeons, rehabilitators, and patients being guarded and cautious in their rehabilitation approach.…”

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confidence: 99%

Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study

Aujla

Ebert

Annear

2021

Orthopaedic Journal of Sports Medicine

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Background: Few studies have reported the return-to-sports (RTS) rate in patients after augmentation of autologous anterior cruciate ligament reconstruction (ACLR) with the Ligament Augmentation and Reconstruction System (LARS). Purpose/Hypothesis: The purpose of this study was to compare postoperative outcomes in patients who underwent ACLR with single-bundle 4-strand hamstring autograft either without augmentation (HA-ACLR group) or with LARS augmentation (AUG-ACLR group). It was hypothesized that clinical outcomes and RTS rates would be better in the AUG-ACLR group at the 1-year follow-up, with similar outcomes in both cohorts by 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR between April 2014 and December 2017 were included in the current comparative study if they were skeletally mature and had 1- and 2-year follow-up outcomes; patients with concomitant meniscal surgery were also included. Included were 66 patients with AUG-ACLR (mean age, 26.8 years; 67% male) and 130 patients with HA-ACLR (mean age, 27.5 years; 61% male). Subjective outcome measures included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score, Lysholm scale, Tegner activity scale, and the Noyes sports activity rating scale. Objective measures included knee laxity, maximal isokinetic knee flexion and extension strength, and the results of 4 functional hop tests. Results: There were no significant differences between the study groups in age, sex distribution, body mass index, time to surgery, or number of concurrent meniscal surgeries. At the 1-year follow-up, the AUG-ACLR group had a significantly higher Tegner score ( P = .001) and rates of RTS ( P = .029) and return to preinjury level of sport ( P = .003) compared with the HA-ACLR group. At the 2-year follow-up, there were no differences in these measures between groups. There were no between-group differences in other subjective outcomes, knee laxity, or strength and hop test results at either postoperative time point. There were also no differences in rerupture rates or other complications between the groups. Conclusion: Patients with AUG-ACLR had higher 1-year postoperative Tegner scores and rates of RTS and preoperative sport level compared with the HA-ACLR group. The 2-year rerupture rate for the AUG-ACLR group was low, and no intra-articular inflammatory complications were noted.

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“…Proprioception is considered a key element in sensorimotor control [ 26 ]. The proprioceptive deficit of a knee with a ruptured or nonfunctional ACL is well documented [ 27 – 31 ]. As a specific sub modality of proprioception, knee JPS test is most often used to assess knee proprioception.…”

Section: Discussionmentioning

confidence: 99%

Comparison of proprioception recovery following anterior cruciate ligament reconstruction using an artificial graft versus an autograft

Liu

Wang

et al. 2022

BMC Musculoskelet Disord

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Background To compare proprioception recovery after anterior cruciate ligament reconstruction (ACLR) with a hamstring tendon autograft versus the artificial Ligament Advanced Reinforcement System (LARS). Material and methods Forty patients (9 females, 31 males) with anterior cruciate ligament (ACL) rupture were enrolled in this prospective study. Patients were randomized to two groups, 1) ACLR using a hamstring tendon autograft (n = 20) or 2) ACLR using artificial LARS (n = 20). Proprioception was assessed with knee joint position sense (JPS) passive-passive test at 45° and 75° flexions, with the contralateral healthy knee as a control baseline to calculate the JPS error. Knee JPS absolute error was used as the main outcome variable and defined as the absolute difference between the reproduction and target angles. Results JPS error in both groups at 3 months after ACLR was significantly higher than that at 12 months. However, no significant difference in JPS error was detected between the LARS and autograft groups at either 3 or 12 months after ACLR. Analyzing JPS data by grouping patients according to whether ACLR was performed more or less than 1 year following injury regardless of graft type showed a statistically significant difference between the groups at 3 months, but not at 12 months, after ACLR. Patients receiving the graft within 1 year of injury had a lower JPS error than those receiving the graft more than 1 year after injury at 3 months. No complications were associated with either ACLR method. Conclusion ACLR with a hamstring tendon autograft or LARS artificial graft is similarly safe and effective for recovering knee proprioception.

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Role of accelerated rehabilitation versus standard rehabilitation following anterior cruciate ligament reconstruction using hamstring graft

Cited by 9 publications

References 21 publications

Individuals following anterior cruciate ligament reconstruction practice underloading strategies during daily activity

Individuals following anterior cruciate ligament reconstruction practice underloading strategies during daily activity

Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study

Comparison of proprioception recovery following anterior cruciate ligament reconstruction using an artificial graft versus an autograft

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