Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 19, Issue 7, pp 1158–1167 | Cite as

Physiotherapy-guided versus home-based, unsupervised rehabilitation in isolated anterior cruciate injuries following surgical reconstruction

Knee

Abstract

Purpose

The aim of this study was to investigate the outcome after ACL reconstruction between a group of patients receiving a standardized, supervised, physiotherapy-guided rehabilitation programme and a group of patients who followed an unsupervised, home-based rehabilitation programme.

Methods

Forty patients with isolated anterior cruciate ligament injuries were allocated to either a supervised physiotherapy intervention group or home-based exercise group. Patients were investigated by an independent examiner pre-operative, 3, 6, 9 and 12 months post-surgery using the following outcome measures: Lysholm Score and Tegner Activity Scale, functional hopping tests, and isometric and isokinetic strength assessments.

Results

Both groups improved significantly (P = 0.01–0.04) following 12 months after surgery. The median Lysholm score increased from 57 (34–90) to 94 (90–100) in the supervised group and 60 (41–87) to 97 (95–100) in the unsupervised group. The median Tegner Activity Scale increased from 3 (2–8) to 6 (3–8) in the supervised group and 4 (2–8) to 5 (3–10) in the unsupervised group. The combined mean symmetry indices for the hopping tests improved from 77.3 ± 18.7 to 86.8 ± 11.1 (supervised) and from 78.1 ± 30.5 to 88.3 ± 10.9 (unsupervised). Isometric and isokinetic strength symmetry indices for knee extension improved from 68.9 ± 23.5 to 82.8 ± 11.9, respectively, 63.7 + 22.8 to 82.7 + 15.1 in the supervised group and from 73.6 ± 20.5 to 76.5 ± 17.9, respectively, 69.5 ± 24.3 to 76.9 ± 16.9 in the unsupervised group. Eccentric strength symmetry indices for knee extension improved from 67.9 ± 27.7 to 87.8 ± 6.8 in the supervised group and from 71.3 ± 17.8 to 82.6 ± 15.6 in the unsupervised group.

Conclusion

This study could not demonstrate a benefit in a rehabilitation programme supervised by a physiotherapist in our population compared to an unsupervised cohort.

Keywords

ACL reconstruction Supervised rehabilitation Physiotherapy Home-based rehabilitation 

References

  1. 1.
    Ageberg E, Thomee R, Neeter C, Silbernagel KG, Roos EM (2008) Muscle strength and functional performance treated with training and surgical reconstruction or training only: a two- to five-years follow-up. Arthr Rheum 15:1773–1779CrossRefGoogle Scholar
  2. 2.
    Augustsson J, Thomee R, Karlsson J (2004) Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:350–356PubMedCrossRefGoogle Scholar
  3. 3.
    Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W (1990) Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orth Relat Res 255:204–214Google Scholar
  4. 4.
    Beard DJ, Dodd CA (1998) Home or supervised rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial. J Orthop Sports Phys 27:134–143Google Scholar
  5. 5.
    Beynnon BD, Johnson RJ, Fleming BC (2002) The science of anterior cruciate ligament rehabilitation. Clin Orth Relat Res 402:9–20CrossRefGoogle Scholar
  6. 6.
    Beynnon B, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) The treatment of anterior cruciate ligament injuries, part 1. Am J Sports Med 33:1579–1601PubMedCrossRefGoogle Scholar
  7. 7.
    Beynnon B, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) The treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med 33:1751–1767PubMedCrossRefGoogle Scholar
  8. 8.
    Canale TS, Beaty JH, Campbell’s Operative Orthopaedics (2007) Mosby, St. Louis, Box 48.2, pp 2855–2885Google Scholar
  9. 9.
    De Carlo MS, Sell KE (1997) The effects of the number and frequency of physical therapy treatments on selected outcomes of treatment in patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 26:332–339PubMedGoogle Scholar
  10. 10.
    Dealy BS, Smolinksi RJ, Wind WM, Bowman DS (2001) Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg 14:85–91Google Scholar
  11. 11.
    De Jong SN, van Caspel DR, van Haeff MJ, Saris DB (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23:21–28PubMedGoogle Scholar
  12. 12.
    Elmlinger BS, Nyland JA, Tillet ED (2006) Knee flexor function 2 years after anterior cruciate ligament reconstruction with semitendinosus-gracilis autografts. Arthroscopy 22:650–655PubMedCrossRefGoogle Scholar
  13. 13.
    Feller JA, Webster KE, Taylor NF, Payne R, Pizzari T (2004) Effect of physiotherapy attendance on outcome after anterior cruciate ligament reconstruction: a pilot study. Brit J Sports Med 38:74–78CrossRefGoogle Scholar
  14. 14.
    Fischer DA, Tewes DP, Boyd JL, Smith JP, Quick DC (1998) Home based rehabilitation for anterior cruciate ligament reconstruction. Clin Orth Relat Res 347:194–199Google Scholar
  15. 15.
    Forster MC, Forster IW (2005) Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee 12:225–230PubMedGoogle Scholar
  16. 16.
    Grant JA, Mohtadi N, Maitland ME, Zernicke RF (2005) Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction. Am J Sports Med 33:1288–1297PubMedCrossRefGoogle Scholar
  17. 17.
    Henriksson M, Ledin T, Good L (2001) Postural Control after Anterior Cruciate Ligament Reconstruction and Functional Rehabilitation. Am J Sports Med 29:359–366PubMedGoogle Scholar
  18. 18.
    Laxdal G, Kartus J, Ejerhed L, Sernert N, Magnusson L, Faxen E, Karlsson J (2005) Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy 21:958–964PubMedCrossRefGoogle Scholar
  19. 19.
    Mattacola CG, Perrin DH, Ganseder BM et al (2002) Strength, functional outcome and postural stability after anterior cruciate ligament reconstruction. J Athl Train 37:262–268PubMedGoogle Scholar
  20. 20.
    Miyasaka KC, Daniel D, Stone ML, Hirshman P (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8Google Scholar
  21. 21.
    Noyes FR, Barber SD, Mangine RE (1991) Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 19:513–518PubMedCrossRefGoogle Scholar
  22. 22.
    O’Meara PM (1993) Rehabilitation following reconstruction of the anterior cruciate ligament. Orthopaedics 16:301–306Google Scholar
  23. 23.
    Osteras H, Augestad LB, Tonde S (1998) Isokinetic muscle strength after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 8:279–282PubMedCrossRefGoogle Scholar
  24. 24.
    Parker MG (1994) Biomechanical and histological concepts in the rehabilitation of patients with anterior cruciate ligament reconstructions. J Orthop Sports Phys Ther 20:44–50PubMedGoogle Scholar
  25. 25.
    Podesta L, Sherman MF, Bonamo JR, Reiter I (1990) Rationale and protocol for postoperative anterior cruciate ligament rehabilitation. Clin Orth Relat Res 257:262–273Google Scholar
  26. 26.
    Rebel M (2000) Coordination training after anterior cruciate ligament surgery. Sportverletz Sportschaden 14:12–19PubMedCrossRefGoogle Scholar
  27. 27.
    Schenck RC Jr, Blaschak MJ, Lance ED, Turturro TC, Holmes CF (1997) A prospective outcome study of rehabilitation programs and anterior cruciate ligament reconstruction. Arthroscopy 13:285–290PubMedCrossRefGoogle Scholar
  28. 28.
    Sernert N, Kartus J, Kohler K et al (1999) Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 7:160–165PubMedCrossRefGoogle Scholar
  29. 29.
    Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299PubMedCrossRefGoogle Scholar
  30. 30.
    Shelbourne KD, Klotz C (2006) What i have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction. J Orthop Sci 11:18–25CrossRefGoogle Scholar
  31. 31.
    Sherman OH, Banffy MB (2004) Anterior cruciate ligament reconstruction: which graft is the best? Arthroscopy 20:974–980PubMedGoogle Scholar
  32. 32.
    Spindler L, Kuhn JE, Freedman KB, Matthes CE, Dittus RS, Harell FE Jr (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32:1986–1995PubMedCrossRefGoogle Scholar
  33. 33.
    Stanish WD, Lai A (1993) New concepts of rehabilitation following anterior cruciate reconstruction. Clin Sports Med 12:25–58PubMedGoogle Scholar
  34. 34.
    Thomson LC, Handoll HH, Cunningham A, Shaw PC (2002) Physiotherapist-led programmes and interventions for rehabilitation of anterior cruciate ligament, medial collateral ligament and meniscal injuries of the knee in adults. Cochrane Database Syst RevGoogle Scholar
  35. 35.
    Treacy SH, Barron OA, Brunet ME, Barrack RL (1997) Assessing the need for extensive supervised rehabilitation following arthroscopic ACL reconstruction. Am J Orthop 26:25–29PubMedGoogle Scholar
  36. 36.
    Trees AH, Howe TE, Dixon J, White L (2006) Exercise for treating isolated anterior cruciate ligament injuries in adults. Cochrane Database Syst RevGoogle Scholar
  37. 37.
    Wilk KE, Reinold MM, Hooks TR (2003) Recent advances in the rehabilitation of isolated and combined anterior cruciate ligament injuries. Orthop Clin North Am 34:107–137PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Musculoskeletal Research UnitCQ UniversityRockhamptonAustralia
  2. 2.Department of Orthopaedic SurgeryRoyal Brisbane HospitalBrisbaneAustralia
  3. 3.The Centre for Health, Exercise and Sports Medicine, School of PhysiotherapyThe University of MelbourneMelbourneAustralia

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