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Preoperative Rehabilitation: Basic Principles

  • Timothy P. Heckmann
  • Frank R. Noyes
  • Sue Barber-WestinEmail author
Chapter

Abstract

This chapter presents a comprehensive rehabilitation program that should be performed before ACL reconstruction and documents data from multiple studies that demonstrate the advantages of formal preoperative therapy in terms of restoration of knee motion, muscle strength, and neuromuscular function. Major issues to treat and resolve before surgery are discussed, including hemarthrosis and knee joint effusion, pain, muscle weakness and inhibition, and abnormal gait mechanics.

Keywords

ACL rehabilitation ACL preoperative rehabilitation Knee motion Neuromuscular function 

References

  1. 1.
    Eitzen I, Holm I, Risberg MA. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009;43(5):371–6.  https://doi.org/10.1136/bjsm.2008.057059.CrossRefPubMedGoogle Scholar
  2. 2.
    Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991;19(4):332–6.CrossRefGoogle Scholar
  3. 3.
    Mauro CS, Irrgang JJ, Williams BA, Harner CD. Loss of extension following anterior cruciate ligament reconstruction: analysis of incidence and etiology using IKDC criteria. Arthroscopy. 2008;24(2):146–53.  https://doi.org/10.1016/j.arthro.2007.08.026.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mohtadi NG, Webster-Bogaert S, Fowler PJ. Limitation of motion following anterior cruciate ligament reconstruction. A case-control study. Am J Sports Med. 1991;19(6):620–4; discussion 624-625.CrossRefGoogle Scholar
  5. 5.
    Wasilewski SA, Covall DJ, Cohen S. Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction. Am J Sports Med. 1993;21(3):338–42.CrossRefGoogle Scholar
  6. 6.
    de Valk EJ, Moen MH, Winters M, Bakker EW, Tamminga R, van der Hoeven H. Preoperative patient and injury factors of successful rehabilitation after anterior cruciate ligament reconstruction with single-bundle techniques. Arthroscopy. 2013;29(11):1879–95.  https://doi.org/10.1016/j.arthro.2013.07.273.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Noyes FR, Barber-Westin SD. Meniscus tears: diagnosis, repair techniques, and clinical outcomes. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes, chap. 23, 2nd ed. Philadelphia: Elsevier; 2017, p. 677–718.  https://doi.org/10.1016/B978-0-323-32903-3.00023-8.CrossRefGoogle Scholar
  8. 8.
    Noyes FR, Barber-Westin SD. Posterior cruciate ligament injuries: diagnosis, operative techniques, and clinical outcomes. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes, chap. 16, 2nd ed. Philadelphia: Elsevier; 2017, p. 447–526.  https://doi.org/10.1016/B978-0-323-32903-3.00016-0.CrossRefGoogle Scholar
  9. 9.
    Noyes FR, Barber-Westin SD. Posterolateral ligament injuries: diagnosis, operative techniques, and clinical outcomes. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes, chap. 17, 2nd ed. Philadelphia: Elsevier; 2017, p. 527–77.  https://doi.org/10.1016/B978-0-323-32903-3.00017-2.CrossRefGoogle Scholar
  10. 10.
    Noyes FR, Barber-Westin SD. Medial and posteromedial ligament injuries: diagnosis, operative techniques, and clinical outcomes. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes, chap. 19, 2nd ed. Philadelphia: Elsevier; 2017, p. 608–35.  https://doi.org/10.1016/B978-0-323-32903-3.00019-6.CrossRefGoogle Scholar
  11. 11.
    Alshewaier S, Yeowell G, Fatoye F. The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review. Clin Rehabil. 2017;31(1):34–44.  https://doi.org/10.1177/0269215516628617.CrossRefPubMedGoogle Scholar
  12. 12.
    Failla MJ, Logerstedt DS, Grindem H, Axe MJ, Risberg MA, Engebretsen L, Huston LJ, Spindler KP, Snyder-Mackler L. Does extended preoperative rehabilitation influence outcomes 2 years after ACL reconstruction? A comparative effectiveness study between the MOON and Delaware-Oslo ACL cohorts. Am J Sports Med. 2016;44(10):2608–14.  https://doi.org/10.1177/0363546516652594.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Logerstedt D, Lynch A, Axe MJ, Snyder-Mackler L. Pre-operative quadriceps strength predicts IKDC 2000 scores 6 months after anterior cruciate ligament reconstruction. Knee. 2013;20(3):208–12.  https://doi.org/10.1016/j.knee.2012.07.011.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shaarani SR, O'Hare C, Quinn A, Moyna N, Moran R, O’Byrne JM. Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(9):2117–27.  https://doi.org/10.1177/0363546513493594.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40(11):705–21.  https://doi.org/10.2519/jospt.2010.3345.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2015;49(6):385–9.  https://doi.org/10.1136/bjsports-2014-093891.CrossRefPubMedGoogle Scholar
  17. 17.
    Noyes FR, Barber-Westin SD. Anterior cruciate ligament revision reconstruction: graft options and clinical outcomes. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes, chap. 8, 2nd ed. Philadelphia: Elsevier; 2017, p. 221–57.  https://doi.org/10.1016/B978-0-323-32903-3.00008-1.CrossRefGoogle Scholar
  18. 18.
    Christino MA, Fantry AJ, Vopat BG. Psychological aspects of recovery following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2015;23(8):501–9.  https://doi.org/10.5435/JAAOS-D-14-00173.CrossRefGoogle Scholar
  19. 19.
    Coronado RA, Bird ML, Van Hoy EE, Huston LJ, Spindler KP, Archer KR. Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review. Clin Rehabil. 2018;32(3):287–98.  https://doi.org/10.1177/0269215517728562.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Noyes FR, Bassett RW, Grood ES, Butler DL. Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am. 1980;62(5):687–95, 757.CrossRefGoogle Scholar
  21. 21.
    Wang JH, Lee JH, Cho Y, Shin JM, Lee BH. Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department. Injury. 2016;47(8):1744–9.  https://doi.org/10.1016/j.injury.2016.05.025.CrossRefPubMedGoogle Scholar
  22. 22.
    Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, Wojtys EM. Quadriceps inhibition induced by an experimental knee joint effusion affects knee joint mechanics during a single-legged drop landing. Am J Sports Med. 2007;35(8):1269–75.CrossRefGoogle Scholar
  23. 23.
    Torry MR, Decker MJ, Millett PJ, Steadman JR, Sterett WI. The effects of knee joint effusion on quadriceps electromyography during jogging. J Sports Sci Med. 2005;4:1–8.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Cosgarea AJ, Sebastianelli WJ, DeHaven KE. Prevention of arthrofibrosis after anterior cruciate ligament reconstruction using the central third patellar tendon autograft. Am J Sports Med. 1995;23(1):87–92.CrossRefGoogle Scholar
  25. 25.
    Meighan AA, Keating JF, Will E. Outcome after reconstruction of the anterior cruciate ligament in athletic patients. A comparison of early versus delayed surgery. J Bone Joint Surg Br. 2003;85(4):521–4.CrossRefGoogle Scholar
  26. 26.
    Shelbourne KD, Johnson GE. Outpatient surgical management of arthrofibrosis after anterior cruciate ligament surgery. Am J Sports Med. 1994;22(2):192–7.CrossRefGoogle Scholar
  27. 27.
    Strum GM, Friedman MJ, Fox JM, Ferkel RD, Dorey FH, Del Pizzo W, Snyder SJ. Acute anterior cruciate ligament reconstruction. Analysis of complications. Clin Orthop Relat Res. 1990; (253):184–9.Google Scholar
  28. 28.
    Shelbourne KD, Foulk DA. Timing of surgery in acute anterior cruciate ligament tears on the return of quadriceps muscle strength after reconstruction using an autogenous patellar tendon graft. Am J Sports Med. 1995;23(6):686–9.CrossRefGoogle Scholar
  29. 29.
    Bach BR, Jones GT, Sweet FA, Hager CA. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results. Am J Sports Med. 1994;22:758–67.CrossRefGoogle Scholar
  30. 30.
    Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2012;42(3):153–71.  https://doi.org/10.2519/jospt.2012.3741.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Culvenor AG, Lai CC, Gabbe BJ, Makdissi M, Collins NJ, Vicenzino B, Morris HG, Crossley KM. Patellofemoral osteoarthritis is prevalent and associated with worse symptoms and function after hamstring tendon autograft ACL reconstruction. Br J Sports Med. 2014;48(6):435–9.  https://doi.org/10.1136/bjsports-2013-092975.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Neuman P, Kostogiannis I, Friden T, Roos H, Dahlberg LE, Englund M. Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury—a prospective cohort study. Osteoarthr Cartil. 2009;17(3):284–90.  https://doi.org/10.1016/j.joca.2008.07.005.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Shelbourne KD, Urch SE, Gray T, Freeman H. Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med. 2012;40(1):108–13.  https://doi.org/10.1177/0363546511423639.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hasegawa S, Kobayashi M, Arai R, Tamaki A, Nakamura T, Moritani T. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol. 2011;21(4):622–30.  https://doi.org/10.1016/j.jelekin.2011.01.005.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Imoto AM, Peccin S, Almeida GJ, Saconato H, Atallah AN. Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review. Sao Paulo Med J. 2011;129(6):414–23.CrossRefGoogle Scholar
  36. 36.
    Feil S, Newell J, Minogue C, Paessler HH. The effectiveness of supplementing a standard rehabilitation program with superimposed neuromuscular electrical stimulation after anterior cruciate ligament reconstruction: a prospective, randomized, single-blind study. Am J Sports Med. 2011;39(6):1238–47.  https://doi.org/10.1177/0363546510396180.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Snyder-Mackler L, Ladin Z, Schepsis AA, Young JC. Electrical stimulation of the thigh muscles after reconstruction of the anterior cruciate ligament. Effects of electrically elicited contraction of the quadriceps femoris and hamstring muscles on gait and on strength of the thigh muscles. J Bone Joint Surg Am. 1991;73(7):1025–36.CrossRefGoogle Scholar
  38. 38.
    Snyder-Mackler L, Delitto A, Bailey SL, Stralka SW. Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation. J Bone Joint Surg Am. 1995;77(8):1166–73.CrossRefGoogle Scholar
  39. 39.
    Wright RW, Preston E, Fleming BC, Amendola A, Andrish JT, Bergfeld JA, Dunn WR, Kaeding C, Kuhn JE, Marx RG, McCarty EC, Parker RC, Spindler KP, Wolcott M, Wolf BR, Williams GN. A systematic review of anterior cruciate ligament reconstruction rehabilitation: part II: open versus closed kinetic chain exercises, neuromuscular electrical stimulation, accelerated rehabilitation, and miscellaneous topics. J Knee Surg. 2008;21(3):225–34.CrossRefGoogle Scholar
  40. 40.
    Perry MC, Morrissey MC, King JB, Morrissey D, Earnshaw P. Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13(5):357–69.CrossRefGoogle Scholar
  41. 41.
    Beynnon BD, Uh BS, Johnson RJ, Abate JA, Nichols CE, Fleming BC, Poole AR, Roos H. Rehabilitation after anterior cruciate ligament reconstruction. A prospective, randomized, double-blind comparison of programs administered over 2 different time periods. Am J Sports Med. 2005;33(3):347–59.CrossRefGoogle Scholar
  42. 42.
    Isberg J, Faxen E, Brandsson S, Eriksson BI, Karrholm J, Karlsson J. Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1108–15.  https://doi.org/10.1007/s00167-006-0138-2.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Beynnon BD, Johnson RJ, Naud S, Fleming BC, Abate JA, Brattbakk B, Nichols CE. Accelerated versus nonaccelerated rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind investigation evaluating knee joint laxity using roentgen stereophotogrammetric analysis. Am J Sports Med. 2011;39(12):2536–48.  https://doi.org/10.1177/0363546511422349.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Fukuda TY, Fingerhut D, Moreira VC, Camarini PM, Scodeller NF, Duarte A Jr, Martinelli M, Bryk FF. Open kinetic chain exercises in a restricted range of motion after anterior cruciate ligament reconstruction: a randomized controlled clinical trial. Am J Sports Med. 2013;41(4):788–94.  https://doi.org/10.1177/0363546513476482.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Tagesson S, Oberg B, Good L, Kvist J. A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain exercise in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function. Am J Sports Med. 2008;36(2):298–307.CrossRefGoogle Scholar
  46. 46.
    Ohkoshi Y, Yasuda K, Kaneda K, Wada T, Yamanaka M. Biomechanical analysis of rehabilitation in the standing position. Am J Sports Med. 1991;19(6):605–11.CrossRefGoogle Scholar
  47. 47.
    Kulas AS, Hortobagyi T, DeVita P. Trunk position modulates anterior cruciate ligament forces and strains during a single-leg squat. Clin Biomech (Bristol, Avon). 2012;27(1):16–21.  https://doi.org/10.1016/j.clinbiomech.2011.07.009.CrossRefGoogle Scholar
  48. 48.
    Denti M, Randelli P, Lo Vetere D, Moioli M, Bagnoli I, Cawley PW. Motor control performance in the lower extremity: normals vs. anterior cruciate ligament reconstructed knees 5-8 years from the index surgery. Knee Surg Sports Traumatol Arthrosc. 2000;8(5):296–300.CrossRefGoogle Scholar
  49. 49.
    Yosmaoglu HB, Baltaci G, Kaya D, Ozer H. Tracking ability, motor coordination, and functional determinants after anterior cruciate ligament reconstruction. J Sport Rehabil. 2011;20(2):207–18.CrossRefGoogle Scholar
  50. 50.
    Zouita Ben Moussa A, Zouita S, Dziri C, Ben Salah FZ. Single-leg assessment of postural stability and knee functional outcome two years after anterior cruciate ligament reconstruction. Ann Phys Rehabil Med. 2009;52(6):475–84.  https://doi.org/10.1016/j.rehab.2009.02.006.CrossRefPubMedGoogle Scholar
  51. 51.
    Hooks TR, Wilk KE, Reinold MM. Comparison of proprioceptive deficits of the involved and noninvolved lower extremity following ACL injury and surgical reconstruction. J Orthop Sports Phys Ther. 2003;33:A59.Google Scholar
  52. 52.
    Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br. 2000;82(6):801–6.CrossRefGoogle Scholar
  53. 53.
    Dutton M. Neuromuscular control. In: Dutton M, editor. Orthopaedic examination, evaluation and intervention. New York: McGraw Hill; 2004. p. 55–7.Google Scholar
  54. 54.
    Wojtys EM, Huston LJ. Neuromuscular performance in normal and anterior cruciate ligament-deficient lower extremities. Am J Sports Med. 1994;22(1):89–104.CrossRefGoogle Scholar
  55. 55.
    Magyar MO, Knoll Z, Kiss RM. Effect of medial meniscus tear and partial meniscectomy on balancing capacity in response to sudden unidirectional perturbation. J Electromyogr Kinesiol. 2012;22(3):440–5.  https://doi.org/10.1016/j.jelekin.2012.01.010.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Malliou P, Gioftsidou A, Pafis G, Rokka S, Kofotolis N, Mavromoustakos S, Godolias G. Proprioception and functional deficits of partial meniscectomized knees. Eur J Phys Rehabil Med. 2012;48(2):231–6.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Muaidi QI, Nicholson LL, Refshauge KM, Adams RD, Roe JP. Effect of anterior cruciate ligament injury and reconstruction on proprioceptive acuity of knee rotation in the transverse plane. Am J Sports Med. 2009;37(8):1618–26.  https://doi.org/10.1177/0363546509332429.CrossRefGoogle Scholar
  58. 58.
    Goetschius J, Kuenze CM, Saliba S, Hart JM. Reposition acuity and postural control after exercise in anterior cruciate ligament reconstructed knees. Med Sci Sports Exerc. 2013;45(12):2314–21.  https://doi.org/10.1249/MSS.0b013e31829bc6ae.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Alonso AC, Greve JM, Camanho GL. Evaluating the center of gravity of dislocations in soccer players with and without reconstruction of the anterior cruciate ligament using a balance platform. Clinics (Sao Paulo). 2009;64(3):163–70.CrossRefGoogle Scholar
  60. 60.
    Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA. Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med. 2016;44(2):384–92.  https://doi.org/10.1177/0363546515623032.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Kamath GV, Murphy T, Creighton RA, Viradia N, Taft TN, Spang JT. Anterior cruciate ligament injury, return to play, and reinjury in the elite collegiate athlete: analysis of an NCAA Division I cohort. Am J Sports Med. 2014;42(7):1638–43.  https://doi.org/10.1177/0363546514524164.CrossRefGoogle Scholar
  62. 62.
    Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA. Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med. 2016;44(12):3083–94.  https://doi.org/10.1177/0363546516658041.CrossRefGoogle Scholar
  63. 63.
    Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med. 2007;35(4):564–74.CrossRefGoogle Scholar
  64. 64.
    Noyes FR, Barber-Westin SD. Prevention and treatment of knee arthrofibrosis. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 1059–102.CrossRefGoogle Scholar
  65. 65.
    Heckmann TP, Noyes FR, Barber-Westin SD. Rehabilitation after ACL reconstruction. In: ACL injuries in the female athlete. Causes, impacts, and conditioning programs. 2nd ed. New York: Springer; 2018. p. 505–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Timothy P. Heckmann
    • 1
    • 2
  • Frank R. Noyes
    • 3
  • Sue Barber-Westin
    • 3
    Email author
  1. 1.Jewish Hospital Orthopaedic Sports Medicine and RehabilitationCincinnatiUSA
  2. 2.Noyes Knee InstituteCincinnatiUSA
  3. 3.Cincinnati Sports Medicine and Orthopaedic CenterThe Noyes Knee InstituteCincinnatiUSA

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