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DOI: 10.1055/s-0037-1606617
Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction?
Publikationsverlauf
Publikationsdatum:
15. September 2017 (online)
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Abstract
Purpose The aim of this study was to assess the effect of knee bracing and timing of full weight bearing after anterior cruciate ligament reconstruction (ACLR) on functional outcomes at mid-term follow-up.
Methods We performed a retrospective study on 41 patients with ACLR. Patients were divided in two groups: ACLR group, who received isolated ACL reconstruction and ACLR-OI group who received ACL reconstruction and adjunctive surgery. Information about age at surgery, bracing, full or progressive weight bearing permission after surgery were collected for the two groups. Subjective IKDC score was obtained at follow-up. Statistical analysis was performed to compare the two groups for IKDC score. Subgroup analysis was performed to assess the effect of postoperative regimen (knee bracing and weight bearing) on functional outcomes.
Results The mean age of patients was 30.8 ± 10.6 years. Mean IKDC score was 87.4 ± 13.9. The mean follow-up was 3.5 ± 1.8 years. Twenty-two (53.7%) patients underwent ACLR only, while 19 (46.3%) also received other interventions, such as meniscal repair and/or collateral ligament suture. Analysis of overall data showed no differences between the groups for IKDC score. Patients in the ACLR group exhibited a significantly better IKDC score when no brace and full weight bearing after 4 weeks from surgery was prescribed in comparison with patients who worn a brace and had delayed full weight bearing. No differences were found with respect to the use of brace and postoperative weight bearing regimen in the ACLR-OI group.
Conclusion Brace and delayed weight bearing after ACLR have a negative influence on long-term functional outcomes. Further research is required to explore possible differences in the patients operated on ACLR and other intervention with respect to the use of a brace and the timing of full weight bearing to identify optimal recovery strategies.
Level of Evidence Level III, retrospective observational study.
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References
- 1 Lobb R, Tumilty S, Claydon LS. A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation. Phys Ther Sport 2012; 13 (04) 270-278
- 2 Hernández LM, Micheo WF, Amy E. Rehabilitation update for the anterior cruciate ligament injured patient: current concepts. Bol Asoc Med P R 2006; 98 (01) 62-72
- 3 Bowers AL, Spindler KP, McCarty EC, Arrigain S. Height, weight, and BMI predict intra-articular injuries observed during ACL reconstruction: evaluation of 456 cases from a prospective ACL database. Clin J Sport Med 2005; 15 (01) 9-13
- 4 Mohtadi NG, Chan DS, Dainty KN, Whelan DB. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 2011; 7 (09) CD005960
- 5 Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther 2012; 42 (07) 601-614
- 6 Negus J, Fransen M, Chen JS, Parker DA, March L. Exercise-based interventions for conservatively or surgically treated anterior cruciate ligament injuries in adults. Cochrane Database Syst Rev 2012; (10) CD010128
- 7 Trees AH, Howe TE, Grant M, Gray HG. WITHDRAWN: Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults. Cochrane Database Syst Rev 2011; 18 (05) CD005961
- 8 Makhni EC, Crump EK, Steinhaus ME. , et al. Quality and variability of online available physical therapy protocols from academic orthopaedic surgery programs for anterior cruciate ligament reconstruction. Arthroscopy 2016; 32 (08) 1612-1621
- 9 Kruse LM, Gray B, Wright RW. Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 2012; 94 (19) 1737-1748
- 10 Wright RW, Preston E, Fleming BC. , et al. A systematic review of anterior cruciate ligament reconstruction rehabilitation: part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. J Knee Surg 2008; 21 (03) 217-224
- 11 Wright RW, Preston E, Fleming BC. , et al. 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 (03) 225-234
- 12 Bordes P, Laboute E, Bertolotti A. , et al. No beneficial effect of bracing after anterior cruciate ligament reconstruction in a cohort of 969 athletes followed in rehabilitation. Ann Phys Rehabil Med 2017; 60 (04) 230-236
- 13 Mayr HO, Stüeken P, Münch EO. , et al. Brace or no-brace after ACL graft? Four-year results of a prospective clinical trial. Knee Surg Sports Traumatol Arthrosc 2014; 22 (05) 1156-1162
- 14 Lindström M, Wredmark T, Wretling ML, Henriksson M, Felländer-Tsai L. Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study. Knee 2015; 22 (06) 559-564
- 15 Wright RW, Fetzer GB. Bracing after ACL reconstruction: a systematic review. Clin Orthop Relat Res 2007; 455: 162-168
- 16 Zaffagnini S, Marcacci M, Lo Presti M, Giordano G, Iacono F, Neri MP. Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 2006; 14 (11) 1060-1069
- 17 Schulz AP, Lange V, Gille J. , et al. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months. Open Access J Sports Med 2013; 4 (04) 243-249
- 18 Lowe WR, Warth RJ, Davis EP, Bailey L. Functional bracing after anterior cruciate ligament reconstruction: a systematic review. J Am Acad Orthop Surg 2017; 25 (03) 239-249
- 19 Filbay SR, Ackerman IN, Russell TG, Macri EM, Crossley KM. Health-related quality of life after anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 2014; 42 (05) 1247-1255
- 20 LaPrade CM, Dornan GJ, Granan LP, LaPrade RF, Engebretsen L. Outcomes after anterior cruciate ligament reconstruction using the norwegian knee ligament registry of 4691 patients: how does meniscal repair or resection affect short-term outcomes?. Am J Sports Med 2015; 43 (07) 1591-1597
- 21 Glass R, Waddell J, Hoogenboom B. The effects of open versus closed kinetic chain exercises on patients with acl deficient or reconstructed knees: a systematic review. N Am J Sports Phys Ther 2010; 5 (02) 74-84
- 22 Uçar M, Koca I, Eroglu M. , et al. Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction. J Phys Ther Sci 2014; 26 (12) 1875-1878
- 23 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 (03) 153-171
- 24 Kim KM, Croy T, Hertel J, Saliba S. Effects of neuromuscular electrical stimulation after anterior cruciate ligament reconstruction on quadriceps strength, function, and patient-oriented outcomes: a systematic review. J Orthop Sports Phys Ther 2010; 40 (07) 383-391
- 25 Lepley LK, Wojtys EM, Palmieri-Smith RM. Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction. Knee 2015; 22 (03) 270-277
- 26 Imoto AM, Peccin S, Almeida GJ, Saconato H, Atallah ÁN. Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review. Sao Paulo Med J 2011; 129 (06) 414-423
- 27 Cooper RL, Taylor NF, Feller JA. A systematic review of the effect of proprioceptive and balance exercises on people with an injured or reconstructed anterior cruciate ligament. Res Sports Med 2005; 13 (02) 163-178
- 28 Ordahan B, Küçükşen S, Tuncay İ, Salli A, Uǧurlu H. The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction. J Back Musculoskeletal Rehabil 2015; 28 (03) 531-537
- 29 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 (01) 34-44
- 30 Kim DK, Hwang JH, Park WH. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction. J Phys Ther Sci 2015; 27 (09) 2693-2696
- 31 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 (06) 385-389