Rehab Centers: Open Kinetic Chain Exercises in a Restricted Range of Motion After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Clinical Trial.

Open Kinetic Chain Exercises in a Restricted Range of Motion After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Clinical Trial.

Filed under: Rehab Centers

Am J Sports Med. 2013 Feb 19;
Fukuda TY, Fingerhut D, Moreira VC, Camarini PM, Scodeller NF, Duarte A, Martinelli M, Bryk FF

BACKGROUND:Recent studies have shown that an early start of open kinetic chain (OKC) exercises for quadriceps strengthening in a full range of motion (ROM) could increase anterior knee laxity after anterior cruciate ligament (ACL) reconstruction with flexor tendons. However, there are no clinical trials that evaluated outcomes of OKC exercises in a restricted ROM for pain, function, muscle strength, and anterior knee laxity at 1 year after surgery. PURPOSE:To determine if an early start of OKC exercises for quadriceps strength in a restricted ROM would promote a clinical improvement without causing increased anterior knee laxity in patients after ACL reconstruction. STUDY DESIGN:Randomized controlled clinical trial; Level of evidence, 1. METHODS:A total of 49 patients between 16 and 50 years of age who underwent ACL reconstruction with semitendinosus and gracilis autografts were randomly assigned to an early start OKC (EOKC) exercise group or a late start OKC (LOKC) exercise group. The EOKC group (n = 25; mean age, 26 years) received a rehabilitation protocol with an early start of OKC (fourth week postoperatively) within a restricted ROM between 45° and 90°. The LOKC group (n = 24; mean age, 24 years) performed the same protocol with a late start of OKC exercises between 0° and 90° (12th week postoperatively). Quadriceps and hamstring muscle strength, 11-point numerical pain rating scale (NPRS), Lysholm knee scoring scale, single-legged and crossover hop tests, and anterior knee laxity were measured to assess outcomes at the 12-week, 19-week, 25-week, and 17-month postoperative follow-up (range, 13-24 months). RESULTS:No difference (P < .05) was noted between groups with respect to demographic data. Both groups (EOKC and LOKC) had a higher level of function and less pain at the 19-week, 25-week, and 17-month assessments when compared with 12 weeks postoperatively (P < .05). The EOKC group had improved quadriceps muscle strength at the 19-week, 25-week, and 17-month follow-up when compared with 12 weeks postoperatively (P < .05); the LOKC group showed improvement only at the 17-month postoperative assessment. However, the analysis between groups showed no difference for all pain and functional assessments, including anterior knee laxity (P > .05). CONCLUSION:An early start of OKC exercises for quadriceps strengthening in a restricted ROM did not differ from a late start in terms of anterior knee laxity. The EOKC group reached the same findings in relation to pain decrease and functional improvement when compared with the LOKC group but showed a faster recovery in quadriceps strength. The nonweightbearing exercises seem appropriate for patients who have undergone ACL reconstruction, when utilized in a specific ROM. The magnitude of difference in quadriceps strength between the 2 rehabilitation protocols was around 5%; however, this difference was not clinically significant, especially because both groups had equal function on the hop tests.
HubMed – rehab

Relationship Between Markers of Type II Collagen Metabolism and Tibiofemoral Joint Space Width Changes After ACL Injury and Reconstruction.

Filed under: Rehab Centers

Am J Sports Med. 2013 Feb 19;
Tourville TW, Johnson RJ, Slauterbeck JR, Naud S, Beynnon BD

BACKGROUND:Those who suffer anterior cruciate ligament (ACL) disruptions are at increased risk of experiencing posttraumatic osteoarthritis (OA); however, by the time they become symptomatic, irreversible damage has likely occurred. Little is known regarding the physiological changes in articular cartilage that occur after an ACL injury and the onset of OA. PURPOSE:To assess whether patient, functional, and clinical outcomes and type II collagen metabolism are associated with abnormal tibiofemoral joint space width (JSW) 4 years after injury and reconstruction. STUDY DESIGN:Cohort study; Level of evidence, 2. METHODS:A total of 35 ACL-injured patients who underwent ACL reconstruction were enrolled soon after injury, as were 32 matched controls. At baseline and 1- and 4-year follow-ups, patient-oriented subjective and objective outcomes and markers of type II collagen metabolism (considered as the ratio of cleavage to synthesis of type II collagen) were evaluated, as were radiographic measurements of JSW changes about the medial and lateral compartments of the knee. ACL-injured patients were divided into normal and abnormal JSW groups. RESULTS:Both ACL-injured groups (normal and abnormal JSW) had an increased ratio of collagen type I and II cleavage product (uC1,2C) to serum procollagen II C-propeptide (sCPII) compared with controls at 1- and 4-year follow-ups. Patients in the ACL group with an abnormal JSW difference had significantly increased cleavage-to-synthesis ratios of type II collagen (assessed as C-terminal cross-linked telopeptide of type II collagen [uCTX-II]/sCPII ratio) compared with controls at 4-year follow-up. ACL-injured patients with an abnormal JSW difference had significantly increased pain and decreased quality of life (Knee Injury and Osteoarthritis Outcome Score [KOOS]) scores than did ACL-injured patients with a normal JSW difference. CONCLUSION:ACL-injured patients with an abnormal tibiofemoral JSW had diminished quality of life, increased pain, and increased type II collagen uCTX-II/sCPII ratios compared with healthy controls. These changes occurred over an interval shortly after injury in patients who were fully functional and who had normal clinical examination findings, no pivoting/giving-way episodes, and no decrease in activity level.
HubMed – rehab

A novel method of using mini external fixator for maintaining web space after the release of contracture and syndactyly.

Filed under: Rehab Centers

Tech Hand Up Extrem Surg. 2013 Mar; 17(1): 37-40
Kamath JB, Vardhan H, Naik DM, Bansal A, Rai M, Kumar A

Syndactyly and postburn contracture of the digits are the common cases seen in a hand clinic. Their management can be roughly divided into 3 stages. In stage 1, syndactyly/postburn contracture of the digits are surgically released; in stage 2, surgical wound care is provided; and in stage 3, the patient undergoes physiotherapy (rehabilitation). The most common method of immobilizing the digit after the release is by plaster of Paris splints. Its demerit includes loss of correction, painful postoperative dressing, and suboptimal graft uptake due to improper immobilization and maceration. We describe a simple and effective method of mitigating the above-mentioned drawbacks using a mini external fixator, after the release of the contracted fingers. The use of this fixator also helps during the surgery (stage 1) as resurfacing of the raw areas becomes quick because 2 surgeons can perform this simultaneously. The web can be further opened up using the fixator to facilitate the suturing of the FTG/flap, after which it can be brought back to its normal position. As the dimension of the raw area created is fully defined it becomes easier to suture the flap/graft with appropriate tension and tie-over dressing. The postoperative dressings become easier and pain free. The maceration of the skin graft and skin margin is reduced as the compressive dressing can be applied to individual fingers rather than a collective dressing. It is advantageous even in stage 3 as it allows the surgeon to customize the splint for each finger.
HubMed – rehab

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