Anterior Cruciate Ligament (ACL) Rehabilitation: Difference between revisions

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=== Before surgery  ===
<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
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RICE and electrotherapy can be applied during several weeks ahead of the surgery in order to reduce swelling and pain, to attempt full range of motion and to decrease joint effusion. This will help the patient to regain better motion and strentgh after the surgery.<ref name="Vijf">I Eitzen, H Moksnes, L Snyder-Mackler, MA Risberg. Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. Journal of Orthopaedic and Sports Physical Therapy 2010;40(11):705-722</ref>  
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== Search Strategy  ==


Therapy pre-ops can encourage strengthening of the quadriceps and hamstrings. Range of motion exercises should be included if there is no pain involved.<ref name="Negen">S. van Grinsven, R. E. H. van Cingel, C. J. M. Holla, C. J. M. van Loon. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18:1128–1144</ref><ref name="Elf">Savio L-Y. Woo, Richard E. Debski, PhD, John D. Withrow, Marsie A. Janaushek. Biomechanics of Knee Ligaments. The American Journal of Sports medicine 1999;27:533</ref>  
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[[Neuromuscular Electrical Stimulation|NMES]] combined with exercise is more effective in improving quadriceps&nbsp;strength than exercise alone<ref name="Kyung-Min">Kyung-Min KiM, Ted Croy, Jay HerTel, SuSan Saliba. 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(7):383-391.</ref>.
== Definition/Description  ==


=== After surgery  ===
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*Week 1
== Clinically Relevant Anatomy  ==


Regular icing and elevation are used to reduce swelling. The goal is full extension and 70 degrees of flexion by the end of the first week. The use of a knee brace and crutches are imperative.
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Multidirectional mobilizations of the patella should be included for at least 8 weeks. Other mobilization exercises in the first 4 weeks are passive extension of the knee (no hyperextension) and passive and active mobilization towards flexion. Strenthening exercises for the calf muscle, hamstring and quadriceps (vastus medialis) can be performed.
== Epidemiology /Etiology  ==


*Week 3-4
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The patient must trie to genuinely increase the stance phase in an attempt to walk with one crutch. With good hamstring/quadriceps control, the use of crutches can be reduced earlier.
== Characteristics/Clinical Presentation  ==


*Week 5
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The use of the knee brace is progessively reduced.<ref name="Vijf" /><ref name="Negen" /> Passive mobilizations should normalize motility but flexion should not yet be thorough. 9 Tonification of hamstrings and quadriceps (vastus medialis) can start in close chain exercises. The exercises should be started on light intensity (50% of maximum force) and progressively increased to 60-70%. The closed chain exercises should be built from less responsible positions (bike, leg presses, step) to more congested starting positions (ex.squad). The progress of the exercise depends on pain, swelling and quadriceps control. Proprioception and coordination exercises can start if the general strength is good. This includes balance exercises on boards and toll.
== Differential Diagnosis  ==


*Week 10
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Forward, backward and lateral dynamic movements can be included as well as isokinetic exercises.<ref name="Negen" />
== Diagnostic Procedures  ==


*Month 3
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After 3 months, patient can move on to functional exercises as running and jumping. As proprioceptive and coordination exercises become heavier, quicker changes in direction are possible. To stimulate coordination and control through afferent and efferent information processing, exercises should be enhanced by variation in visible input, surface stability (trampoline), speed of exercise performance, complexity of the task, resistance, one or two-legged performance, etc.<ref name="Negen" />
== Outcome Measures ==


*Month 4-5
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Final goal is to maximize endurance and strength of the knee stabilizers, optimize neuromuscular control with plyometric exercises and to add the sport-specific exercises. Acceleration and deceleration, variations in running and turning and cutting manoeuvers improve arthrokinetic reflexes to prevent new trauma during competition.<ref name="Elf">Arna Risberg, Inger Holm. The Long-term Effect of 2 Postoperative Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction A Randomized Controlled Clinical Trial With 2 Years of Follow-Up. The American Journal of Sports medicine 2009; 37: 1958</ref>
== Examination  ==


*Return to sport
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[http://thejacksonclinics.com/wp-content/uploads/2012/01/20110531_June2011PerspectivesforPatients.pdf When Should an Athlete Return to Sport After an ACL Surgery?]
== Medical Management <br>  ==


== Accelerated Rehab Program  ==
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[http://www.kneeclinic.info/rehab_markdecarlo.php Accelerated ACL Reconstruction Rehabilitation Program]
== Physical Therapy Management <br>  ==


==Adjuncts ==
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NMES -&nbsp;Neurotech's Kneehab XP Quadriceps Therapy System has been shown to significantly improve rehab following ACL reconstruction<ref name="Kneehab">Sven Feil, John Newell, Conor Minogue and Hans H. Paessler. [http://ajs.sagepub.com/content/early/2011/02/20/0363546510396180.full.pdf+html?ijkey=28W1kfCXExivc&amp;amp;amp;amp;keytype=ref&amp;amp;amp;amp;siteid=amjsports 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 February 22, 2011</ref>.
== Key Research  ==
 
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== Resources <br>  ==
 
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== Clinical Bottom Line  ==
 
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
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== References  ==
 
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Revision as of 16:13, 17 March 2012

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy[edit | edit source]

add text here related to databases searched, keywords, and search timeline

Definition/Description[edit | edit source]

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Clinically Relevant Anatomy[edit | edit source]

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Epidemiology /Etiology[edit | edit source]

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Characteristics/Clinical Presentation[edit | edit source]

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Differential Diagnosis[edit | edit source]

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Diagnostic Procedures[edit | edit source]

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Outcome Measures[edit | edit source]

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Examination[edit | edit source]

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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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