Summary

Exceptional measures related to the COVID-19 led to the stop of rehabilitation with physiotherapist after ACLR changing the postoperative social habits and leading to self-guided rehabilitation with a significant increase of the rate of cyclops syndrom.

Abstract

Introduction

After Anterior Cruciate Ligament Reconstruction (ACLR), complete extension should be recovered before the 6th week otherwise the risk of cyclop syndrome is significantly increased. The COVID 19 pandemic has led to a lockdown and to the absence of supervised rehabilitation with physiotherapist for several weeks, requiring self-made rehabilitation for patients operated just before this lockdown. The hypothesis was that the rate of cyclops syndrom increased during the lockdown with self-guided rehabilitation with a significant increase of the anterior arthrolysis rate.

Methods

A COVID series cohort of 72 patients operated with hamstrings graft for ACLR between February 10 and March 16, 2020 had a part of the rehabilitation of the first 6 postoperative weeks done during the lockdown with videos on a dedicated website. A clinical examination was performed at a minimum follow-up of 1 year with analysis of the range of motion, IKDC, Lysholm, Tegner and ACL-RSI scores. This series was compared to a matched-paired control cohort of 72 patients operated in 2019 with a complete classical postoperative supervised-rehabilitation with a physiotherapist.

Results

In the COVID series, mean follow-up was 14,5 months, rate of second surgery for clinical cyclops syndrom was 11,1% (8 patients). The rate was 1,4% in the control series with a statistical difference (p=0,01). In the COVID series, anterior arthrolysis was done with a mean delay of 8,6 months after the primary surgery, four patients had another surgery (3 for meniscal procedure, one for device removal). Mean Lysholm was 86,6 ± 14,1 (range, 38-100); Tegner was 5,6 ± 2,3 (range 1-10); Subjective IKDC was 80,3 ± 14,7 (range 33-100) and RSI-scale was 77,3 ± 19,4 (range 33-100) in the COVID series.

Conclusion

Exceptional measures related to the COVID-19 led to the stop of rehabilitation with physiotherapist after ACLR changing the postoperative social habits and leading to self-guided rehabilitation with a significant increase of the rate of cyclops syndrom. The dedicated website wasn’t enough efficient to support unexpected self-guided rehabilitation. Self-guided rehabilitation could benefit of improvement of interactive that must be at least as effective as supervised-rehabilitation methods.