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Early ROM exercise after ACLR with hamstring autograft does not cause joint laxity : A Prospective Randomized Controlled Trial, 2 years follow up


Jeong-Ku Ha, MD, phD, Prof
KOREA, REPUBLIC OF

Early ROM exercise after ACLR with hamstring autograft does not cause joint laxity : A Prospective Randomized Controlled Trial, 2 years follow up

Jeong-Ku Ha, MD, phD, Prof, KOREA, REPUBLIC OF Kyu Sung Chung, MD, PhD, Prof., KOREA, REPUBLIC OF

Seoul Paik Hospital, Inje University, Seoul, KOREA, REPUBLIC OF

2021 Congress   ePoster Presentation     rating (1)

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Instability

Treatment / Technique

Repair / Reconstruction Arthroscopy Autograft Single Bundle

Ligaments

ACL

Diagnosis Method

Physical Examination MRI

Sports Medicine

Rehabilition / Physical Therapy Evidence Based Medicine

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Summary: Early ROM exercise after ACLR with hamstring autograft does not cause harmful effect on joint

Background

There is no consensus regarding the optimal time to start rehabilitation after anterior cruciate ligament reconstruction (ACL-R). Graft motions within the bone tunnel can cause windshield-wiper-effect and bungee-effect and their relation to accelerated rehabilitation is not yet studied.

Purpose

To prospectively evaluate role of accelerated rehabilitation in clinical and radiologic changes including tunnel sizes on femur and tibia, following ACL-R using hamstring graft.
STUDY DESIGN:
Randomized controlled trial(RCT); Level of evidence, 1.

Methods

Thirty eight patients who had a primary ACL-R with a semitendinosus tendon autograft from a single orthopaedic surgeon were prospectively randomized into 2 groups; early group initiates rehabilitation in 3 days after the surgery and delayed group initiates the rehabilitation after 3 weeks of the surgery. Each patient underwent clinical evaluation(VAS score, Pivot shift test, Anterior drawer test, KT2000, range of motion, complications etc.) and radiologic evaluation(tibial and femoral tunnel size on plain knee x-ray and knee three dimensional CT) at scheduled manner on 3, 6, 12, 24 weeks, 1 year, 2 years. The tunnel widening was measured at the three points on each image of x-ray and CT(Aperture, mid-point and end-point of tunnel from articular side).

Results

Thirty eight patients (including 25 males), mean age 27.5±8.56 years, BMI 24.1±0.5 underwent ACL-R. There were significant differences between two groups in ROM at POD 3 weeks(119.89 versus 55.53, p<0.0001), POD 6 weeks(131.88 versus 108.61, p<0.0001), Tegner score at POD 12 weeks(19.80 versus 12.44, p=0.024). Three patients(16%) in delayed group but no one in the early group showed severe stiffness at POD 6 weeks and underwent brisement under anesthesia. There was no difference in joint laxity measured by KT-2000. Tunnel sizes showed gradual increase as time passes but did not present any differences between two groups. Other clinical scores including VAS score, Pivot shift test grade, one-hop test, vertical-hop test, isokinetic muscle strength, IKDC score and Lysholm score also showed no significant differences between two groups.

Conclusion

There is no difference in joint laxity and other clinical and radiological results with early rehabilitation after ACL-R compared to delayed rehabilitation during 2 years follow up, except limitation of motion found in some patients of delayed group at early follow up period.

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