Introduction. Ruptures to the anterior cruciate ligament (ACL) are one of the most common debilitating knee injuries that can result in significant functional impairments (16). Reconstructive surgery of the ACL is encouraged as the treatment of choice, specifically for individuals who plan on returning to competitive sporting activities, or perform at extreme levels of physical activity. Some of the most vital and fundamental elements to producing a favorable outcome following ACL reconstructive surgery are the involvement in both preoperative and postoperative rehabilitation programs. The volume of literature that is generated reflects this notion as every year, various techniques and treatment protocols are employed during rehabilitation …show more content…
both before and after undergoing autograft ACL reconstruction. Although ACL damage frequently occurs in populations aged 15-45 years, it can occur in people of any age group (9). With roughly 200,000 injuries to the ACL occurring annually, and around 100,000 knees being reconstructed, developing efficient surgical procedures and therapeutic techniques to assist with recovery is integral (5,9). Anterior cruciate ligament surgery and rehabilitation has evolved drastically over the last few decades. This is mainly due to an overall increase in the number of clinicians participating in extensive clinical experience, improvements in surgical techniques, and a better understanding of how to properly rehab a patient back to full muscle functionality and range of motion. Clinicians are starting to change their approach from total immobilization and zero muscle activity prior to and post surgery, to minimal range of motion restrictions paired with prompt muscle activity and the utilization of weight-bearing exercises (3). Failure to institute early restoration of full joint movement and weight bearing can be the difference between a successful and unsuccessful surgery. It is of paramount importance for a patient to restore full ROM and near normal strength for the operation and accelerated rehabilitation. Doing so will benefit the knee in providing static and dynamic stability, and return to work, sports and daily living at an optimal level. The objective of this aim is to expedite the patient recovery process while establishing full strength and end range of motion (EROM) of the knee using an accelerated rehabilitation regimen against those matched controls for age, sex, race, etc., who use a non-accelerated rehabilitation regimen. To obtain this objective, I will test the hypothesis that administering an accelerated rehab program immediately after autograft ACL reconstruction will yield better results in regards to overall functionality of the knee, range of motion, joint stability, and the levels of strength compared bilaterally to the patients non-injured extremity. Accelerated rehabilitation of patients has been shown to give the best results as reported by De Carlo and Shelbourne and the Journal of Orthopedic and Sports Physical Therapy (8). Kevin E. Wilk, PT, DPT, as well as Shelbourne performed a novel study in which their patient populations within the ranges of 15-45 were put through a rehabilitation program that operated at an accelerated pace. As a result, they saw many functional improvements such as greater degrees of flexion and extension, increased gait and balance, and strength gains that were achieved at a faster rate (17). Justification and Feasibility. Traditional rehabilitation regimens post ACL reconstruction will typically span over a 9-12 month period (39-52 weeks) before patients achieve full ROM and fulfill the requirements that allow them to return to return to activity phase (14). Wilk suggests with literature and evidence that after receiving autograft ACL surgery, patients can develop full strength and functional ability within 16-24 weeks by using an accelerated approach and without damaging or loosening the graft. Shelbourne describes a strong correlation between postoperative accelerated rehabilitation programs and a highly successful clinical outcome. Due to the controversies surrounding accelerated ACL rehabilitation, and the concept of gaining complete knee extension/flexion, ROM, muscle strength, and ligament and joint stability researchers and clinicians felt justified in carrying out a study that compared traditional rehabilitation versus an accelerated approach. The overall objectives that were taken under consideration included nearly all aspects in regards to functionality of the knee (14). Many studies have placed patients recovering from ACL reconstruction on rehab regimens with the hope to improve various aspects concerned with how well and at what levels the knee can function. Treatment programs, accelerated or non-accelerated commonly encompass similar exercises and physical activity such as stretching, strength training, and activation of muscles through electrical stimulation. The intensity and general progression of therapy is where the two significantly contrast. With the use of weight bearing exercises, or strength training within the accelerated regimen, it has been proven to limit muscle weakness as a consequence of immobilization after surgery. Shelbourne carried out this method of intervention every week, 2-3 times per week, while progressively increasing weight and the degrees to which the knee was stretched. The results were assessed using The Cybex Isokinetic Device, a machine that tests the specific muscle strength at various joints (ankle, knee, hip, and shoulder) and showed that these patients regained strength much faster while performing better and with much more confidence within 3 months of rehabilitation. Using the accelerated program, patients performed at a mean value of 92.65% strength with their injured knee compared bilaterally to their uninjured knee. The traditional program showed a value of 79.40% strength with their injured knee, compared to the non-injured (8). Current accelerated programs have gradually changed over time in response to clinical observations and trends concerning ACL rehabilitation.
They permit immediate full weight bearing and restoration of full ROM after undergoing reconstruction. Rehab programs, however, still need to be progressed according to specific guidelines and parameters concerning the patient abilities. Patients participating in these programs progressed themselves faster through the protocols, and were actually gaining knee extension at much earlier periods despite the need to allow time for ligaments and collagen within the knee to heal before stressing the inserted graft. In addition, there were dramatic decreases in the number of surgical manipulations that would traditionally be required to achieve full ROM after the rehabilitation program began (8).
Using a Vibromyography (VMG) Transducer to Assess Quadriceps-Hamstring Activity Following ACL Reconstruction.
Figure 2. Simultaneous VMG recording from the left vastus lateralis and biceps femoris during squat exercise in individual with reconstructed ACL in right
…show more content…
knee. Vibromyography (VMG) transducers have been validated to accurately assess the rehabilitation progress of the quadriceps in all populations following ACL reconstruction (1).
Post operation on the ACL frequently results in inhibition of the quadriceps and significant amounts of atrophy that require prolonged rehabilitations in order to reverse. Before return to activity, an accurate assessment of the quadriceps muscle is critical. Traditional techniques will typically use Isokinetic Dynamometers; a machine designed to measure the muscle strength of the injured and uninjured knees. However, a researcher by the name of Lephart reported that the isokinetic strength test alone couldn’t suitably evaluate a patient’s ability to return to activity because they only measure the peak torque that the quadriceps muscle and knee has the potential to reach, and has no direct association to overall functional performance (1). Shown in Figure 2, is a simultaneous VMG recording of several muscles within the left quadriceps—left vastus lateralis and biceps femoris—during a squat exercise in a patient with a reconstructed ACL of the right knee. A greater level of muscle activity of the lateralis during quiet standing demonstrates that the patient is favoring the right leg. This figure depicts recordings from the left leg (uninjured leg) and demonstrates dominance of the left quadriceps muscle during the eccentric contraction phase (squatting down), with maintained balance during the concentric
phase (rising up). However, it is clear that the left quadriceps muscle does not shut off during the resting phase of the squat. This is ultimately indicative of the patient “blocking” or “protecting” the injured leg while in the resting phase. Figure 3. Simultaneous VMG recording from the right vastus lateralis and biceps femoris during squat exercise in individual with reconstructed ACL in right knee following six months of rehabilitation Figure 3 shows VMG recording of several muscles within the right quadriceps—right vastus lateralis and biceps femoris—during a squat exercise in a patient with a reconstructed ACL of the right knee following a six month period of rehabilitation. Recordings from this figure display partial inhibition of the quadriceps (lateralis muscle), predominantly evident during the eccentric contraction (squatting down), and also during concentric contraction (rising up), where the effort of the biceps femoris muscle group clearly surpasses the effort of the lateralis muscle group (1).
The incidence and prevalence rate of anterior cruciate ligament (ACL) injuries in female athletes continues to increase over time (Prodromos, Han, Rogowski, Joyce, & Shi, 2007). With the growing rate in the amount of young women participating in sports, data has shown that the rate of ACL injury increases linearly with this participation ("The Relationship Between Static Posture and ACL Injury in Female Athletes," 1996). This epidemic of ACL injuries in female athletes, young or old, continues to be problematic in the athletic world. This problem not only affects the athlete themselves, but also the coaches and the sports medicine community.
The anterior cruciate ligament (ACL) is one of the most important of your four major knee ligaments. The function of the ACL is to provide stability to the knee and minimize stress across the knee joint. It restrains excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur). It also limits rotational movements of the knee. “Greater external knee valgus and internal rotation moments have been shown to increase loading on the ACL in vitro and are thought to be associated with the increased risk of noncontact ACL injury” (Effects 2011). A tear to the anterior cruciate ligament results from overstretching of this ligament within the knee. It’s usually due to a sudden stop and twisting motion of the knee, or a “...
Tearing the ACL is now considered an epidemic in the United States over 100,000 recorded incidences are reported each year (Moeller). While such a finding may be good for orthopedic doctors and surgeons, this is not good for millions of athletes’ competing these days in high intensity sports. This is especially a problem for female athletes who are two to four times more likely to tear their ACL than men (Moeller). This is one of the biggest mysteries about ACL tears is the difference between the number of injuries seen in women and men. Women tend to tear there ACL far more frequently then men. While not everyone agrees that gender itself is the source of the problem, evidence is growing that females are learning too late that participating in sports can also become the first step to ruining an active lifestyle.
This case involved a 53 year old man who sustained a significant tear of his rotator cuff while playing baseball. He underwent surgical repair and was given a referral for physical therapy. The referral was to begin passive ROM 3 times per week for 2 weeks then initiate a supervised home program of active exercise for 2 weeks, and elastic resistance exercises for internal and external rotation every other day for a month. 2 weeks after surgery, he had his first PT visit in a sports medicine clinic that was managed by an athletic trainer (ATC).”
...is the only issue that they have to worry about. When a patient is able to walk for a specific period of time without pain then they can jog for the other 50% of the time. Progressing on through activities that require more strength for pushing off running is the next activity that is tested. Eventually a person can walk backwards and do patterned running such as figure 8’s, S’s and Z’s. Sports oriented rehab for ankles requires a little longer recovery time because their ankle must stand up to the forces that their sport demands. Such activities must take place under a trainer, coach, or physical therapist that is familiar with the sport. Activities whether they be every day or in a sport can be accompanied by ankle braces every often to add strength to the joint until strength is built up completely.
The most common knee injury in sports is damage to the anterior cruciate ligament (ACL) through tears or sprains. “They occur in high demand sports that involve planting and cutting, jumping with a poor landing, and stopping immediately or changing directions” (University of Colorado Hospital). The ACL is a ligament that runs diagonally in the middle of the knee and found at the front of the patellar bone. Its function involves controlling the back and forth motion of the knee, preventing the tibia from sliding out in front of the femur, and providing rational stability to the knee. Interestingly, women are more prone to ACL injuries than men. The occurrence is four to six times greater in female athletes.
In November of 2010, I was playing basketball in the fifth game of my senior season. It was just like any other game. However, I would soon find out otherwise. It was late in the game; I drove into the lane and got fouled hard. I was knocked so off-balance that I speared the floor with my knee. As soon as my knee hit the floor I heard a “snap” that I will never forget for the rest of my life. Little did I know at the time, that would be the last shot of my high school basketball career. Not long after my injury, I consulted a doctor. After getting an x-ray and an MRI, the doctor informed me that I had completely torn my ACL and would need to have surgery. An ACL tear can be a very devastating injury. The anterior cruciate ligament (ACL) is one of the four major ligaments within the knee. The ACL is one of the most commonly injured ligaments, injured by an estimated 200,000 patients each year. Of the 200,000 annual ACL injuries, surgery is performed in approximately 100,000 cases. There are many types of reconstructive surgery on the ACL. However, there is an alternative to surgery in the form of physical therapy.
(2014). Effects of Kinesiology Taping on Repositioning Error of the Knee Joint after Quadriceps Muscle Fatigue. Physical Therapy Science 26(6); 921-923.
Retrieved September 16, 2000 from: http://www. www.sechrest.com/mmg/knee/kneeacl.html. Arthroscopic ACL Reconstruction -. et al. (July 11, 1999).:Arthroscopy.com. Retrieved September 16, 2000 from: http://www.arthroscopy.com/sp05018.htm.
... This patient, after treatment, had completed ROM and was able to get back to daily activities (Papa 2012). GISTM has been shown to work on all types of injuries, whether the patient had surgery or not. GISTM is becoming a well-known tool in the clinical world and is a reason for faster recovery periods (Black 2010). Works Cited Black D. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique.
A 16-year-old, female high school soccer player, Lindsey Robinson, tore her anterior cruciate ligament (ACL) during a soccer game. Interestingly, she was not the only one in her team who injured her ACL, but several of her teammates have torn the same ligament as well during the soccer season. Lephart (2002) found that women involved in physical activity are more susceptible to acquiring the ACL injuries than men who are involved in the same physical activity (as cited in Ogden, 2002). According to “ACL Injury Prevention” (2004), the numbers of female ACL ruptures have increased for the past ten years. Over 1.4 million women have suffered from the ACL rupture, which is twice the rate of the previous decade.
The majority of ACL injuries suffered during athletic participation are of the noncontact variety. Three main noncontact mechanisms have been identified planting and cutting, straight-knee landing and one-step stop landing with the knee hyperextended. Pivoting and sudden deceleration are also common mechanisms of noncontact ACL injury. Basketball, soccer, and volleyball consistently produce some of the highest ACL injury rates across various age groups. Other activities with a high rate of injury are gymnastics, martial arts, and running. In most sports, injuries occur more often in games than in practice. Many injuries have occurred during the first 30 minutes of play. One-reason physicians are seeing more ACL injuries in female patients that more women play sports, and they play more intensely. But as they continued to do more studies, they are finding that women's higher rate of ACL is probably due ...
Orthopedic surgeons are responsible for mending and operating on the musculoskeletal system. “Orthopedics is a medical specialty that focuses on the diagnosis, care, and treatment of patients with disorders of the bones, joints, muscles, ligaments, tendons, nerves, and skin” (Career in Orthopaedics). Depending on the damage the patient has sustained determines how the orthopedic surgeon is able to correct the patient’s injury. In many cases there are multiple ways of correcting the patient’s injury such as; using medical, physical, and rehabilitative techniques to using complex surgical methods. “Typically, as much as 50 percent of the orthopedic surgeon’s practice is devoted to no surgical or medical management of injuries or disease and 50 percent to surgical management” (Career in Orthopaedics). The majority of surgeons, including orthopedic surgeons, prefer to choose the least invasive procedures such as; arthroscopy which is a technological advancement allowing orthopedic surgeons to use special cameras in order to diagnose and treat a joint with minimal cutting and trauma to...
The purpose of the squat is to train the muscles around the knees and hip joints, as well as to develop strength in the lower back, for execution of basic skills required in many sporting events and activities of daily living. Because a strong and stable knee is extremely important to an athlete or patient’s success, an understanding of knee biomechanics while performing the squat is helpful to therapists, trainers, and athletes alike (11). Because most activities of daily living require the coordinated contraction of several muscle groups at once, and squatting (a multi-joint movement) is one of the few strength training exercises that is able to effectively recruit multiple muscle groups in a single movement, squats are considered one of the most functional and efficient weight-bearing exercises whether an individual’s goals are sport specific or are for an increased quality of life
Traumatic injuries seem to occur a lot in the sport of football. Knee injuries seem to be one of the most occurring traumatic injuries in football (Become an Advocate for Sports Safety). The main types of traumatic knee injuries are: tearing/spraining of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and the meniscus, which is the cartilage that is in the knee (Become an Advocate for Sports Safety). The anterior cruciate ligament (ACL) is a very vital ligament in the knee. It is the main stabilizer of the knee. Surprisingly usually the anterior cruciate ligament is torn from a non-contact twisting of the knee (5 Most Common Football injuries (and How to Prevent Them)). The knee normally pops and it will begin to swell and it may feel unstable (5 Most Common Football injuries (and How to Prevent Them)). Swelling depends on the severity in the tear of the ligament. The anterior cruciate ligament is one of the four main ligaments that provide stability to the knee joint (Common Football Injuries). It is the most important out of the four. Injuries to any of the cruciate ligaments in the knee are most of the time sprains (Common Football Injuries). The anterior cruciate ligament being the most often stretched, strained, sprained or either tore (Common Football Injuries). Most of the knee injuries that occur in footbal...