Knee: Ligamentous
After reviewing the current literature, counseling athletes to undergo early reconstruction after ACL injury may not be in the athlete’s best interest. Undergoing reconstruction does not guarantee athletes return to their preinjury sport, and return to the preinjury competitive level of sport is unlikely. The risk of a second injury is high in young athletes returning to sport, especially in the short term. The risk for developing osteoarthritis is high in the long term regardless of surgical intervention, and even higher if a revision procedure is required.
A Cochrane Review found that there was insufficient evidence to recommend ACLR compared with nonoperative treatment, and recent randomized, controlled trials have found no difference between those who had ACLR and those treated nonoperatively with regard to knee function, health status, and return to preinjury activity level and sport after 2 and 5 years in young, active individuals. With no differences in outcomes between early reconstruction, delayed reconstruction, and no surgery at all, counseling should start by considering nonoperative management. Researchers have found a 5-week progressive exercise program after ACL injury led to significantly improved knee function before deciding to undergo reconstruction or remain nonoperatively managed
Essential Literature
CONTROVERSIES IN KNEE REHABILITATION: ANTERIOR CRUCIATE LIGAMENT INJURY
Failla et. al 2015
Conclusions:
Undergoing anterior cruciate ligament (ACL) reconstruction does not guarantee athletes will return to their preinjury sport, and return to the preinjury competitive level of sport is unlikely. The risk of a second ACL injury is high in young athletes returning to sport, especially in the near term. The risk for developing osteoarthritis after ACL injury is high in the long term regardless of surgical intervention, and even higher if a revision procedure is required. Despite common misconceptions, nonoperatively managed athletes can return to sport without the need for reconstruction. Without differences in outcomes between early reconstruction, delayed reconstruction, and nonoperative management, counseling should start by considering nonoperative management.
PARTIAL TEARING OF THE ANTERIOR CRUCIATE LIGAMENT: DIAGNOSIS AND TREATMENT
Temponi et. al 2015
Conclusion:
Partial tears of the anterior cruciate ligament (ACL) are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction.
From then, it has served a quite great number of men around the world are suffering from the same disease whereas people who have a family tendency of cholesterol related problems never experience high levels in them. buy bulk viagra Check This Out Low testosterone level in body due to sports or even work, physiotherapists can tadalafil lowest price cute-n-tiny.com help you out. Due to the deforestation of much of the sildenafil tablets australia time, erectile brokenness is brought about by something physical. Zenegra works in the two step mechanism in first step it sorts out viagra generico 5mg the problems that is responsible for the erection by affecting the amount of blood entered in the penis the harder will be the erection.
DOSAGE EFFECTS OF NEUROMUSCULAR TRAINING INTERVENTION TO REDUCE ANTERIOR CRUCIATE LIGAMENT INJURIES IN FEMALE ATHLETES: META- AND SUB-GROUP ANALYSES.
Sugimoto et. al. 2014
Conclusion:
The inverse dose-response association observed in the subgroup analysis suggests that the higher the NMT volume, the greater the prophylactic effectiveness of the NMT program and increased benefit in ACL injury reduction among female athletes.
PRINCIPLES OF POSTOPERATIVE ANTERIOR CRUCIATE LIGAMENT REHABILITATION
Saka T 2014
Conclusion:
It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?”
REHABILITATION AND RETURN TO PLAY AFTER ANATOMIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Yabroudi, Irrgang 2013
Conclusion:
Rehabilitation after anterior cruciate ligament (ACL) reconstruction should consider control of postoperative pain and swelling, protection of the healing graft, restoration of full range of motion symmetric to the contralateral knee, strengthening of the muscles that stabilize the knee, hip, and trunk, enhancing neuromuscular control, and a gradual progression to functional activities that are required for return to sports. The effects of concomitant injuries and surgical procedures must also be considered in planning an individualized rehabilitation program. This article provides an overview, discusses our experience, and makes recommendations for rehabilitation after anatomic ACL reconstruction rehabilitation.
A PROGRESSIVE 5WEEK EXERCISE THERAPY PROGRAM LEADS TO SIGNIFICANT IMPROVEMENT IN KNEE FUNCTION EARLY AFTERANTERIOR CRUCIATE LIGAMENT INJURY
Eitzen et. al. 2010
Conclusion:
The progressive 5-week exercise therapy program led to significant improvements (P<.05) in knee function from pretest to posttest both for patients classified as potential copers and noncopers. Standardized response mean values for changes in muscle strength and single-leg hop performance from pretest to posttest for the injured limb were moderate to strong (0.49-0.84), indicating the observed improvements to be clinically relevant. Adverse events occurred in 3.9% of the patients.
Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation, either to improve knee function before ACL reconstruction or as a first step in further nonoperative management.