Anterior Cruciate Ligament Injury Rehabilitation in Athletes
Tóm tắt
Postoperative rehabilitation is a major factor in the success of an anterior cruciate ligament (ACL) reconstruction procedure. Clinical investigations of patients after ACL reconstruction have shown that immobilisation of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the articular, ligamentous, and musculature structures that surround the knee. Early joint motion is beneficial for; reducing pain, capsular contractions, articular cartilage, and for minimising scar formation that limit joint motion. These findings, combined with graft materials that have biomechanical properties similar to the normal ACL, and adequate fixation strength, have led many to recommend aggressive rehabilitation programmes that involve contraction of the dominant quadriceps muscles. Recently, a prospective, randomised study of rehabilitation following ACL reconstruction has presented evidence that a closed kinetic chain exercise programme (foot fixed against a resistance) results in anterior-posterior knee laxity values that are similar to the contralateral normal knee. Also, open kinetic chain exercises (foot not fixed against a resistance) result in increased anterior-posterior knee laxity compared with the normal knee. Criteria must be observed because the relationship between rehabilitation exercises and the healing response of an ACL graft is unknown at present. Biomechanical studies of healing ACL grafts performed in animals have shown that the graft requires a long time to revascularise and heal, and that the biomechanical behaviour of the graft never returns to normal. Functional knee braces provide a protective strain-shielding effect on the ACL when anterior shear loads and internal torques are applied to the knee in the non-weight-bearing condition. However, the strain shielding effect of functional braces decrease as the magnitude of anterior shear and internal torque applied to the knee increase. Future studies should strive to determine the actual loads transmitted across the knee and ACL graft strain during various rehabilitation exercises and relate these to the healing response of the knee and graft.
Tài liệu tham khảo
Buckwalter JA. Activity vs rest in the treatment of bone, soft tissue and joint injuries. Iowa Orthop J 1995; 15: 29–42
Paulos L, Noyes FR, Grood ES, et al. Knee rehabilitation after anterior cruciate ligament reconstruction and repair. Am J Sports Med 1981; 9: 140–9
Steadman JR. Rehabilitation of acute injuries of the anterior cruciate ligament. Clin Orthop 1983; 172: 129–32
Akeson WH, Amiel D, Woo SL-Y. Immobility effects on synovial joints. The pathomechanics of joint contracture. Biorheology 1980; 17: 95–110
Haggmark T, Erickson E. Cylinder or mobile cast brace after knee ligament surgery: a clinical analysis and morphological and enzymatic study of changes in quadriceps muscle. Am J Sports Med 1979; 7: 48–56
Jozsa L, Jarvinen M, Kannus P, et al. Fine structural changes in the articular cartilage of the rat’s knee following short-term immobilization in various positions: a scanning electron microscopical study. Int Orthop 1987; 11: 129–33
Jozsa L, Reffy A, Jarvinen M, et al. Cortical and trabecular osteopenia after immobilization — a quantitative histological study in rats. Int Orthop 1988; 12: 169–72
Jozsa L, Thöring J, Jarvinen M, et al. Quantitative alterations in intramuscular connective tissue following immobilization: an experimental study in rat calf muscle. Exp Mol Pathol 1988; 49: 267–78
Kennedy JC. Symposium: current concepts in the management of knee instability. Contemp Orthop 1982; 5: 59–78
Noyes FR. Functional properties of knee ligaments and alterations induced by immobilization. Clin Orthop Rel Res 1977; 123: 210–42
Noyes FR, Mangine RE, Barber S. Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 1987; 15: 149–60
Shelbourne KD, Nitz P. Accelerated rehabilitation after ACL reconstruction. Am J Sports Med 1990; 18: 292–9
MacDonald PB, Hedden D, Pacin O, et al. Effects of accelerated rehabilitation programs after anterior cruciate ligament reconstruction with combined semitendinosus-gracilis autograft and a ligament augmentation device. Am J Sports Med 1995; 23: 588–92
Shelbourne DK, Klootwyk TE, Wilckens JH, et al. Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program. Am J Sports Med 1995; 23: 575–9
Beynnon BD, Fleming BC, Johnson RJ, et al. Anterior cruciate ligament strain behavior during rehabilitation exercises in-vivo. Am J Sports Med 1995; 23: 24–34
Draganich LF, Vahey JW. An in-vitro study of anterior cruciate ligament strain induced by quadriceps and hamstrings forces. J Orthop Res 1990; 8: 57–63
Henning CE, Lynch MA, Glick KR. An in-vivo strain gage study of elongation of the anterior cruciate ligament. Am J Sports Med 1985; 13: 22–6
Jurist KA, Otis JC. Anteroposterior tibiofemoral displacements during isometric extension efforts. The role of external load and knee flexion angle. Am J Sports Med 1985; 13: 254–8
Lutz GE, Palmitier RA, An KN, et al. Comparison of tibiofemoral forces during open-kinetic chain and closed-kinetic chain exercises. J Bone Joint Surg Am 1993; 75: 732–9
Shoemaker SC, Markolf KL. Effects of joint load on the stiffness and laxity of ligament deficient knees. J Bone Joint Surg Am 1985; 67: 136–46
Yack HJ, Collins CE, Whieldon TJ. Comparison of closed and open kinetic chain exercises in the anterior cruciate ligament deficient knee. Am J Sports Med 1993; 21: 49–54
Bell C. On the nervous circle which connects the voluntary muscles with the brain. Philos Trans R Soc Lond B 1826; 116: 163–73
Sherrington CS. The integrative action of the nervous system. London: Constable, 1906
Barrett DS. Proprioception and function after anterior cruciate econstruction. J Bone Joint Surg Br 1991; 73: 833–7
Barrack RL, Skinner HB, Buckley SL. Proprioception in the anterior cruicate deficient knee. Am J Sports Med 1989; 17: 1–6
Good L, Beynnon BD, Gottlieb DJ, et al. Joint position sense is not changed after ACL disruption [abstract]. Trans Orthop Res Soc 1995; 20(1): 95
Corrigan JP, Cashman WF, Brady MP. Proprioception in the cruciate deficient knee. J Bone Joint Surg Br 1992; 74: 247–50
Klein BP, Blaha JD, Simons W. Anterior cruciate deficient knees do not have altered proprioception [abstract]. Orthop Trans 1992; 16: 539
Beard DJ, Kyberd PJ, Fergusson CM, et al. Proprioception after rupture of the anterior cruciate ligament. An object indication for the need for surgery? J Bone Joint Surg Br 1993; 75: 311–5
Jennings AG, Seedholm BB. Proprioception in the knee and reflex hamstrings contraction. J Bone Joint Surg Br 1994; 76: 491–4
Beynnon BD, Gottlieb D, Elmqvist L-G, et al. The latency of reflex muscle contraction in normal and anterior cruciate ligament deficient subjects. Orthop Trans 1994; 8(2): 450–1
Wojtys EM, Huston LJ. Neuromuscular performance in normal and anterior cruciate ligament deficient lower extremities. Am J Sports Med 1994; 22: 89–104
Newton PO, Horibe S, Woo SL-Y. Experimental studies of anterior cruciate ligament autografts and allografts. In: Daniel DM, Akeson WH, O’Conner JJ, editors. Knee ligaments: structure, function, injury and repair. New York: Raven Press, 1990: 389–9
Beynnon BD, Johnson RJ, Fleming BC, et al. The measurement of elongation of anterior cruciate grafts in-vivo. J Bone Joint Surg Am 1994; 76: 520–31
Beynnon BD, Pope MH, Wertheimer CM, et al. The effect of functional knee-braces on strain on the anterior cruciate ligament in-vivo. J Bone Joint Surg Am 1992; 74: 1298–312
Arms SW, Donnermeyer D, Renström P, et al. The effect of knee braces on anterior cruciate ligament strain [abstract]. Trans Orthop Res Soc 1987; 12: 245
Butler DL, Grood ES, Noyes FR, et al. Mechanical properties of primate vascularized vs nonvascularized patellar tendon grafts: changes over time. J Orthop Res 1989; 7: 68–79
Bailock RT, Woo SL-Y, Lyon RM, et al. Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: a long term histological and biomecanical study. J Orthop Res 1989; 7: 474–85
Jackson DW, Grood ES, Cohn BT, et al. The effect of in-situ freezing of the anterior cruciate ligament. J Bone Joint Surg Am 1991; 73: 201–13
Beynnon BD, Johnson RJ, Tohyama H, et al. The relationship between anterior-posterior knee laxity and the structural properties of the patellar tendon graft. A study in canines. Am J Sports Med 1994; 22: 812–20
Glasgow SG, Gabriel JP, Sapega AA, et al. The effect of early versus late return to vigorous activities on the outcome of anterior cruciate reconstruction. Am J Sports Med 1993; 21: 243–8
Barber-Westin SD, Noyes FR. The effect of rehabilitation and return to activity on anterior-posterior knee displacements after anterior cruciate ligament reconstruction. Am J Sports Med 1993; 21: 264–70
Rosen MA, Jackson DW, Atwell EA. The efficacy of continuous passive motion in the rehabilitation of anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20: 122–7
Richmond JC, Gladstone J, MacGillivray J. Continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: comparison of short-versus long-term use. J Arthroscop Rel Res 1991; 7: 39–44
Bynum EB, Barrack RL, Alexander AH. Open versus closed kinetic chain exercises after anterior cruciate ligament reconstruction. Am J Sports Med 1995; 23: 401–6