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Document Title: Beynnon-AJSM-Mar05.shtml
Article Title: Rehabilitation After Anterior Cruciate Ligament Reconstruction -- A Prospective, Randomized, Double-Blind Comparison of Programs Administered Over 2 Different Time Intervals
Authors: Bruce D. Beynnon, PhD, Benjamin S. Uh, MD, Robert J. Johnson, MD, Joseph A. Abate, MD, Claude E. Nichols, MD, Braden C. Fleming, PhD, A. Robin Poole, PhD, DSc and Harald Roos, MD, PhD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: March 2005
Volume 33, pages 347-359
Keywords: ACL reconstruction, rehabilitation, protocol, post-operative, return-to-activities training, ligamentization, revascularization.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: The authors found that delayed and accelerated ACL-reconstruction-rehabilitation protocols both bring good results. However, they looked for more than just the improvement in knee stability, and delved into the issue of long-term effects on articular cartilage. They noted with concern that the levels of articular-cartilage biomarkers remained elevated for extended periods; this is something which merits further investigation. But the elevated biomarkers do indeed confirm that an ACL-injury history has a major impact on articular cartilage.
ABSTRACT
Background: There are adverse effects associated with immobilization of the knee after anterior cruciate ligament reconstruction, yet very little is known about how much activity will promote adequate rehabilitation without permanently elongating the graft, producing graft failure, or creating damage to articular cartilage.
Hypothesis: Rehabilitation with either an accelerated or nonaccelerated program produces no difference in anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and the synovial fluid biomarkers of articular cartilage metabolism.
Study Design: Randomized controlled clinical trial; Level of evidence, 1.
Methods: Twenty-five patients who tore their anterior cruciate ligament were enrolled and underwent anterior cruciate ligament reconstruction. Patients were randomized to accelerated rehabilitation or nonaccelerated rehabilitation. At the time of surgery and 3, 6, 12, and 24 months later, measurements of anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and cartilage metabolism were completed.
Results: At the 2-year follow-up, there was no difference in the increase of anterior knee laxity relative to the baseline values that were obtained immediately after surgery between the 2 groups (2.2-mm vs 1.8-mm increase relative to the normal knee). The groups were similar in terms of clinical assessment, patient satisfaction, activity level, function, and response of the bio-markers. After 1 year of healing, synthesis of collagen and turnover of aggrecan remained elevated in both groups.
Conclusion: Anterior cruciate ligament reconstruction with a bone–patellar tendon–bone graft followed by either accelerated or nonaccelerated rehabilitation produces the same increase of anterior knee laxity. Both programs had the same effect in terms of clinical assessment, patient satisfaction, functional performance, and the biomarkers of articular cartilage metabolism. There is concern that the cartilage biomarkers remained elevated for an extended period.
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