Restricted accessResearch articleFirst published online 2019-5
Isokinetic knee strength and proprioception before and after anterior cruciate ligament reconstruction: A comparison between home-based and supervised rehabilitation
Rehabilitation after anterior cruciate ligament (ACL) reconstruction focuses on restoring knee deficiencies and function. However, the extent of the clinician’s direct supervision that is required to recover knee function is unknown.
OBJECTIVE:
To investigate differences in isokinetic knee strength improvement, endurance, and proprioception between home-based (HBR) and supervised rehabilitation (SR).
METHODS:
Thirty participants were randomly allocated to each group after reconstruction. Isokinetic knee strength and proprioception were measured using the Biodex multi-joint and stability systems, respectively, before and after intervention.
RESULTS:
The SR group showed a significant improvement from baseline, but not the HBR group (SR group, from 1.94 1.44 to 1.02 0.92, 0.05; HBR group, from 1.69 0.88 to 1.61 0.90, 0.05). There was a significant effect of exercise type on proprioception scores after controlling for pretest values ( 0.05). No significant difference in isokinetic knee strength was observed between the groups.
CONCLUSIONS:
HBR recovered knee strength as effectively as the SR, but SR was more effective than HBR for the recovery of proprioception and functional knee movement. This result indicates that guidance from health professionals play an important role in enhancing proprioception for patients following ACL reconstruction.
ClaytonRA. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008; 39(12): 1338-44.
2.
MosesBOrchardJOrchardJ. Systematic review: Annual incidence of ACL injury and surgery in various populations. Research in Sports Medicine. 2012; 20(3-4): 157-79.
3.
BeynnonBDJohnsonRJAbateJAFlemingBCNicolsCE. Treatment of anterior cruciate ligament injuries, part I. Am J Sport Med. 2015; 33(10): 1579-602.
4.
GohSBoyleJ. Self evaluation and functional testing two to four years post ACL reconstruction. Aust J Physiother. 1997; 43(4): 255-62.
5.
BarrackRLSkinnerHBBuckleySL. Proprioception in the anterior cruciate deficient knee. Am J Sport Med. 1989; 17(1): 1-6.
de JongSNvan CaspelDRvan HaeffMJSarisDB. Arthroscopy. 2007; 23(1): 1-11.
8.
EitzenIHolmIRisbergM. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009; 43(5): 371-6.
9.
ReiderBArcandMADiehlLHMroczekKAbulenciaAStroudCCPalmMGilbertsonJStaszakP. Proprioception of the knee before and after anterior cruciate ligament reconstruction. Arthroscopy. 2003; 19(1): 2-12.
10.
TsepisEVagenasGGiakasGGeorgoulisA. Hamstring weakness as an indicator of poor knee function in ACL-deficient patients. Knee Surg Sports Traumatol Arthrosc. 2004; 12(1): 22-9.
11.
WilliamsGNBuchananTSBarrancePJAxeMJSnyder-MacklerL. Quadriceps weakness, atrophy, and activation failure in predicted noncopers after anterior cruciate ligament injury. Am J Sport Med. 2005; 33(3): 402-7.
12.
WojtysEMHustonLJ. Longitudinal effects of anterior cruciate ligament injury and patellar tendon autograft reconstruction on neuromuscular performance. Am J Sport Med. 2000; 28(3): 336-44.
13.
CoppolaSMCollinsSM. Is physical therapy more beneficial than unsupervised home exercise in treatment of post surgical knee disorders? A systematic review. Knee. 2009; 16(3): 171-5.
14.
YabroudiMAIrrgangJJ. Rehabilitation and return to play after anatomic anterior cruciate ligament reconstruction. Clin Sports Med. 2013; 32(1): 165-75.
15.
Van GrinsvenSVan CingelRHollaCVan LoonC. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010; 18(8): 1128-44.
16.
BeynnonBDJohnsonRJNaudSFlemingBCAbateJABrattbaBNicholsCE. Accelerated versus nonaccelerated rehabilitation after anterior cruciate ligament reconstruction a prospective, randomized, double-blind investigation evaluating knee joint laxity using roentgen stereophotogrammetric analysis. Am J Sport Med. 2011; 39(12): 2536-48.
17.
GerberJPMarcusRLDibbleLEGreisPEBurksRTLaStayoPC. Effects of early progressive eccentric exercise on muscle size and function after anterior cruciate ligament reconstruction: A 1-year follow-up study of a randomized clinical trial. Phys. Ther. 2009; 89(1): 51-9.
18.
ShelbourneKDNitzP. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sport Med. 1990; 18(3): 292-9.
GrantJAMohtadiNGMaitlandMEZernickeRF. Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction: A randomized clinical trial. Am J Sport Med. 2005; 33(9): 1288-97.
21.
BeardDJDoddCA. Home or supervised rehabilitation following anterior cruciate ligament reconstruction: A randomized controlled trial. J Orthop Sports Phys Ther. 1998; 27(2): 134-43.
22.
De CarloMSSellKE. The effects of the number and frequency of physical therapy treatments on selected outcomes of treatment in patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 1997; 26(6): 332-9.
23.
ParkJHJeongWKLeeJHChoJJLeeDH. Postural stability in patients with anterior cruciate ligament tears with and without medial meniscus tears. Knee Surg Sports Traumatol Arthrosc. 2015; 23(1): 240-5.
24.
BottaroMRussoAFOliveiraRJ. The effects of rest interval on quadriceps torque during an isokinetic testing protocol in elderly. J Sports Sci Med. 2005; 4(3): 285-90.
25.
DrouinJMValovich-mcLeodTCShultzSJGansnederBMPerrinDH. Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol. 2004; 91(1): 22-9.
26.
SchmitzRArnoldB. Intertester and intratester reliability of a dynamic balance protocol using the Biodex Stability System. J Sport Rehabil. 1998; 7(2): 95-101.
HinmanMR. Factors affecting reliability of the Biodex Balance System: A summary of four studies. Journal of Sport Rehabilitation. 2000; 9(3): 240-52.
29.
KarimiNEbrahimiIKahriziSTorkamanG. Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pakistan Journal of Medical Sciences. 2008; 24(3): 372-7.
30.
GrantJAMohtadiNG. Two-to 4-year follow-up to a comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction. Am J Sport Med. 2010; 38(7): 1389-94.
31.
EkdahlCBromanG. Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: A comparative study with healthy subjects. Ann Rheum Dis. 1992; 51(1): 35-40.
32.
BicerEKLustigSServienESelmiTASNeyretP. Current knowledge in the anatomy of the human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2010; 18(8): 1075-84.
33.
NorwoodLACrossMJ. Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities. Am J Sport Med. 1979; 7(1): 23-6.
34.
AgebergEZätterströmRMoritzUFridénT. Influence of supervised and nonsupervised training on postural control after an acute anterior cruciate ligament rupture: A three-year longitudinal prospective study. J Orthop Sports Phys Ther. 2001; 31(11): 632-44.
35.
DanielDMStoneMLDobsonBEFithianDCRossmanDJKaufmanKR. Fate of the ACL-injured patient a prospective outcome study. Am J Sport Med. 1994; 22(5): 632-44.
36.
EkdahlC. Postural control, muscle function and psychological factors in rheumatoid arthritis: Are there any relations? Scand J Rheumatol. 1992; 21(6): 297-301.
37.
FitzgeraldGK. Open versus closed kinetic chain exercise: Issues in rehabilitation after anterior cruciate ligament reconstructive surgery. Phys. Ther. 1997; 77(12): 1747-54.
