Clinical and functional outcomes of anterior cruciate ligament reconstruction and rehabilitation

Author: BADIU ANCUTA DIANACo-author: MACEC ADELINAScientifics coordinator: Lecturer RUSSU OCTAV MD,PHD Universitatea de Medicina si Farmacie Targu Mures

Introduction

The anterior cruciate ligament originates from the medial and anterior aspect of tibial plateau and runs superiorly, laterally and posteriorly toward its insertion on the lateral femoral condyle.

It provide 85% of total restraining force of anterior translation and prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses.

Introduction

Introduction

The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. In the United States (US) there are between 100,000 and 200,000 ACL ruptures per year, with an annual incidence in the general population of approximately 1 in 3500, although the actual incidence may be higher .

Introduction

There are four clasic symptoms : 1. hear a pop from inside the knee 2. feel the knee give away at the time of injury 3. swollen immediately or within a few hours 4. severe pain can not continue play

All patients were operated using single bundle ACL reconstruction technique and the rehabilitation protocol was identical to all of them.

The Aim of The Study :

The aim of this study is to demonstrate the clinical and functional outcomes of ACL reconstruction and rehabilitation. 

Material and method:

47 patients 18 females

29 males aged between 13-59 (mean age 27.4) treated at Orthopaedics and

Traumatology Clinc II in Târgu Mureș

March 2012 – May 2013

Results and discussions : Average score before andafter the sugery

  BEFORE AFTER

Number of values 47 47

Minimum 21,00 69,00

25% Percentile 43,00 85,00

Median 51,00 90,00

75% Percentile 60,00 99,00

Maximum 74,00 100,0

Mean 51,34 90,00

Std. Deviation 13,47 7,457

p-0.0001

0

50

100

150

51.34

90.00

Results and discussions :The score before surgery

65-83 10 21,3%

<65 37 78,7%

Total 47 100.0%

Codes X  before surgery

65-83< 65

Results and discussions :

The score after the surgery

65-83 7 14,9%

84-94 27 57,4%

95-100 13 27,7%

Total 47 100.0%

Codes X  After surgery

65-83

84-94

95-100

Results and discussions :

1. Limp

Before surgery After surgery

None - 91,5%

Slight or periodical

66% 8,5%

Severe and constant

34%

Before surgery After surgery

None 80,2 % 100%

Stick or crutch 29,8% -

Weight bearing impossible

-

2. Support

Results and discussions :

3. Pain

Before surgery After surgery

None - 34%

Inconstant and slight during severe exertion 12,8% 63,8%

Marked during severe exertion 36,2% 2,1%

Marked on or after walking more then 2 km 36,2% -

Marked on or after walking less then 2 km 14,9% -

Constant - -

Results and discussions :

4. Instability

Before surgery After surgery

Never giving way - 75,5%

Rarely during athletics or other severe exertion

34% 25,5%

Frequently during athletics or other severe exertion 

36,2% -

Occasionally in daily activities 29,8% -

Often in daily activities - -

Every step - -

Results and discussions :

5. Locking

Before surgery After surgery

No locking and no catching sensations

0 51,1%

Catching sensation but no locking

19,1% 48,9%

Locking occasionally 63,8% 0

Frequently 17% 0

Locked joint on examination 0 0

Results and discussions :

Before surgery After surgery

None 0 51,1%

On severe exertion 53,2% 44,7%

On ordinary exertion 44,7% 4,2%

Constant 2,1% 0

6. Swelling

Results and discussions :

7. Stair-climbing

Before surgery After surgery

No problems 4,3% 97,9%

Slightly impaired 91,5% 2,1%

One step at a time 4,3% 0

Impossible 0 0

Results and discussions :

Before surgery After surgery

No problems 0 55,3%

Slightly impaired 63,8% 40,4%

Not beyond 90° 36,2% 4,3%

Impossible 0 0

8. Squatting

Results and discussions :

Conclusions

Using Tegner Lysholm Knee Scoring Scale we have managed to demonstrate an improvement of life condition of the patients after ACL reconstruction and rehabilitation.

Bibliography

1. Kisner C,Colby LA:The knee.Therapeutic exercise:foundations and techniques,4th ed. Philadelphia:F>A> Davis Company;2002. 2. Magee DJ: Orthopaedic physical assessment, 4th ed. Philadelphia: Saunders; 2002. 3. Hall CM, Brody LT: The knee.Therapeutic exercise: Moving toward function.Philadelphia : Lippincott Williams and Wilkins; 1999. 4. Barret DS : Proprioception and function after anterior cruciate reconstruction.J Bone Join Surg Br 73:83, 1991. 5. Koceja DM, Karmen G : Conditioned patellar tendon reflexes in sprint and endurance- trained athletes.Med Sci Sports Exerc 20:172, 1998. 6.Lysholm J, Gillquist J : Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10-3:150-4. 7. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009; 37-5:890-7.

Thank you for your attention !