Rehabilitation following bone-patellar tendon-bone graft ACL reconstruction

Sammanfattning: The overall purpose of this Thesis was to improve treatment and rehabilitation after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone graft. Study I: The purpose of this study was to evaluate and compare closed kinetic chain (CKC) training and a combination of closed and open kinetic chain (OKC) quadriceps exercises following ACL reconstruction on anterior knee laxity and isokinetic muscle torque. Another purpose was to determine whether this leads to improved knee function and improve the ability to return to sporting activities. Forty-four patients, aged 18-40 years, were randomised and matched into two intervention groups, each comprising 22 patients. Combined OKC and CKC rehabilitation protocol was superior to CKC alone by resulting in significantly better quadriceps torque (Kin-Com@ dynamometer) and a two months earlier return to pre-injury level of sports without compromising knee joint stability (KT-1000). Study II: The purpose of this study was to evaluate if a normal knee, bandaged as after an ACL reconstruction and placed in a straight post-operative brace lies in full knee extension (0°). Another purpose was to evaluate if a postoperative brace in slight hyperextension could prevent extension deficit after an ACL reconstruction. Five healthy subjects with known hyperextension of their knees underwent an Xray examination. This showed that the brace had to be set in -10° to get all their knees in hyperextension. Forty-four patients were then randomised into two groups, either using a brace in 0° or -5° during three weeks. At three months follow-up there were no group differences in anterior knee laxity (KT-1000). A brace set at -5° led to less extension deficit than a brace set at 0° using a goniometer with long lever arms. Study Ill: The first purpose of this study was to evaluate the frequency of anterior knee pain (AKP) before and after ACL reconstruction using either the central or the medial third of the patellar-tendon as a graft. The second purpose was to study whether there was a gender difference in the amount of AKP. The third purpose was to study possible correlations between AKP and quadriceps weakness. AKP was evaluated before and after ACL reconstruction with a functional knee score tested for reliability, r=0.96. Thirty out of 35 patients reported less AKP on an average 8.4±2.6 months after ACL reconstruction compared to before. In terms of AKP there was no significant difference between the use of the central or medial patellar tendon graft, and no significant difference between gender. There was no correlation between AKP and quadriceps torque (Kin-Com@ dynamometer). Study IV: The purpose of this follow-up investigation was to study possible relations between anterior knee laxity, knee function, personality and return to sports after bonepatellar tendon-bone ACL reconstruction. Another purpose was to check whether knee laxity could distinguish patients that were able to return to pre-injury activity level after ACL reconstruction from those that did not. Forty-nine physically active patients were seen at a 7.2 year follow-up. One third of the patients returned to pre-injury level of sports. These patients had a significantly better functional outcome (KOOS) and a significantly lower degree of Somatic Trait Anxiety, Psychic Trait Anxiety and Stress Susceptibility (Swedish universities scales of personality). There were no significant group differences regarding anterior knee laxity (KT-1000). This study shows that some personality characteristics rather than instrumented knee laxity tests may predict the outcome of ACL reconstruction with respect to return to sports at pre-injury level.