Efficacy of two rehabilitation programs after anterior cruciate ligament surgical reconstruction

This study is conducted & submitted in partial fulfillment of the requirements for the master degree in physical therapy department of health rehabilitation sciences college of applied medical sciences King Saud University, Riyadh, Kingdom of Saudi Arabia, 1428H - 2007GBACKGROUND AND PURPOSE: Anterior cruciate ligament (ACL) rupture is one of the most common and most serious traumatic injuries among physically active individuals. An estimated 70% of these ACL injuries are sports related. Repair of the injured anterior cruciate ligament (ACL) is currently a common surgical procedure carried out routinely and arthroscopically at many centers in the Kingdom of Saudi Arabia (KSA). Closed kinetic chain (CKC) exercises rather than open kinetic chain (OKC) exercises play a primary role in ACL rehabilitation protocols. A CKC exercise is one where the foot is opposed by "considerable resistance" (e.g., squatting, bicycling). CKC activities are modeled as closed linkages where movement in one joint produces movement in all the other joints of an extremity. The purpose of this study was to evaluate the differences between the using of closed kinetic chain exercises alone and the traditional rehabilitation program after anterior cruciate ligament reconstruction. METHODS: Forty patients with ACL reconstruction completed this study. In the group (1) there were (20) patients with ages ranged from 21 to 30 years and mean 25.80 (± 3.22) years while in the group (2) there were (20) patients with ages ranged from 20 to 30 years and mean 26.10 (± 3.24) years. All patients in group (1) followed traditional physical therapy program which consists of group of defferent types of exercises while all patients in group (2) did closed kinetic chain exercises postoperative for 16 weeks for both groups. The main outcome measures were visual analogue scale (VAS) of pain, range of motion and muscle activity by electromyography (EMG) which applied before physical therapy program and after 16 weeks of physical therapy for both groups. RESULTS: The difference in pain score, range of motion (passively and actively) and muscle activity levels reached statistical significance (p= 0.000) after 16 weeks of physical therapy. Before physical therapy, there was no difference between both groups (p=0.387), but after 16 weeks of physical therapy, there was a significant improvement in pain reduction (p=0.000) in closed kinetic chain subjects more than the subjects in traditional physical therapy program. The mean range of motion passively and actively increased in flexion after 16 weeks of physical therapy. The mean range of motion passively and actively decreased in extension after 16 weeks of physical therapy. Comparing the range of motion between the traditional physical therapy program and closed kinetic chain exercises after 16 weeks of physical therapy in passive and active extension was significant (p=0.000) where the traditional physical therapy was more effective in improving extension range of motion than closed kinetic chain exercises, but there was no difference in passive flexion (p=0.356) and active flexion (p=0.415) between the groups. For muscle activity measures, the mean amplitude of muscle unit potential and the mean number of muscle unit potentials of the affected thigh increased in quadriceps (vastus medialis obliquus (VMO), vastus lateralis (VL)) and hamstring (biceps femoris and semitendenosus) after 16 weeks of physical therapy. Before physical therapy, there was no difference between both groups in amplitude values of vastus medialis obliquus (p=0.514), vastus lateralis (p=0.511), biceps femoris (p=0.845) and semitendenosus (p=0.127)), but after 16 weeks of physical therapy, there was a significant increase in amplitude values (p=0.000) in traditional physical therapy program subjects more than the subjects in closed kinetic chain group. The differences in the number of muscle unit potentials after 16 weeks of physical therapy in quadriceps and hamstring muscles showed a significant increase in the traditional physical therapy program more than closed kinetic chain exercises (p=0.000). CONCLUSION: There was highly positive statistical significant improvement in VAS of pain, passive and active in flexion and extension range of motion and muscle activity of quadriceps and hamstring muscles in the traditional physical therapy program (group 1) and in the closed kinetic chain exercises (group 2) after 16 weeks of physical therapy after ACL reconstruction. The closed kinetic chain exercises were effective in pain reduction more than traditional physical therapy program, but the traditional physical therapy program was effective in improvement of knee extension range of motion and muscle activity more than the closed kinetic chain exercises and there was no difference in improvement of knee flexion range of motion between the traditional physical therapy program and the closed kinetic chain exercises