Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial

Patra, Saroj Kumar; Nanda, Saurav Narayan; Patro, Bishnu Prasad; Sahu, Nabin Kumar; Mohnaty, Chitta Ranjan; Jain, Mantu

doi:10.1055/s-0042-1748969

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Original Article • Rev. bras. ortop. 57 (3) • 2022 • https://doi.org/10.1055/s-0042-1748969 copy

Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial^* * Work developed at the Department of Trauma and Emergency, AIIMS, Bhubaneswar, India.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the effectiveness of the early accelerated rehabilitation and delayed conservative rehabilitation protocols after arthroscopic anterior cruciate ligament reconstruction, in terms of the International Knee Documentation Committee (IKDC) score, pain (according to the Visual Analog Scale), laxity, and stiffness one year postoperatively to determine the best outcome.

Materials and Methods A total of 80 subjects were divided into 2e groups (early accelerated group and delayed conservative group), which were analyzed by the Pearson Chi-squared and Wilcoxon rank-sum tests.

Results

One year postoperatively, knee laxity was significantly higher (p = 0.039) in the early accelerated group compared with the delayed conservative group. Regarding postoperative pain (according to the Visual Analogue Scale) and IKDC scores, both groups presented similar results. The postoperative range of motion was better in the early accelerated group, but this was not statistically significant (p = 0.36).

Conclusion

One year postoperatively, the early accelerated rehabilitation protocol was associated with significant knee laxity compared to the delayed conservative rehabilitation protocol.

Keywords
anterior cruciate ligament injuries; anterior cruciate ligament reconstruction; rehabilitation

Variables	Early rehabilitation (n = 40)	Delayed rehabilitation (n = 40)	p-value
Age in years: median (IQR) [range]	34 (28-39) [18-60]	33 (26-38) [18-60]	0.66
Male gender: mean (%)	37 (92.5%)	36 (90%)	0.99
Height in cm: median (IQR) [range]	165.3 (159.1-172) [152-179.2]	164.8 (158.4-171.8) [151.9-179]	0.57
Weight in kg: median (IQR) [range]	65 (58-70) [54.4-82]	65.6 (60.1-72.2) [53.4-82.6]	0.76
BMI in kg/m²: median (IQR) [range]	24 (22-27) [16-38]	26 (22.6-27.4) [15.8-29]	0.43

Variables	Early rehabilitation (n = 40)	Delayed rehabilitation (n = 40)	p-value
IKDC score: median (IQR)	49 (45-52.1)	48.2 (44.8-52.1)	0.75
Visual Analog Scale score: mean (%)			0.78
Mild	34 (85%)	32 (80%)
Moderate	6 (15%)	8 (20%)
Severe	0	0
Range of motion: mean (%)			0.216
< 90° (low)	0	0
90°-120° (medium)	8 (20%)	15 (37.5%)
> 120° (good)	32 (80%)	25 (62.5%)

Variables	Early rehabilitation (n = 40)	Delayed rehabilitation (n = 40)	p-value
IKDC score: median (interquartile range)	89.5 (85.2-92.1)	89.6 (85.4-92.5)	0.91
Visual Analog Scale score: mean (%)			0.51
Mild	38 (95%)	38 (95%)
Moderate	1 (2.5%)	2 (5%)
Severe	1 (2.5%)	0
Range of motion: mean (%)			0.36
< 90° (low)	4 (10%)	5 (12.5%)
90°-120° (medium)	7 (17.5%)	13 (32.5%)
> 120° (good)	29 (72.5%)	22 (55%)
Laxity score: mean (%)			0.039^{^*}
No laxity	27 (67.5%)	37 (92.5%)
Grade 1	10 (25%)	3 (7.5%)
Grade 2	2 (5%)	0
Grade 3	1 (2.5%)	0

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Saroj Kumar Patra, MS Orthopaedics, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Pin-751019, Odisha, India (e-mail: drsaroj123@gmail.com).

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Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial* * Work developed at the Department of Trauma and Emergency, AIIMS, Bhubaneswar, India.

Abstract

Objective

Results

Conclusion

Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial^* * Work developed at the Department of Trauma and Emergency, AIIMS, Bhubaneswar, India.