Knee pain after anterior cruciate ligament reconstruction: Evaluation of a rehabilitation protocol

被引:9
作者
Gadea F. [1 ]
Monnot D. [2 ]
Quélard B. [2 ]
Mortati R. [2 ]
Thaunat M. [2 ]
Fayard J.M. [2 ]
Sonnery-Cottet B. [2 ]
机构
[1] Département d'Orthopédie-Traumatologie I, CHU Trousseau
[2] Centre Orthopédique Paul Santy, 69008 Lyon
关键词
ACL reconstruction; Anterior cruciate ligament; Anterior knee pain; Hamstring; IKDC score; Isokinetic; Knee surgery; Muscular defect; Patellar tendon; Reconstruction; Rehabilitation;
D O I
10.1007/s00590-013-1248-4
中图分类号
学科分类号
摘要
Introduction: Anterior knee pain (AKP) is a rare and difficult complication following anterior cruciate ligament (ACL) reconstruction. This disabling pain is persistent with conventional rehabilitation protocols. The aim of this work is to validate a new rehabilitation protocol that may improve the patients and allow return to daily activities including sports. Materials and methods: Forty-three patients identified with functional AKP after ACL reconstruction was enrolled in the rehabilitation protocol between 2009 and 2011. The series included twenty-six patients with hamstring grafting and seventeen patients with patellar tendon transplant. This study compares the functional outcomes and pain scores before and after the isokinetic protocol until the last follow-up at an average of 25.7 months after surgery. The evaluation was performed according to the International Knee Documentation Committee (IKDC) and included a pain assessment using the visual analog scale. Statistical analysis used Student's t-test for unpaired data and the Pearson correlation test for the variables. The IKDC scores were compared by the Wilcoxon test. Results: Functional outcomes and pain are significantly improved (p < 0.0001). The average IKDC score improved with 28 points and the pain improved with 3.2 points on the visual analog scale (VAS). The results are correlated with the follow-up time (p = 0.008) but not correlated with the delay between the surgery and the beginning of the isokinetic protocol. Discussion: Isokinetic rehabilitation provides a significant improvement in the knee function as measured by the IKDC score and by the VAS, regardless of the painful period preceding the program. The function improvement continues after the end of the protocol, but the pain may not completely disappear. The isokinetic rehabilitation program may resume functional AKP related to muscular deficit and may be used as the starter of other physical therapy protocols. Level of evidence: IV. © 2013 Springer-Verlag.
引用
收藏
页码:789 / 795
页数:6
相关论文
共 32 条
[1]  
Gaudot F., Chalencon F., Nourissat G., Et al., Impact of anterior knee pain on mid term outcome after anterior cruciate ligament reconstruction, Rev Chir Orthop, 94, 8 SUPPL., pp. 372-374, (2008)
[2]  
Gaudot F., Leymarie J.-B., Drain O., Boisrenoult P., Charrois O., Beaufils P., Double-incision mini-invasive technique for BTB harvesting: Its superiority in reducing anterior knee pain following ACL reconstruction, Orthop Traumatol Surg Res, 95, 1, pp. 28-35, (2009)
[3]  
Freedman K.B., D'Amato M.J., Nedeff D.D., Kaz A., Bach Jr. B.R., Arthroscopic anterior cruciate ligament reconstruction: A metaanalysis comparing patellar tendon and hamstring tendon autografts, American Journal of Sports Medicine, 31, 1, pp. 2-11, (2003)
[4]  
Natri A., Jarvinen M., Latvala K., Kannus P., Isokinetic muscle performance after anterior cruciate ligament surgery. Long-term results and outcome predicting factors after primary surgery and late-phase reconstruction, Int J Sports Med, 17, 3, pp. 223-228, (1996)
[5]  
Condouret J., Cohn J., Ferret J.-M., Et al., Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons, Rev Chir Orthop, 94, 8 SUPPL., pp. 375-382, (2008)
[6]  
Carter T.R., Edinger S., Isokinetic evaluation of anterior cruciate ligament reconstruction: Hamstring versus patellar tendon, Arthroscopy, 15, 2, pp. 169-172, (1999)
[7]  
Kobayashi A., Higuchi H., Terauchi M., Kobayashi F., Kimura M., Takagishi K., Muscle performance after anterior cruciate ligament reconstruction, International Orthopaedics, 28, 1, pp. 48-51, (2004)
[8]  
Dauty M., Tortellier L., Rochcongar P., Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: Analysis of literature, International Journal of Sports Medicine, 26, 7, pp. 599-606, (2005)
[9]  
Lautamies R., Harilainen A., Kettunen J., Sandelin J., Kujala U.M., Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: Comparison between bone-patellar tendon-bone and hamstring tendon autografts, Knee Surg Sports Traumatol Arthrosc, 16, 11, pp. 1009-1016, (2008)
[10]  
Ageberg E., Roos H.P., Silbernagel K.G., Thomee R., Roos E.M., Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: A cross-sectional comparison 3 years post surgery, Knee Surg Sports Traumatol Arthrosc, 17, 2, pp. 162-169, (2009)