A Review of Systematic Reviews on Anterior Cruciate Ligament Reconstruction Rehabilitation

A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation

Subsequent instability and locking is common.

The anterior cruciate ligament (ACL) is the primary stabilising structure inside the knee, limiting anterior translation of tibia on the femur as well equally tibial internal rotation. Injuries are more common in loftier need sports and unremarkably follow non- contact trauma such equally landing incorrectly from a spring, pivoting or decelerating suddenly, but tin occur after direct contact or collision. Subsequent instability and locking is mutual and reconstructive surgery followed by lengthy rehabilitation is often required to stabilise the joint. Although at that place is general consensus that post-operative rehabilitation is essential, the components of programmes vary.

The aim of this review was to decide which rehabilitation components are supported by high quality systematic reviews to be included in a mail-operative ACL reconstruction rehabilitation programme for a diversity of outcomes including force ROM (range of movement), pain, laxity, action levels and return to sport (RTS)

Here'south what they did

Electronic databases were searched to Apr 2011 for systematic reviews published in English comparing any physiotherapy intervention from the day of isolated ACL reconstructive surgery with 'standard treatment'.

Reviews were graded using criteria described by van Tulder et al (2003), where the level of evidence for each intervention outcome was dependent on the number and quality of RCTs for each intervention, e.g. Strong: consistent findings among multiple high quality RCTS, Moderate: consequent findings among multiple low quality RCTs and/or Clinical Control Trials (CCTs) and/or ane high quality RCT.

The authors assessed risk of bias for each included review using the PRISMA checklist (LINK); the maximum score a review could attain was 27.

Here's what they found

Only five reviews were included assessing viii rehabilitation components. No evidence was establish to strongly or moderately back up a particular treatment. Many RCTs lacked item on the use of different treatments at different time points, what the comparative 'standard handling' was, or the amount of physiotherapy input. Alien evidence levels betwixt reviews occurred because the master outcomes of i were 'role' and 'RTS', which limited the number of studies included in that review (Trees et al. 2005). Even so they found

Potent bear witness of no added benefit of bracing (0-6 weeks) compared to standard treatment in the short term
Moderate evidence of no added benefit of continuous passive motion to standard treatment for increasing range of move
Moderate evidence of equal effectiveness of airtight versus open up kinetic chain exercises on knee pain, laxity and part at 6-14 weeks
Moderate bear witness of equal effectiveness of dwelling versus clinic based rehabilitation on knee laxity, ROM, strength and function at half-dozen – 12 months, and
Limited evidence of no significant deviation between accelerated (19 weeks) and non-accelerated (32 weeks) rehabilitation on function and articulatio genus laxity.

Four out of the five reviews scored 18 or less on the PRISMA quality checklist indicating a higher risk of bias. Ane review (Trees et al. 2005) scored 23 out of 27 [notation that one of our Elves (Howe) was an author on this review].

The authors concluded

"The lack of clarity surrounding the corporeality of physiotherapy input with dwelling based rehabilitation is important when considering the prove that a home based exercise programme is as effective as a clinic based program"

The Musculoskeletal Elf's view

There still remains a question over what are the most effective components of ACL reconstruction rehabilitation programmes. However this review of systematic reviews identifies what components do not significantly better outcomes and are therefore non recommended. More work has nonetheless to exist washed!

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A Review of Systematic Reviews on Anterior Cruciate Ligament Reconstruction Rehabilitation