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| A structured accelerated versus control rehabilitation pathway after anterior cruciate ligament reconstruction using autologous hamstrings demonstrates earlier improvement in physical outcomes without increasing graft laxity: a randomized controlled trial |
| Ebert JR, Edwards P, Joss B, Annear PT |
| Physical Therapy in Sport 2022 May;55:271-281 |
| clinical trial |
| 6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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OBJECTIVES: To investigate whether an accelerated rehabilitation pathway could enhance strength and functional symmetry after ACLR, without affecting laxity. DESIGN: Randomized Controlled Trial. SETTING: Private rehabilitation clinic. PARTICIPANTS: 44 patients randomized to an 'Accelerated' (n = 22) or 'Control' (n = 22) rehabilitation intervention. MAIN OUTCOME MEASURES: Graft laxity (primary outcome), isokinetic knee extensor and flexor strength, hop tests, surveys, sport participation, re-injuries and re-operations. RESULTS: No knee laxity differences (p > 0.05) were observed. A significantly greater (p = 0.006) percentage of Accelerated (77.3%) versus Control (59.1%) patients were participating in Level 1 or 2 pivoting sports at 12 months. Greater limb symmetry indices were observed in the Accelerated group for knee extensor strength at 6 (p < 0.0001), 12 (p = 0.010) and 24 (p = 0.005) months, as well as the triple hop at 6 (p = 0.015) and 9 (p = 0.008) months, and the triple crossover hop at 6 (p < 0.0001) and 9 (p = 0.009) months. One ipsilateral re-tear was observed (Control group, 17 months). No differences (p > 0.05) existed in surveys apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, better (p = 0.001) in the Accelerated group at 12 months. CONCLUSIONS: Accelerated rehabilitation produced earlier improvement in strength and hop LSIs, without increasing graft laxity.
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