Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

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Proprioceptive and Functional Outcome of the Knee in Arthroscopic Anterior Cruciate Ligament Reconstruction of a Preserved Remnant Tissue


Affiliations
1 Department of Physical Medicine and Rehabilitation, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India
     

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Background: Injury to the ACL(Anterior Cruciate Ligament) not only causes mechanical instability but also leads to functional deficit in the form of diminished proprioception of the knee joint. This study analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability.

Method: 100 patients who underwent ACL reconstruction surgery and completed Simple and Effective Rehabilitation Protocol(SERP) with minimum duration of 2 years from surgery to follow up, were all assessed for proprioception, stability and functional outcome of the reconstructed knee. They were assessed by the knee joint position sense, single leg hop test for both the normal and reconstructed knee and KOOS questionnaire respectively.

Result: Chi square table value for 1degree freedom at 0.05 was 3.84, hence the calculated Chi square values of proprioception knee in supine lying, proprioception knee in standing and single leg hop are less than table value of the accepted hypothesis which concludes that, there is no significant difference between the scores of selected outcome variables among reconstructed knee and normal knee subjects. The calculated paired‘t’ and ‘t’ table value with respect to the functional outcome of knee in operated and normal subjects was 6.53 and 2.66 respectively at 0.005 level.

Conclusion: There was no significant difference of Proprioception between the scores of selected outcome variables among reconstructed knee and normal knee in supine lying, standing and single leg hop. But it shows that there is significant difference of 2.66 at 0.005 level between reconstructed knee and normal knee groups with respect to the functional outcome of knee after two years of follow-up in ACL reconstructed knees.


Keywords

ACL, Remnant Tissue, Reconstruction, Joint Position Sense, Stability, Functional Outcome.
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  • MacDonald PB, Hedden D. Proprioception in Anterior Cruciate Ligament-Deficient and Reconstructed Knees. Am J Sports Med 1996; 24(6):774-8.

  • Yasuda K, Kondo E, Kitamura N, Kawaguchi Y, Kai S, Tanabe Y. A pilot study of anatomic doublebundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation. The Journal of Arthroscopic & related Surgery. 2012; 28(3): 343-353.

  • Adachi N, Ochi M,Uchio Y, Iwasa J, Ryoke K, Kuriwaka M. Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense, Acta Ortho Scand 2002; 73: 330-334.

  • Ali SD, Noor S,Mangi IK, Ail Shah SK, Sufyan M. Functional outcome of ACL reconstruction using patellar bone tendon bone graft. J Pak Med Assoc.2014 ;64(12):79-82.

  • Swanik BC, Lephart SM. Proprioception, kinesthesia and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone joint Surg. 2004; 86-A (2):328-34.

  • Shishir SM, Abraham MM, Martin NJ, Kanagasabai R, Gnanadoss JJ. Simple and Effective Rehabilitation Programme (SERP) for patients undergoing Arthroscopic Anterior Cruciate Ligament (ACL) reconstruction in Indian scenario. Indian Journal of Physiotherapy & Occupational Therapy. 2013;7(4):222-228.

  • Salavathi M, Akhbari B, Mohammadi F, Mazaheri M, Khorrami M. Knee Osteoarthritis Outcome Score (KOOS); reliability and validity in competitive sports athletes after anterior cruciate ligament reconstruction. Br J Sports Med. 2011;19(4):406-10

  • . Ewa M, Roos PT, Roos HP, Lohmander S, Charlotte, Bruce DB. Knee Injury and Osteoarthritis Outcome Score (KOOS) – Development of a Self – Administered Outcome Measure Journal of Orthopaedic& Sports Physical Therapy, 1998 :28 (2) :88– 96.

  • Reichenbach S, Juni P, Nuesch E, Frey F, Ganz R. To determine the validity and reliability of manual goniometers for measuring. Phys Ther.1987;67(12):1867 – 1872.

  • Sekiya I, Muneta T, Ogiuchi T, Yagishita K, Yamamoto H. Significance of the Single- Legged Hop Test to the Anterior Cruciate LigamentReconstructed Knee in Relation to Muscle Strength and Anterior Laxity. Am J Sports Med. 1998;26(3): 384-388.

  • Fitzgerald GK, Lephart SM, Hwang JH, Wainner MRS.Hop Tests as Predictors of Dynamic Knee Stability.Journal of Orthopaedic & Sports Physical Therapy. 2001; 31(10):588–597.

  • Dhillon MS, Bali K, Prabhakar S. Proprioception in anterior cruciate ligament deficient knees And its relevance in anterior cruciate ligament reconstruction. Indian J Orthop.2011;45( 4): 294-300.

  • Mir SM, Hadian MR, Talebian S, Nasseri N. Functional assessment of knee joint position Sense following anterior cruciate ligament reconstruction, Br J Sports Med. 2008; 42(4):300-3.

  • Lee B, Kwon SW, Kim JB, Choi HS, Min KD. Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft. The Journal of Arthroscopic & related Surgery. 2008; 24(5): 560-568.

  • Lokhande MV, Shetye J, Mehta A , Deo MV. Assessment of knee joint position in weight Bearingand non-weight bearing positions in normal knee. Journal of Krishna Institute of Medical Sciences . 2013; 2(2): 94-101.

  • Lephart SM, Kocher MS, Fu FH, Borsa PA, Harner CD. Proprioception following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil. 1992;1(1):188-196.

  • Takahashi T, Kondo E, Yasuda K, Miyatake S, Kawaguchi Y, Onodera J, Kitamura N. Effects of Remnant Tissue Preservation on the Tendon Graft in Anterior Cruciate Ligament Reconstruction, American Journal of Sports Medicine. 2016; 44 (7), 1708-1716. doi.org/10.1177/0363546516643809

  • Lee BI, Min KD, Choi HS, Kim JB, Kim ST. Arthroscopic anterior cruciate ligament Reconstruction with the tibial-remnant preserving technique using a hamstring graft. Arthroscopy. 2006;22(340). doi:10.1016/j.arthro.2005.11.010

  • Pap G, Machner A, Nebelung W, Awiszus F. Detailed analysis of proprioception in normal and ACL deficient knees. J Bone Joint Surg Br. 1999;81:764–8.

  • Zhang S, Matsumoto T, Uefuji A. Anterior cruciate ligament remnant tissue harvested within 3-months after injury predicts higher healing potential.BMC Musculoskeletal Disorder , 2015; 16.390 . doi.org/10.1186/s12891-015-0855-0.

  • Muneta T, Koga H. Anterior cruciate ligament remnant and its values for Preservation , Asia- Pacific J of Sports Medicine, Arthroscopic ,Rehabilitation and Technology. 2017; 7, 1-9.

  • Kim Sj, Jo SB, Kim TW, Chang JH, Choi HS, Oh KS. A modified arthroscopic anterior cruciate Ligament double-bundle reconstruction technique wit autogenous quadriceps tendon graft remnant – preserving technique. arch Ortho Trauma Surg.2009 ;29(3):403-7.

  • . Song G, Zhang Y, Zhang H, Li J, Chen X, Li XZ, Feng Y H. The anterior cruciate ligament remnant: To leave it or not? Arthroscopy – J of Arthroscopic and Related Surgery. 2013;29(7),1253-1262.

  • Uefuji A, Matsumoto T, Matsushita T, Ueha T, Zhang S, Kurosaka M, Kuroda R. Age-related differences in anterior cruciate ligament remnant vascular-derived cells, American Journal of Sports Medicine .2014; 42(6),1478-1486.

  • YoshieT, KazunoriY, Nobuto KE. Clinical result of anterior cruciate ligament reconstruction with ligament remnant tissue preservation: A systematic review. Asia –Pacific J sports Med, Arthroscopy, Reh and Technology. 2006;4,1-8.

  • Hogervorst T, Brand R. Mechanoreceptors in joint function :current concepts review. J Bone Joint Surg Am.1998;80,1365 – 1378.

  • IwasaJ, Ochi M, Adachi N. Proprioceptive improvement in knees with anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 2000; 381,168 – 176.


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  • Proprioceptive and Functional Outcome of the Knee in Arthroscopic Anterior Cruciate Ligament Reconstruction of a Preserved Remnant Tissue

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Authors

I. Srikanth
Department of Physical Medicine and Rehabilitation, Pondicherry Institute of Medical Sciences, Puducherry, India
S. M. Shishir
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India
S. Yamamalini
Department of Physical Medicine and Rehabilitation, Pondicherry Institute of Medical Sciences, Puducherry, India
Najimudeen Syed
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India

Abstract


Background: Injury to the ACL(Anterior Cruciate Ligament) not only causes mechanical instability but also leads to functional deficit in the form of diminished proprioception of the knee joint. This study analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability.

Method: 100 patients who underwent ACL reconstruction surgery and completed Simple and Effective Rehabilitation Protocol(SERP) with minimum duration of 2 years from surgery to follow up, were all assessed for proprioception, stability and functional outcome of the reconstructed knee. They were assessed by the knee joint position sense, single leg hop test for both the normal and reconstructed knee and KOOS questionnaire respectively.

Result: Chi square table value for 1degree freedom at 0.05 was 3.84, hence the calculated Chi square values of proprioception knee in supine lying, proprioception knee in standing and single leg hop are less than table value of the accepted hypothesis which concludes that, there is no significant difference between the scores of selected outcome variables among reconstructed knee and normal knee subjects. The calculated paired‘t’ and ‘t’ table value with respect to the functional outcome of knee in operated and normal subjects was 6.53 and 2.66 respectively at 0.005 level.

Conclusion: There was no significant difference of Proprioception between the scores of selected outcome variables among reconstructed knee and normal knee in supine lying, standing and single leg hop. But it shows that there is significant difference of 2.66 at 0.005 level between reconstructed knee and normal knee groups with respect to the functional outcome of knee after two years of follow-up in ACL reconstructed knees.


Keywords


ACL, Remnant Tissue, Reconstruction, Joint Position Sense, Stability, Functional Outcome.

References