Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

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Simple and effective Rehabilitation Programme (SERP) for Patients Undergoing Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction in Indian Scenario


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

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Introduction: Rehabilitation after surgery for an Anterior Cruciate Ligament (ACL) reconstruction is a lengthy process. Return to sports and other activities take months. There are many variations of ACL rehabilitation. Most of the protocols are extensive and do not suite the Indian scenario where the compliance of the patient and cost of physiotherapy are the major limiting factors. Hence, we decided to develop and validate a Simple and Effective Rehabilitation Programme (SERP) for patients undergoing ACL reconstruction in our scenario.

Materials and methodology: Fifty patients with isolated ACL tear with or without partial menisectomy were selected for this systematic review from November 2010 to July 2012. All 50 patients underwent arthroscopic ipsilateral quadruple hamstring tendon reconstruction (semitendinosis and gracilis double folded) using endobutton (Smith and Nephew) for femoral fixation and bio absorbable interference screw for tibial graft fixation. They were subjected to SERP. SERP is a home based programme consisting of 5 phases spanning over 6 months. Test- retest was done using Modified Cincinnati Rating system Questionnaire on a prospective basis. The results were than analysed.

Results: Applying the Modified Cincinnati Rating System Questionnaire, results were tabulated. 84% of the patients had excellent results and 16 % had good results at the end of 3 months. At the end of 6 months, 94 % of patients had excellent results and 6% had good results. The result remained the same after 1 year of follow-up. There were no fair or poor results.

Conclusion: SERP is a home based programme which is understandable, convenient and reliable for patients who are undergoing arthroscopic ACL reconstruction; especially in our setting with excellent functional outcome.


Keywords

SERP (Simple and Effective Rehabilitation Programme), Anterior Cruciate Ligament, Modified Cincinnati Rating System Questionnaire
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  • Kevin E. Wilk,Christopher Arrigo, James R. Andrews, William G. Clancy. Rehabilitation after Anterior Cruciate Ligament Reconstruction in the Female Athlete. Journal of Athletic Training 1999;34(2):177-193.

  • Mark S. De Carlo, K. Donald Shelbourne, john R. McCarroll, Arthur C. Rettig. Traditional versus Accelerated Rehabilitation following ACL Reconstruction: A One-Year follow-up. JOSPT, Volume 15, Number 6, June 1992; pg-309-316.

  • Brandsson S, Faxen E, Kartus KJ, Eriksson BI,Karlsson, et al. Is knee brace advantageous after anterior cruciate ligament surgery? A prospective, randomised study with a 2 year follow-up. Scand J Med Sci Sports. 2001;11:110- 114.

  • Wilk KE, Andrews JR, Clancy WG, et al. Anterior cruciate ligament reconstruction rehabilitationthe results of aggressive rehabilitation: a 12-week follow-up in 212 cases. Isokin Exerc Sci. 1992;2:82- 91.

  • Jonas Isberg, Eva Faxén, Sveinbjörn Brandsson, Bengt I Eriksson, Johan Kärrholm, Jon Karlsson. Early active extension after Anterior Cruciate Ligament reconstruction does not result in increased laxity of the knee. Knee Surg Sports Traumatology Arthroscopy 2006;14:1108-1115.

  • Järvinen M, Natri A, Lehto M, Kannus P. Reconstruction of chronic anterior cruciate ligament insufficiency in athletes using a bonepatellar tendon-bone autograft. A two-year follow up study. Int Orthop 1995;19:1-6.

  • Shelbourne KD, Klootwyk M, Wilckens J, Decarlo M. Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated program. Am J Sports Med 1995;23:575-579.

  • Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 1990;18:292-299.

  • Bynum EB, Barrack RL, Alexander AH. Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction - a prospective randomized study. Am J Sports Med 1995;23: 401-406.

  • Fitzgerald GK. Open versus closed kinetic chain exercise: issues in rehabilitation after anterior cruciate ligament reconstructive surgery. Phys Ther. 1997 Dec;77(12):1747-54.

  • Morrisey MC, Drechsler WI, Morrisey D, Knight PR, Armstrong P, McAuliffe T. Effects of distally fixated versus non-distally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction. Physical Therapy 2002;82:35-43.

  • Morrisey MC, Hudson ZL, Drechsler WI, Coutts FJ, Knight PR, Ki JB. Effects of open versus closed kinetic chain training on knee laxity in the early period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatology Arthroscopy 2000;8:343-348.

  • Yack HJ, Collins CE, Whieldon TJ. Comparison of closed and open kinetic chain exercise in the anterior cruciate ligament-deficient knee. Am J Sports Med. 1993;21:49-54.

  • Delay BS, Smolinski R, Wind WM, Bowman DS. Current practices and opinions in ACL reconstruction and rehabilitation: Results of a survey of the American Orthopaedic Society for Sports Medicine (Summary). Am J of Knee Surgery, 2001; 14(2): 85-91.

  • Ochi M, Iwasa J, Uchio Y, Adachi N, Sumen Y. The regeneration of sensory neurons in the reconstruction of the anterior cruciate ligament. Journal of Bone and Joint Surgery (Br).1999;81: 902-906.

  • 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. International Journal of Sports edicine.1996;17(223-228).

  • DeVita P, Hortobagyi T, Barrier J. Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation. Medicine and Science in Sports and Exercise. 1998;30(10): 1481-1488.

  • Keays SL, Bullcok-Saxton JE, Newcombe P, Bullock MI. The effectiveness of a preoperative home-based physiotherapy programme for chronic anterior cruciate ligament deficiency. Physiotherapy Research International. 2006;11(4): 204-218.


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  • Simple and effective Rehabilitation Programme (SERP) for Patients Undergoing Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction in Indian Scenario

Abstract Views: 492  |  PDF Views: 0

Authors

S. M. Shishir
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India
M. Manoj Abraham
Department of Physical Medicine & Rehabilitation, Pondicherry Institute of Medical Sciences, Pondicherry, India
Nikhil Joseph Martin
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India
R. Kanagasabai
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India
James J. Gnanadoss
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India

Abstract


Introduction: Rehabilitation after surgery for an Anterior Cruciate Ligament (ACL) reconstruction is a lengthy process. Return to sports and other activities take months. There are many variations of ACL rehabilitation. Most of the protocols are extensive and do not suite the Indian scenario where the compliance of the patient and cost of physiotherapy are the major limiting factors. Hence, we decided to develop and validate a Simple and Effective Rehabilitation Programme (SERP) for patients undergoing ACL reconstruction in our scenario.

Materials and methodology: Fifty patients with isolated ACL tear with or without partial menisectomy were selected for this systematic review from November 2010 to July 2012. All 50 patients underwent arthroscopic ipsilateral quadruple hamstring tendon reconstruction (semitendinosis and gracilis double folded) using endobutton (Smith and Nephew) for femoral fixation and bio absorbable interference screw for tibial graft fixation. They were subjected to SERP. SERP is a home based programme consisting of 5 phases spanning over 6 months. Test- retest was done using Modified Cincinnati Rating system Questionnaire on a prospective basis. The results were than analysed.

Results: Applying the Modified Cincinnati Rating System Questionnaire, results were tabulated. 84% of the patients had excellent results and 16 % had good results at the end of 3 months. At the end of 6 months, 94 % of patients had excellent results and 6% had good results. The result remained the same after 1 year of follow-up. There were no fair or poor results.

Conclusion: SERP is a home based programme which is understandable, convenient and reliable for patients who are undergoing arthroscopic ACL reconstruction; especially in our setting with excellent functional outcome.


Keywords


SERP (Simple and Effective Rehabilitation Programme), Anterior Cruciate Ligament, Modified Cincinnati Rating System Questionnaire

References