Comparison between standard and supervised rehabilitation program after ACL reconstruction

The incidence of postoperative complaints, in terms of ROM deficit or muscle weakness, may be higher in patients who undergo a non supervised rehabilitation program. There is difference in the effectiveness of a supervised rehabilitation program and a standard physical therapy in patients after 3 months following ACL reconstruction with bone-patellar tendon-bone graft. Randomized controlled trial. There were 60 patients, (20-45 years) enrolled in this study All patients underwent on ACL reconstruction by the same surgeon. Before and after the surgery the patients received a complete and detailed booklet and videotape regarding their postoperative treatment. The patients received the same instructions on how to perform the exercises, the number of sets and repetitions, and exercise progression. The complete rehabilitation program used in this study consisted of three phases. The goal of the first one was the complete ROM recovery, the second one the strengthening recovery and the third one the proprioception recovery. In our present study only the first two phases were considered. All patients, regardless of grouping, followed the same protocol during the first two weeks after surgery, using the same model of CPM machine. In the supervised protocol (Group 1) 30 patients (27 male, 3 female) were cared for at the physical therapy department of our institution by an expert physical therapist who received a thorough training. The patients of this Group performed the same amount of exercises with the same progression, and under constant supervision. The patients of standard group (Group 11) were treated at outside centres by different therapist without any control if exercises were performed properly. This Group included 30 patients, 26 male and 3 female. The patients were evaluated by the surgeon and the physical therapist after 7, 15 days, 1 month, 2, and 3 months after surgery. At each visit, all patients were instructed by the same therapist about the new exercises introduced in the subsequent session. All patients were evaluated 4 times: preoperatively for baseline measurements, at 1, 2, and 3 months. The same person performed all assessments. The assessor was blinded to group assignment throughout the study. The assessment included a standard goniometer measurement. Extension ROM was measured with patients positioned prone with the knee joint positioned slightly beyond the end of the plinth. For the active knee flexion, the patient was examined supine on the plinth and he was invited to reach actively the most comfortable flexed knee position. Isometric evaluation of thigh strength was performed at 1, 2, and 3 months after surgery. The isometric assessment was performed with dynamometer set at 30 degrees and 900 for quadriceps and at 90 degrees for hamstrings muscles. There were no clinical relevant differences demonstrated at baseline preop assessment between the 2 Groups. All patients, enrolled in this study, regained full flexion and extension and none underwent on manipulative or surgical treatment. The patients of the first Group regained knee extension in a shorter time whereas the patients of Group II were able to achieve full flexion in a shorter time compared to Group 1. The patients of the Group I had a significantly higher percentage of muscle strength, (10% more strength in both quadriceps and hamstrings in the supervised Group) at final evaluation. A standard program of postop ACL reconstruction may achieve an acceptable result without complaints. A supervision of every step during the postoperative period is able to reduce thetime and is more effective in regaining the muscle power.