Article
An early return to vigorous activity may destabilize anterior cruciate ligaments reconstructed with hamstring grafts1

https://doi.org/10.1016/S0003-9993(03)00621-XGet rights and content

Abstract

Fujimoto E, Sumen Y, Urabe Y, Deie M, Murakami Y, Adachi N, Ochi M. An early return to vigorous activity may destabilize anterior cruciate ligaments reconstructed with hamstring grafts. Arch Phys Med Rehabil 2004;85:298–302.

Objective

To evaluate the actual date of the return to activity and its impact on the postsurgical stability of anterior cruciate ligament reconstruction (ACLR) using hamstring grafts.

Design

A retrospective analysis. The time of return to activity was determined by a questionnaire at 24 to 36 months after ACLRs.

Setting

An orthopedic center.

Participants

Fifty consecutive patients who had ACLRs using hamstring grafts 24 to 36 months earlier.

Interventions

Not applicable.

Main outcome measure

The time of return to activity from a questionnaire and serial KT-2000 data at 3, 6, 12, 18, and 24 months postsurgery.

Results

Patients were divided into 2 groups according to their KT-2000 side-to-side difference at 12, 18, and 24 months postsurgery. Group I consisted of patients whose differences were 3mm or less. Group II consisted of patients whose differences were more than 3mm. At 12 and 18 months postsurgery, significant differences were detected for the time of return to running and full-speed running. A multiple regression analysis for postsurgical stability at 24 months and the time of return to these 5 activities indicated that the time of return to full-speed running and sports activities had an effect on ACL stability.

Conclusions

An early return to vigorous activities is not recommended in patients undergoing ACLRs with hamstring grafts.

Section snippets

Participants

Inclusion criteria for our study were (1) unilateral ACL rupture without posterior cruciate ligament injury or collateral ligament injury requiring surgery; (2) positive presurgical pivot shift test; (3) at least –5° to 140° of knee excursion achieved postsurgically with no knee motion complications resulting in an arthroscopic release of contracted scar tissues or permanent loss of motion; (4) at least 2 years of serial arthrometer data and a patient follow-up; (5) no unusual rehabilitation

Questionnaire

The time of return to 5 activities (running, full-speed running, sports activities, unorganized sports, organized sports) is summarized in table 1. Although patients generally commenced running at 6 months postsurgery, 7 started running sooner than 6 months: 3 patients began running at 3 months, 2 patients at 4 months, and 2 patients at 5 months. The average start of full-speed running was around 11 months postoperatively; 1 patient started at 5 months, 9 patients started at 6 months, 1

Discussion

To our knowledge, this is the first study to use a follow-up questionnaire about the patients’ time of their return to activities (running, full-speed running, sport activity, unorganized sports, organized sports). A questionnaire was given to those patients who had an ACLR 24 to 36 months before their regular visit to our hospital, unless the patients were unsure about the time of their return to sports activities at more than 36 months after surgery. The results revealed that some patients

Conclusions

Our study showed that some patients are highly motivated for an early return to sports activity after their ACLR, and that these patients had poor ACL stability. Our results also indicated that the start of running, full-speed running, and sports activities could affect both the intermediate postsurgical stability and the 24-month stability. We concluded that an early return to vigorous activity is not recommended in ACLR using hamstring grafts.

References (21)

  • H. Nakano et al.

    Interference screw fixation of doubled flexor tendon graft in anterior cruciate ligament reconstruction—biomechanical evaluation with cyclic elongation

    Clin Biomech (Bristol, Avon)

    (2000)
  • S.G. Glasgow et al.

    The effect of early versus late return to vigorous activities on the outcome of anterior cruciate ligament reconstruction

    Am J Sports Med

    (1993)
  • K.D. Shelbourne et al.

    Acute anterior cruciate ligament injury

    Indiana Med

    (1990)
  • K.D. Shelbourne et al.

    Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program

    Am J Sports Med

    (1995)
  • K.D. Shelbourne et al.

    Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. A two- to nine-year followup

    Am J Sports Med

    (1997)
  • S.D. Barber-Westin et al.

    The effect of exercise and rehabilitation on anterior-posterior knee displacements after anterior cruciate ligament autograft reconstruction

    Am J Sports Med

    (1999)
  • S.M. Howell et al.

    Brace-free rehabilitation, with early return to activity, for knees reconstructed with a double-looped semitendinosus and gracilis graft

    J Bone Joint Surg Am

    (1996)
  • S.M. Howell et al.

    Comparison of endoscopic and two-incision techniques for reconstructing a torn anterior cruciate ligament using hamstring tendons

    Arthroscopy

    (1999)
  • P. Aglietti et al.

    Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction

    Am J Sports Med

    (1994)
  • D.B. O’Neill

    Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques

    J Bone Joint Surg Am

    (1996)
There are more references available in the full text version of this article.

Cited by (22)

  • Graft Remodeling and Ligamentization after Anterior Cruciate Ligament Reconstruction

    2018, The Anterior Cruciate Ligament: Reconstruction and Basic Science: Second Edition
  • Intratunnel versus extratunnel fixation of hamstring autograft for anterior cruciate ligament reconstruction

    2012, Arthroscopy - Journal of Arthroscopic and Related Surgery
    Citation Excerpt :

    They advocated a return to “light” sports at 8 weeks after surgery. In contrast, Beynnon et al.,43 who studied patients after ACL reconstruction with BPTB autografts, and Fujimoto et al.,44 who studied patients after ACL reconstruction with hamstring autografts, have cautioned that early release to physical activity may increase knee laxity risk. When deciding on the timing of safe FWB timing, the knee surgeon is concerned with initial soft-tissue graft fixation.

  • Analysis of return to competition and repeat rupture for 298 anterior cruciate ligament reconstructions with patellar or hamstring tendon autograft in sportspeople

    2010, Annals of Physical and Rehabilitation Medicine
    Citation Excerpt :

    Ainsi, ils ne retrouvent pas plus de laxité entre les dix patients, faisant un programme de rééducation accéléré après OTR, et les 12 patients, faisant une rééducation non accélérée, même si le faible nombre de participants diminue la puissance statistique du travail. En revanche, Fujimoto et al. [12], pour le DIDT, estiment qu’une reprise de la course trop rapide entraîne des laxités significatives, en faveur d’une détente de la plastie. De même, Heijne et Werner [16] ont montré l’augmentation de la laxité après travail sur chaise à quadriceps à quatre semaines de l’intervention pour les DIDT.

  • A prospective study of 3-day versus 2-week immobilization period after anterior cruciate ligament reconstruction

    2007, Knee
    Citation Excerpt :

    However, the mean side-to-side differences of anterior laxity would become stable after 24 months' follow-up as well as previous reports [8,20]. Fujimoto et al. [21] reported the first serial arthrometer measurements of ACL reconstruction using hamstring tendons. At the 24-month follow-up evaluation, 37 patients (74%) had a functional reconstruction and normal displacement measurements.

View all citing articles on Scopus
1

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

View full text