Skip to main content
SpringerLink
Log in

Physiotherapy-guided versus home-based, unsupervised rehabilitation in isolated anterior cruciate injuries following surgical reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to investigate the outcome after ACL reconstruction between a group of patients receiving a standardized, supervised, physiotherapy-guided rehabilitation programme and a group of patients who followed an unsupervised, home-based rehabilitation programme.

Methods

Forty patients with isolated anterior cruciate ligament injuries were allocated to either a supervised physiotherapy intervention group or home-based exercise group. Patients were investigated by an independent examiner pre-operative, 3, 6, 9 and 12 months post-surgery using the following outcome measures: Lysholm Score and Tegner Activity Scale, functional hopping tests, and isometric and isokinetic strength assessments.

Results

Both groups improved significantly (P = 0.01–0.04) following 12 months after surgery. The median Lysholm score increased from 57 (34–90) to 94 (90–100) in the supervised group and 60 (41–87) to 97 (95–100) in the unsupervised group. The median Tegner Activity Scale increased from 3 (2–8) to 6 (3–8) in the supervised group and 4 (2–8) to 5 (3–10) in the unsupervised group. The combined mean symmetry indices for the hopping tests improved from 77.3 ± 18.7 to 86.8 ± 11.1 (supervised) and from 78.1 ± 30.5 to 88.3 ± 10.9 (unsupervised). Isometric and isokinetic strength symmetry indices for knee extension improved from 68.9 ± 23.5 to 82.8 ± 11.9, respectively, 63.7 + 22.8 to 82.7 + 15.1 in the supervised group and from 73.6 ± 20.5 to 76.5 ± 17.9, respectively, 69.5 ± 24.3 to 76.9 ± 16.9 in the unsupervised group. Eccentric strength symmetry indices for knee extension improved from 67.9 ± 27.7 to 87.8 ± 6.8 in the supervised group and from 71.3 ± 17.8 to 82.6 ± 15.6 in the unsupervised group.

Conclusion

This study could not demonstrate a benefit in a rehabilitation programme supervised by a physiotherapist in our population compared to an unsupervised cohort.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ageberg E, Thomee R, Neeter C, Silbernagel KG, Roos EM (2008) Muscle strength and functional performance treated with training and surgical reconstruction or training only: a two- to five-years follow-up. Arthr Rheum 15:1773–1779

    Article  Google Scholar 

  2. Augustsson J, Thomee R, Karlsson J (2004) Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:350–356

    Article  PubMed  Google Scholar 

  3. Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W (1990) Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orth Relat Res 255:204–214

    Google Scholar 

  4. Beard DJ, Dodd CA (1998) Home or supervised rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial. J Orthop Sports Phys 27:134–143

    CAS  Google Scholar 

  5. Beynnon BD, Johnson RJ, Fleming BC (2002) The science of anterior cruciate ligament rehabilitation. Clin Orth Relat Res 402:9–20

    Article  Google Scholar 

  6. Beynnon B, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) The treatment of anterior cruciate ligament injuries, part 1. Am J Sports Med 33:1579–1601

    Article  PubMed  Google Scholar 

  7. Beynnon B, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) The treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med 33:1751–1767

    Article  PubMed  Google Scholar 

  8. Canale TS, Beaty JH, Campbell’s Operative Orthopaedics (2007) Mosby, St. Louis, Box 48.2, pp 2855–2885

  9. De Carlo MS, Sell KE (1997) The effects of the number and frequency of physical therapy treatments on selected outcomes of treatment in patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 26:332–339

    PubMed  Google Scholar 

  10. Dealy BS, Smolinksi RJ, Wind WM, Bowman DS (2001) Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg 14:85–91

    Google Scholar 

  11. De Jong SN, van Caspel DR, van Haeff MJ, Saris DB (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23:21–28

    PubMed  Google Scholar 

  12. Elmlinger BS, Nyland JA, Tillet ED (2006) Knee flexor function 2 years after anterior cruciate ligament reconstruction with semitendinosus-gracilis autografts. Arthroscopy 22:650–655

    Article  PubMed  Google Scholar 

  13. Feller JA, Webster KE, Taylor NF, Payne R, Pizzari T (2004) Effect of physiotherapy attendance on outcome after anterior cruciate ligament reconstruction: a pilot study. Brit J Sports Med 38:74–78

    Article  CAS  Google Scholar 

  14. Fischer DA, Tewes DP, Boyd JL, Smith JP, Quick DC (1998) Home based rehabilitation for anterior cruciate ligament reconstruction. Clin Orth Relat Res 347:194–199

    Google Scholar 

  15. Forster MC, Forster IW (2005) Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee 12:225–230

    PubMed  Google Scholar 

  16. Grant JA, Mohtadi N, Maitland ME, Zernicke RF (2005) Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction. Am J Sports Med 33:1288–1297

    Article  PubMed  Google Scholar 

  17. Henriksson M, Ledin T, Good L (2001) Postural Control after Anterior Cruciate Ligament Reconstruction and Functional Rehabilitation. Am J Sports Med 29:359–366

    PubMed  CAS  Google Scholar 

  18. Laxdal G, Kartus J, Ejerhed L, Sernert N, Magnusson L, Faxen E, Karlsson J (2005) Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy 21:958–964

    Article  PubMed  Google Scholar 

  19. Mattacola CG, Perrin DH, Ganseder BM et al (2002) Strength, functional outcome and postural stability after anterior cruciate ligament reconstruction. J Athl Train 37:262–268

    PubMed  Google Scholar 

  20. Miyasaka KC, Daniel D, Stone ML, Hirshman P (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8

    Google Scholar 

  21. Noyes FR, Barber SD, Mangine RE (1991) Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 19:513–518

    Article  PubMed  CAS  Google Scholar 

  22. O’Meara PM (1993) Rehabilitation following reconstruction of the anterior cruciate ligament. Orthopaedics 16:301–306

    Google Scholar 

  23. Osteras H, Augestad LB, Tonde S (1998) Isokinetic muscle strength after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 8:279–282

    Article  PubMed  CAS  Google Scholar 

  24. Parker MG (1994) Biomechanical and histological concepts in the rehabilitation of patients with anterior cruciate ligament reconstructions. J Orthop Sports Phys Ther 20:44–50

    PubMed  CAS  Google Scholar 

  25. Podesta L, Sherman MF, Bonamo JR, Reiter I (1990) Rationale and protocol for postoperative anterior cruciate ligament rehabilitation. Clin Orth Relat Res 257:262–273

    Google Scholar 

  26. Rebel M (2000) Coordination training after anterior cruciate ligament surgery. Sportverletz Sportschaden 14:12–19

    Article  PubMed  CAS  Google Scholar 

  27. Schenck RC Jr, Blaschak MJ, Lance ED, Turturro TC, Holmes CF (1997) A prospective outcome study of rehabilitation programs and anterior cruciate ligament reconstruction. Arthroscopy 13:285–290

    Article  PubMed  Google Scholar 

  28. Sernert N, Kartus J, Kohler K et al (1999) Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 7:160–165

    Article  PubMed  CAS  Google Scholar 

  29. Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299

    Article  PubMed  CAS  Google Scholar 

  30. Shelbourne KD, Klotz C (2006) What i have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction. J Orthop Sci 11:18–25

    Article  Google Scholar 

  31. Sherman OH, Banffy MB (2004) Anterior cruciate ligament reconstruction: which graft is the best? Arthroscopy 20:974–980

    PubMed  Google Scholar 

  32. Spindler L, Kuhn JE, Freedman KB, Matthes CE, Dittus RS, Harell FE Jr (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32:1986–1995

    Article  PubMed  Google Scholar 

  33. Stanish WD, Lai A (1993) New concepts of rehabilitation following anterior cruciate reconstruction. Clin Sports Med 12:25–58

    PubMed  CAS  Google Scholar 

  34. Thomson LC, Handoll HH, Cunningham A, Shaw PC (2002) Physiotherapist-led programmes and interventions for rehabilitation of anterior cruciate ligament, medial collateral ligament and meniscal injuries of the knee in adults. Cochrane Database Syst Rev

  35. Treacy SH, Barron OA, Brunet ME, Barrack RL (1997) Assessing the need for extensive supervised rehabilitation following arthroscopic ACL reconstruction. Am J Orthop 26:25–29

    PubMed  CAS  Google Scholar 

  36. Trees AH, Howe TE, Dixon J, White L (2006) Exercise for treating isolated anterior cruciate ligament injuries in adults. Cochrane Database Syst Rev

  37. Wilk KE, Reinold MM, Hooks TR (2003) Recent advances in the rehabilitation of isolated and combined anterior cruciate ligament injuries. Orthop Clin North Am 34:107–137

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Musculoskeletal Research Unit, CQ University, PO Box 4045, Rockhampton, QLD, 4700, Australia

    Erik Hohmann

  2. Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, QLD, Australia

    Kevin Tetsworth

  3. The Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia

    Adam Bryant

Authors
  1. Erik Hohmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin Tetsworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adam Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik Hohmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hohmann, E., Tetsworth, K. & Bryant, A. Physiotherapy-guided versus home-based, unsupervised rehabilitation in isolated anterior cruciate injuries following surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 19, 1158–1167 (2011). https://doi.org/10.1007/s00167-010-1386-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1386-8

Keywords

Search

Navigation