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The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

ABSTRACT: BACKGROUND:To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). METHOD:A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. RESULTS:The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored 'high' risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p?

SUBMITTER: Carter HM

PROVIDER: S-EPMC7533034 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

Carter Hayley M HM Littlewood Chris C Webster Kate E KE Smith Benjamin E BE

BMC musculoskeletal disorders 20201003 1

<h4>Background</h4>To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR).<h4>Method</h4>A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was u ...[more]

PMID: 33010802

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Project description:Pre- and postoperative rehabilitation are important to the management of patients with anterior cruciate ligament (ACL) reconstruction, but little attention has been given to the costs. This study evaluated the pre- and postoperative rehabilitation charges in patients with ACL reconstruction in the United States.Patients receive preoperative rehabilitation less commonly than postoperative rehabilitation.Retrospective database study.Level 4.Using the PearlDiver database, we identified patients undergoing ACL reconstruction from 2007 through 2011 using Current Procedural Terminology codes. The associated rehabilitation charges billed to insurance providers for 90 days preoperatively and 6 months postoperatively were categorized as physical therapy or as durable medical equipment (DME). The charges were examined by year and geographic region and represented as per-patient average charges (PPACs).A total of 92,179 patients were identified in the study period. The PPAC for rehabilitation was $241 during the 90-day preoperative period and $1876 for the 6-month postoperative period. Patients averaged 2 preoperative sessions for physical therapy, with 44% of patients receiving preoperative rehabilitation in contrast with an average of 17 postoperative sessions per patient in 93% of patients. Rehabilitation charges were greater postoperatively than preoperatively (P < 0.05). Preoperatively, 24% of patients received a DME, while 35% received a DME postoperatively. Preoperative rehabilitation PPACs were highest in the Northeast, followed by Midwest, South, and West (P < 0.05). There were no significant differences in postoperative rehabilitation PPACs for geographic region (P = 0.43).Preoperative rehabilitation charges were lower than postoperative charges. A patient undergoing ACL reconstruction typically received 9 times more sessions of postoperative physical therapy than preoperative.This study found that preoperative supervised rehabilitation for patients with ACL reconstruction was infrequent across the United States.

Project description:OBJECTIVES:To investigate the biomechanical characteristics of patients with anterior cruciate ligament (ACL) injury by gait analysis, surface electromyography (SEMG), and proprioception test, and provide rehabilitation suggestions according to the results. METHODS:In this retrospective cohort study, 90 adults with unilateral ACL injury, ranging in age from 19 to 45?years (66 men and 24 women, average age: 30.03?±?7.91) were recruited for this study form May 2018 to July 2019. They were divided into three groups according to the time after the injury: group A (3-week to 1.5-month), group B (1.5-month to 1?year), and group C (more than 1?year). The SEMG signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) and the root mean square (RMS) were used to assess muscular activity. SEMG were used to analyze muscles function, gait analysis was used to evaluate the walking stability, balance and location assessment were used to analyze the proprioception. RESULTS:Through the comparison between bilateral limbs, all muscles strength shown decreased (RF: 239.94?± 129.70 vs 364.81?±?148.98, P = 0.001; VM: 298.88?±?175.41 vs 515.79?±?272.49, P = 0.001; VL:389.54?± 157.97 vs 594.28?±?220.31, P <?0.001) and the division of proprioception became larger (tandem position: 7.79?±?1.57 vs 6.33?±?1.49, P = 0.001; stance with one foot: 8.13?±?0.84 vs 7.1?±?0.57, P = 0.003; variance of 30°: 6.96?±?3.15 vs 4.45?±?1.67, P = 0.03; variance of 60°: 4.64?±?3.38 vs 2.75?±?1.98, P = 0.044) in the injured side when compared to the non-injured and 26 gait parameters were shown difference in group A. In group B, the muscle strength of VL shown decreased (VL: 381.23?±?142.07 vs 603.9?±?192.72, P <?0.001) and the division of location of 30° became larger (7.62?±?4.98 vs 4.33?±?3.24, P = 0.028) in the injured side when compared to the non-injured side and there were eight gait parameters that showed differences. In group C, the muscle strength and proprioception showed no differences and only 16 gait parameters showed differences between the bilateral limbs. CONCLUSION:The results proved the deterioration of proprioception in 30° of injured side will not recover and non-injury side and will become worse after 1?year from the injury; among the VL, VM, and RF, the recovery rate of VL is the slowest and bilateral straight leg raising (SLR) (30°) is the best way to train it; the gait stability will be worse after 1?year from the injury. Therefore, we suggest that the training for proprioception in 30° and VL are important for the rehabilitation, and the ACL reconstruction should be performed within 1?year.

Project description:PurposeTo compare postoperative pain scores and opioid use between patients undergoing a standard arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft with those undergoing a suture repair augmented with an extracellular matrix scaffold (bridge-enhanced ACL repair) performed through an arthrotomy and to determine factors predictive of postoperative opioid use and levels of overprescription.MethodsA nonrandomized controlled trial was conducted with 20 patients (10 ACLR, 10 bridge-enhanced ACL repair), aged 18 to 35 years. All surgeries were performed by a single surgeon. A pain medication log was provided to patients on discharge. No regional anesthesia was performed. Pain scores via a visual analog pain scale were recorded at each visit. Correlations between preoperative and intraoperative characteristics and postoperative opioid use were determined.ResultsThe total morphine-equivalent dose ranged from 30 to 309 mg (4-42 pills oxycodone) for the ACLR group and 75 to 254 mg (10-34 pills oxycodone) for the bridge-enhanced ACL repair group. The average opioid use per day was 35.8 mg for the patients undergoing bridge-enhanced ACL repair and 44.2 mg for patients undergoing ACLR (P = .29). Pain scores at time points up to 2 years postoperatively were not significantly different between the 2 groups. Across both groups, the average oversupply of oxycodone was 46 pills per patient, a greater than 70% unused opiate rate. Preoperative body mass index and preoperative Knee Injury and Osteoarthritis Outcome Scores pain score were predictive of greater postoperative opioid use per day, whereas age, concurrent meniscal repair, and operative time were not.ConclusionsTotal overall opiate intake was not different between the patients undergoing bridge-enhanced ACL repair through an arthrotomy and those undergoing arthroscopic ACLR. Both groups had similar pain scores from 2 weeks to 2 years postoperatively. Greater body mass index and greater preoperative pain (lower Knee Injury and Osteoarthritis Outcome Scores pain score) correlated with greater postoperative opioid use per day. There was an overprescription of opioids across all patients.Level of evidenceLevel III, case control study (therapeutic).

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The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

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The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review.

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