Anterior Cruciate Ligament Surgery 1 Post-Operative Effects of Anterior Cruciate Ligament Surgery

Post-Operative Effects of Anterior Cruciate Ligament Surgery Alexandrea Flint April 22, 2014

Anterior Cruciate Ligament Surgery 2 Chmielewski, Terese L., Debi Jones, Tim Day, Susan M. Tillman, Trevor A. Lentz, and Steven Z. George. "The Association of Pain and Fear of Movement/Reinjury With Function During Anterior Cruciate Ligament Reconstruction Rehabilitation." Journal of Orthopaedic & Sports Physical Therapy 38.12 (2008): 746-753. Print. Chmielewski and his team used a clinical database to extract 97 patients information that had recently had anterior cruciate ligament surgery within the last year. The group of researchers were curious about the fear of reinjury and movement during ACL reconstruction rehabilitation. They hypothesized that the fear of reinury and movement post-surgery would decrease as the time of rehabilitation increased, while the function of the patients knees would increase significantly. The team concluded that fear of movement and or reinjury decreased during ACL reconstruction rehabilitation and were greatly associated with the timeframe in which the patients returned back to sports. This article is significant in my research because of the fact that it examines the psychological effects of patients who have undergone ACL reconstruction. These post-surgical effects are key to my findings especially since this article explains the mental aspects of the healing process during rehabilitation. Crawford, Dennis C., Sara E. Hallvik, Ryan C. Petering, Samantha M. Quilici, Loren O. Black, Stephanie A. Lavigne, Jodi Lapidus, and Lynn M. Marshall. "Post-operative complications following primary ACL reconstruction using allogenic and autogenic soft tissue grafts: Increased relative morbidity risk is associated with increased graft diameter." The Knee 20.6 (2013): 520-525. Print. Dennis Crawford and his team of experts took on the task of comparing the risk of complications associated with allogenic grafts and autogenic grafts during routine follow ups six months following surgery. The team restricted their study to people ages 12 to 60 years of age; the group of patients remaining contained 413 people. The group hypothesized that allogenic grafts were associated with a decreased risk of complications within the six month time span of rehabilitation. They found that 66% of the 413 people used in the study received allograft surgery, which demonstrated an increased risk of complications compared to the autograft tissue. This article is important to my research because it explains the significance between surgeries and the post-operative effects that they may have. The difference between the surgeries had an impact on complications that patients went through and that is pertinent to my research. Eitzen, Ingrid, Hvard Moksnes, Lynn Snyder-Mackler, and May Arna Risberg. "A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury." Journal of Orthopaedic & Sports Physical Therapy 40.11 (2010): 705-721. Print. Ingrid Eitzen and her team decided present their exercise therapy program to patients and observe the effects that it had on knee function in the early stages after anterior cruciate ligament rehabilitation. The crew included 100 patients in their program within a short three weeks after surgery. Knee function before and after this program were recorded in reference to quadriceps tests, hamstrings tests, and hop tests. Eitzen hypothesized with her team that this program would significantly help patients within the early stage of rehabilitation. The results concluded that there were significant improvements in the posttest compared to the pretest for all patients, whether they were categorized as copers or noncopers. This short term exercise program is believed to have a significant effect on patients in the early stages of rehab. The team is proud of their work and believes that this program should be incorporated into all early stage rehabilitation programs. I chose this article because of the postoperative program that the team designed for the early stages in rehab to improve the rate at which an

Anterior Cruciate Ligament Surgery 3 athlete can return to sports. This study has revolutionized anterior cruciate ligament reconstruction rehabilitation by designing a program that makes the rehab quicker for athletes. Kim, Kyung-Min. "Effects Of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction On Quadriceps Strength, Function, And Patient-Oriented Outcomes: A Systematic Review." Journal of Orthopaedic and Sports Physical Therapy 40 (2010): 383-391. Print. Doctor Kim and his team of experienced researchers performed a review of randomized control trials on the effects of neuromuscular electrical stimulation on functional performance of quadriceps following ACL reconstruction. This group included 8 randomized control trials after limiting their groups extensively to include the patients that they wanted. After extensive research the team found out that neuromuscular electrical stimulation (NMES) is more effective than exercise alone when it comes to quadriceps strength. The team however was not able to conclude whether or not NMES had an effect on the functional performance of quadriceps. The team also found inconsistencies in the NMES parameters and the application of the NMES. Although the research did not conclude all that the team wished, it did help my research in proving that neuromuscular electrical stimulation may increase the function of quadriceps strength. With this information post-operative effects may change and possibly improve the time of recovery in athletes after ACL reconstruction. Lentz, Trevor A., Giorgio Zeppieri, Susan M. Tillman, Peter A. Indelicato, Michael W. Moser, Steven Z. George, and Terese L. Chmielewski. "Return to Preinjury Sports Participation Following Anterior Cruciate Ligament Reconstruction: Contributions of Demographic, Knee Impairment, and Self report Measures." Journal of Orthopaedic & Sports Physical Therapy 42.11 (2012): 893-901. Print. Lentz and his team conducted a study to examine the differences in the clinical variables between patients that return to sports level injuries as opposed to those who dont a year after surgery. The team included 94 patients, including 60 men that were post anterior cruciate ligament reconstruction one year after the fact. Of the 94 patients 52 or 55% said yes to returning to the same level of sports that they did compared to preinjury. One very intriguing fact of this study was that patients that said yes to returning to sports had less knee effusion, fewer cases of knee instability levels, a lower knee pain, and a higher quadriceps peak. The factors that were most strongly associated to a return to sports were selfreported knee function, knee effusion, and the cases of instability. This article is one of the most significant articles to my research due to the fact that it proves that patients who returned to the same sport levels after ACL reconstruction were better off than patients who decided to retire from those strenuous activities. In terms of post-operative measures in most cases patients would be better off returning to the same sport levels a year after ACL reconstruction in order to maintain a healthy lifestyle. Mcdermott, Ian D.. "Graft options for ACL reconstructive surgery." Orthopaedics and Trauma 27.3 (2013): 156-163. Print. Mcdermott conducted a research study with his team on all of the different graft options that are offered to patients for ACL reconstructive surgery. These graft options include autografts, allografts, xenografts, and synthetic grafts; among hamstring grafts and tendon grafts. In his article Ian Mcdermott includes all of the postives and negatives in each surgery that a patient may receive which is advantageous to future patients. Another huge aspect of this article is the inclusion of where you may receive these grafts along with the diagrams of how the grafts are reconstructed in your knee. The graft

Anterior Cruciate Ligament Surgery 4 strength and diameter is included in charts in this article for the necessary graft that a patient may need in accordance to their knee structure. I chose this article for the mere fact that it thoroughly explains the difference in receiving the different grafts. It pertains to my research because of the fact that Ian includes the positive and negative effects of getting these grafts, which include post-operative effects. Murray, Martha M.."Use of a biomedical scaffold to stimulate anterior cruciate ligament healing also minimizes Posttraumatic Osteoarthritis after surgery." The American Journal of Sports Medicine 41 (2013): 1762-1772. Print. Martha M. Murray accompanied by Braden Fleming researched what the effect would be if surgeons used a biomedical scaffold on posttraumatic osteoarthritis. The team of two hypothesized that the structural properties of ACLs treated with bioenhanced ACL repair, bioenhanced ACL reconstruction, and conventional ACL treatments would have results superior to untreated ACLs. They took 64 Yucatan mini pigs and had them undergo procedures in the four above groups to see what the results would yield. The results concluded that the bioenhanced ACL repair, bioenhanced ACL reconstruction, and conventional ACL surgery yielded less tissue damage after 12 months of healing then no treatment at all. This proved the partnership right and made great strides for athletes looking for an answer as to whether or not to get surgery. These results greatly helped my research in the fact that it was concluded that any type of ACL surgery was significantly better than none at all. As for athletes it is not stated which is better for them but it is assumed seeing as these results were for people who were not looking to return back to sports. Myer, Gregory D., Laura C. Schmitt, Jensen L. Brent, Kevin R. Ford, Kim D. Barber Foss, Bradley J. Scherer, Robert S. Heidt, Jon G. Divine, and Timothy E. Hewett. "Utilization of Modified NFL Combine Testing to Identify Functional Deficits in Athletes Following ACL Reconstruction." Journal of Orthopaedic & Sports Physical Therapy 41.6 (2011): 377-387. Print. Myers and his team of researchers wanted to see if they could use modified NFL Combine Testing to identify deficits in athletes post ACL reconstruction. The group took 18 patients with a median age of 16 who had returned to sports within a year of anterior cruciate ligament reconstructive surgery. They then put these athletes through the same testing that NFL players go through to see if the functional performance would be the same as it was during regular testing. The hypothesis was that there would be a difference due to the testing due to the extensive coverage of movements. They concluded that there were unilateral deficits while they were not evident in bipedal performance or during the modified testing in that matter. Although the groups hypothesis was proved wrong it showed great advances in respect to knowing that the NFL Combine Testing would not show a significant difference in deficits. A process of elimination is sometimes necessary in conclusive research so that the next group who works off of your findings knows not to try the same thing. I picked this article to show the process of elimination and because hypotheses are not always correct but the research always has a purpose in the long run. Piva, Sara. "Patella Fracture during Rehabilitation After Bone-Petallar Tendon- Bone Anterior Cruciate Ligament Construction." Journal of Orthopedic Sports and Physical Therapy 39 (2009): 278-286. Print. Sara Piva decided to do research on patella fracture during rehabilitation of the anterior cruciate ligament which is really rare to find. This fracture has been seen in two cases when there was the use of a bone-petallar tendon-bone graft autograft. In both cases the patients were 23 year old males who were undergoing ACL reconstructive rehabilitation and were both increasingly sustaining normal

Anterior Cruciate Ligament Surgery 5 improvements of rehab until the fracture occurred. Piva in her explanatory research thinks that following ACL reconstruction clinicians need to improve quadriceps strength as well as providing strength for the healing graft. The patients should protect the patellar donor site as well as try to minimize the patellofemoral pain. This article is very unique in the respect that it covers research that is not very popular in the field of the anterior cruciate ligament healing process. I chose this because of the rarity of the subject, showing that there are many different complications while trying to go through the rehabilitation process. Quatman, C. E., A. Kiapour, C. K. Demetropoulos, A. Kiapour, S. C. Wordeman, J. W. Levine, V. K. Goel, and T. E. Hewett. "Preferential Loading of the ACL Compared to the MCL during Landing: A Novel In Sim Approach Yields the Multi-Planar Mechanism of Dynamic Valgus during ACL Injury." Orthopaedic Journal of Sports Medicine 1.4 Suppl (2013): 1-10. Print. Carmen Quatman and a group of determined researchers decided to discover the differences between the ACL and MCL during landing and the possible loading preferences that certain patients may have. The group hypothesized that knee abduction and internal tibial rotation movements would be disproportionate with an increase in ACL strain compared to the MCL strain. They took 17 lower extremity cadavers (9 female and 8 male) and simulated testing of a broad range of landings after jumps to see the results. It was concluded that anterior cruciate ligament failure occurred 15 out of the 17 times while the tibial shear force and knee abduction movements were significantly higher in the ACL. The magnitude of the applied loads, no matter how high they were, were still not sufficient to compromise the MCLs integrity. This is a great research study that proves that the tearing of the ACL does not lead to a torn MCL or necessarily a meniscus. I chose this article for the pure fact that it shows that the outcome of the ACL does not always determine what will happen to the MCL. In regards to recovery and post-surgery it explains that there is no correlation between ACL and MCL strains or tears. Risberg, May, Inger Holm, and Ole Tjomsland. "Prospective Study of Changes in Impairments and Disabilities after Anterior Cruciate Ligament Reconstruction ." Journal of Orthopedic and Sports Physical Therapy 29 (1999): 400-413. Print. Risberg along with her cooperatives designed a research plan to find out the possible changes in impairments and disabilities after ACL reconstruction. The team also wished to assess the relationships that may be crucial to ACL surgery within 2 months to a year after surgery. There were 60 patients who had received ACL surgery in the past year who participated in this study. The group used disability measures, the Cincinnati knee score and lower limb performance with follow ups 3 and 6 months and 1 and 2 years after the reconstructive surgery. The Cincinnati knee score performance increased in improvement from 1 year as opposed to 6 months. After the results came in the group concluded that up to 2 years may be needed in order to regain normal quadriceps muscle performance following ACL reconstruction. Also the pain experienced in the knee explained the outcome of the Cincinnati knee score performance. This article contributed to my research by showing that along with rehab, time may be needed to heal certain aspects of the knee after it has undergone such a major ACL surgery. Robbins, Shawn M.k., Jessica M. Clark, and Monica R. Maly. "Longitudinal Gait and Strength Changes Prior to and Following an Anterior Cruciate Ligament Rupture and Surgical Reconstruction: A Case Report." Journal of Orthopaedic & Sports Physical Therapy 41.3 (2011): 191-B4. Print. Shawn Robbins along with his intelligent group of researchers did a case study on a 23 year old woman who sustained a noncontact rupture of her right ACL. This is indeed a rare case that examines deficits following anterior cruciate ligament ruptures and subsequent reconstructive surgery. The group

Anterior Cruciate Ligament Surgery 6 collected both kinematic and kinetic gait data along with knee strength and range of motion. Before her injury the patient had low external knee flexion movement during the gait. This case and research set up future studies that may need to examine if a low external knee flexion movement or a sport related injury may cause ACLs to rupture. 13 months after her surgery the patient still experienced deficits in gait and strength. This article was relevant in my research because of the fact that the ACL is still yet to be discovered. There is a lot of things that we as researchers are not aware of and there are so many things that we can discover about the anterior cruciate ligament. Rare cases like these are a gateway to new discoveries and research cases that may be advantageous in the future. Schmitt, Laura C., Mark V. Paterno, and Timothy E. Hewett. "The Impact of Quadriceps Femoris Strength Asymmetry on Functional Performance at Return to Sport Following Anterior Cruciate Ligament Reconstruction." Journal of Orthopaedic & Sports Physical Therapy 42.9 (2012): 750-759. Print. Schmitt and her group of researchers conducted a cross sectional study to investigate the quadriceps femoris muscle strength asymmetry at the time of return to sport on self- reported function. They researchers used 55 individuals with a mean age of 17 years who were cleared to return to sports and 35 uninjured individuals to participate in the study. The group of previously injured individuals was divided into a high quadriceps group and a low quadriceps group. A knee evaluation score sheet was used to assess self-reported function while hop tests were used to determine functional performance. The groups of previously hurt individuals score significantly lower than the control group of individuals who were healthy. It was concluded that individuals post-surgery who had weaker quadriceps femoris function demonstrated weaker function whereas the stronger group demonstrated results closer to the control group. This is a very significant article for my research because of the fact that this research group proved that individuals who had stronger quadriceps femoris were likely to return to sports as if they had never been injured. This is very important for athletes to realize that they need to really strengthen their quads in order to maintain a higher level of rehabilitation. Snow, Shannon L., and Shaun J. O'laughlin. "Limited Knee Extension Following Anterior Cruciate Ligament Injury." Journal of Orthopaedic & Sports Physical Therapy 39.8 (2009): 635-635. Print. Snow along with Shaun Olaughlin researched a certain case where a 24 year old man had knee pain for a month after reporting twisting his knee. At the time of his injury the man reported hearing a popping noise, with immediate swelling and an inability to bear weight on that particular knee. When he was sent to the Physical Therapist, right knee effusion was noted along with a lack of extension in that knee. Finally after seeing no significant increase in the knee he received an MRI which revealed that there was indeed a right tear in his anterior cruciate ligament. The tearing of the ACL explained why there was a lack of extension in the right knee along with knee effusion. This is significant because of the signs that your body gives you after you tear your ACL whether it is sport related or not. The sooner an individual recognizes that their ACL is torn the sooner they may receive surgery to fix the problem at hand. Also it shows the importance of receiving reconstructive surgery and how it may better your knee extension and your knee in general. Sugimoto, Dai, Gregory D. Myer, Heather M. Bush, Maddie F. Klugman, Jennifer M. Medina Mckeon, and Timothy E. Hewett. "Compliance With Neuromuscular Training and Anterior Cruciate Ligament Injury Risk Reduction in Female Athletes: A Meta-Analysis." Journal of Athletic Training 47.6 (2012): 714-723. Print. Dai Sugimoto along with a team of experts examined the compliance of neuromuscular training and anterior cruciate ligament injury risk reduction in females. The group used different scholarly databases

Anterior Cruciate Ligament Surgery 7 to find ACL prevention articles to compare and combine. Along with this search the researchers made sure that the number of ACL injuries was reported, what neuromuscular training was used, females were included, the study design was controlled and compliance data was included. This limited the number of articles that were used but also made the data that they collected very specific and significant to their design study (6 of 205 studies were used). It was concluded that ACL rates were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance. The group believes that attending and acquiring these neuromuscular trainings may indeed be an important factor in preventing ACL injuries. I chose this article of ACL prevention of injuries because of the fact that in some parts of the article it differentiates the probability of woman tearing their ACLs compared to men. This is very advantageous to researchers and my research because if there is a difference in how and why women tear their ACLs then maybe there are certain ways to treat womens ACLs compared to men, and the rehabilitation time.