Evaluation on the Effectiveness of an Accelerated Anterior ... · Evaluation on the Effectiveness...
Transcript of Evaluation on the Effectiveness of an Accelerated Anterior ... · Evaluation on the Effectiveness...
Evaluation on the Effectiveness of an Accelerated Anterior Cruciate Ligament Reconstruction Rehabilitation Program for Chinese Recreational Players
WONG Y B Physiotherapist II Hospital Authority / Tuen Mun Hospital
Hospital Authority Convention 2014 8th May 2014
Introduction
• Anterior cruciate ligament (ACL) injury
– 25.4% knee injury in high school athletes of US (Swenson 2013)
• Accelerated ACL program
– Effective in elite athletes
– Limited studies in Chinese recreational players
Objective • To evaluate the effectiveness of the accelerated
ACL reconstruction rehabilitation program in Chinese recreational players
Inclusion Criteria • Chinese recreational player • Aged 15 to 50 • ACL injury without meniscal injury, fracture & patella
pathology
Methodology 9-12 months
Return to sports
6 - 8 months Isokinetic training Agility training
12 months Return to sports
Conventional ACL Rehabilitation Program
Wk 2-4 Hinge brace 30-60 deg. NWB
Wk 8-10 FWB
Wk.12 -20
Phase 3 • Isokinetic
training • Agility training
Wk.4-12
Phase 2 • Close kinetic chain
training • Proprioceptive
training
The Accelerated ACL Rehabilitation Program
Wk.2-3
Phase 1 • Early mobilization • FWB
Accelerated program : • Allow earlier
mobilization, FWB & strengthening
• Faster restoration of joint range and muscle strength
• Allow less intensive follow-up in later phase
• Safe return to sports comparable to conventional program
Wk 12 onwards Gentle strengthening
Outcome Evaluation
Rate of returning to sports • Self report Rate of re-injury • Self report
Telephone interview
Post Training 1 year
Isokinetic muscle strength • Low speed (120 deg/sec) • High speed (240 deg/sec)
Cybex (Humac Norm770)
Post-op Week 12
Post-op 1/2 year
Agility • Time hop test Functional leg power • Distance hop test
Hop test
Result – Demographic Data 70 recreational players were recruited (From 2011 to 2013).
0
10
20
30
40
15-24 25-34 35-44 45-50
Sub
ject
No
.
Age group
Age range 15-47 (mean 27)
0
10
20
30
40
155-164 165-174 175-184 185-194
Sub
ject
No
.
Height (cm)
Range of height (cm) 155-190 (mean 172)
0
10
20
30
40
50-59 60-69 70-79 80-89 90-99 100-109
Sub
ject
No
.
Weight (kg)
Range of weight (kg) 50-104 (mean 70)
91%
9%
Males
Females
82.2
56.6 50.1
33.6
115.3
71.8 72.5
44.1
Extensor (120deg/sec)
Extensor (240deg/sec)
Flexor (120deg/sec)
Flexor (240deg/sec)
Before rehabilitation After rehabilitation
Peak Torque Strength (Nm) (p< 0.001)
64.8
72.4 77
86.5 85.5 89.8
97 104.4
Extensor (120deg/sec)
Extensor (240deg/sec)
Flexor (120deg/sec)
Flexor (240deg/sec)
Before rehabilitation After rehabilitation
Peak Torque Ratio (%) (p ≤ 0.001)
Result
Result
3.71
2.87
0
0.5
1
1.5
2
2.5
3
3.5
4
Before rehabilitation After rehabilitation
Seco
nd
s
Improvement in Time hop test (p=0.001)
122.3
143.2
110
115
120
125
130
135
140
145
Before rehabilitation After rehabilitation
Ce
nti
met
re (
cm)
Improvement in Distance hop test (p< 0.001)
Telephone interview: 53 patients were successfully contacted 43 (81%) patients returned to original recreational sports 48 (91%) of them reported without re-injury.
Conclusion
Accelerated ACL rehabilitation program was found to be effective in improving
• Muscle strength
• Agility
• With most subjects return to sports
in Chinese recreational players.
Acknowledgement Our team members
• Ms. MAK MY; Senior Physiotherapist, Physiotherapy Department, TMH, NTWC
• Mr. CHUNG KM; Physiotherapist I, Physiotherapy Department, TMH, NTWC
• Mr. CHIU HN; Physiotherapist II, Physiotherapy Department, TMH, NTWC
Special thank to :
• Ms. POON YHP; Department Manager, Physiotherapy Department, TMH, NTWC
• Dr. WUN YC; Consultant, Department of Orthopedics and Traumatology, Tuen Mun Hospital, NTWC
Reference Slides
0
10
20
30
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<35 36-45 46-55 >55
No
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sub
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No. of sessions
Distribution of session no.
Professional versus Recreational Players
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120
Peak Torque (Nm) Peak Torque Ratio(%)
Osteras et al 1998 TMH
Isokinetic test of knee flexor at 240 deg/sec
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30
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50
60
70
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90
100
Peak Torque (Nm) Peak Torque Ratio(%)
Osteras et al 1998 TMH
Isokinetic test of knee extensor at 240 deg/sec