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

40

50

60

<35 36-45 46-55 >55

No

. of

sub

ject

s

No. of sessions

Distribution of session no.

Professional versus Recreational Players

0

20

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60

80

100

120

Peak Torque (Nm) Peak Torque Ratio(%)

Osteras et al 1998 TMH

Isokinetic test of knee flexor at 240 deg/sec

0

10

20

30

40

50

60

70

80

90

100

Peak Torque (Nm) Peak Torque Ratio(%)

Osteras et al 1998 TMH

Isokinetic test of knee extensor at 240 deg/sec