A study of functional recovery following anterior cruciate ligament reconstruction

• Main Author: Letchford, Robert
• Published: Cardiff University 2015
• Subjects: 617.4; R Medicine (General)
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.687693

Introduction: Anterior cruciate ligament reconstruction (ACLR) and rehabilitation is an accepted intervention for non-coping ACL injured subjects. There is an expectation from ACL injured subjects and the international clinical community that ACLR should enable recovery to pre-injury knee function, activity performance and participation. However, few studies use comprehensive methods to assess this expectation and the reality seems to be a highly variable and often incomplete recovery that is difficult to predict. Improved understanding of recovery of these subjects may identify targets for novel rehabilitation interventions that improve outcomes. Methods: Prospective longitudinal data were collected from 74 ACL injured subjects before surgery and on 5 occasions during the first year following ACLR. Data from a matched healthy group (n=61) were used to define healthy normative values. Outcome measures included; Structure (arthroscopic and MRI findings), Function (IKDC SKF, Lysholm, VAS pain), Activity (2D digital video motion analysis of performance and strategy variables during gait, single leg squat and hop for distance) and Participation (Tegner). Group differences and recovery were assessed with inferential statistics; regression methods identified predictors of recovery. Results: These ACL injured subjects were highly symptomatic non-copers with a prolonged period between injury and surgery. There were statistically and clinically significant deficits from healthy in all outcome measures before surgery, which improved one year following ACLR; however the majority failed to fully recover. Bilateral deficits in activity performance and strategy were identified during all three functional activities. Recovery at one year was not predicted by any of the outcome measures in the pre or post-operative period. However, activity performance at one year was predicted by pre-operative and early post-operative gait velocity and squat depth. Conclusions: Whilst these highly symptomatic non-coping ACLD subjects benefited from ACLR and rehabilitation, expectations of full recovery by one year proved unrealistic for most. Pre-operative deficits appear to be too large for current interventions to overcome. Early diagnostics, classification and intervention should be considered to reduce pre-operative impairments. Bilateral and hierarchical deficits in activities suggest that further development of task oriented rehabilitation strategies should be built on biomechanical and motor control/learning theories to improve outcomes. Utilising technology to facilitate greater engagement in rehabilitation and increasing frequency and intensity of rehabilitation interventions should be considered. Further development of clinically applicable methods to measure and provide real time feedback on both performance and strategy in functional activities are therefore required.