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Effects of early extension on the ACL reconstructed knee

1 May 1990


Current literature does not substantiate that there is a best way to rehabilitate an anterior cruciate ligament (ACL) reconstructed knee. This paper investigates the effects of allowing the reconstructed knee to go into terminal extension immediately after surgery. Range of motion (ROM) patterns of full extension in the postsurgical brace were compared to bracing with ROM restrictions into full extension initially after ACL reconstruction. A retroactive chart review of the 109 medical records was performed for patients having surgeries done within the last two years by various surgeons in Oregon. Only those patients having the same type of reconstruction (middle third of the patellar tendon) were used for the study. Each patient was mailed a Lysholm knee rating questionnaire to assess the function and stability of their reconstructed knee. Sixty-four questionnaires were returned. They were scored on a 100 point scale and grouped according to their brace restrictions. A t-test was performed to determine any significant difference between the two groups. The t-test performed on the Lysholm scores found no significant difference between groups at the 95% confidence level (p = .05). The ROM progression for the early extension group was much better, averaging within five degrees of full extension by the seventh week, compared to fifteen degrees for the restricted group. However, the restricted group had better initial flexion range, averaging approximately 100 degrees the first week of rehabilitation, compared to a 65 degree average for the terminal extension group. However, the groups had similar flexion ranges by the twelfth week. From the results of this study, it may be assumed that early terminal extension does not jeopardize the function and stability of the reconstructed knee. In fact, it may allow the patient to achieve full extension sooner with less pain and effort. Significant ROM progression differences were found between patients depending on what surgeon performed the reconstruction. It may be that the specific surgical technique influences the success of the ACL reconstruction more than the rehabilitation protocol.


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