Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals.
BACKGROUND
There are adverse effects associated with immobilization of the knee after anterior cruciate ligament reconstruction, yet very little is known about how much activity will promote adequate rehabilitation without permanently elongating the graft, producing graft failure, or creating damage to articular cartilage.


OBJECTIVE
Rehabilitation with either an accelerated or nonaccelerated program produces no difference in anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and the synovial fluid biomarkers of articular cartilage metabolism.


METHODS
Randomized controlled clinical trial; Level of evidence, 1.


METHODS
Twenty-five patients who tore their anterior cruciate ligament were enrolled and underwent anterior cruciate ligament reconstruction. Patients were randomized to accelerated rehabilitation or nonaccelerated rehabilitation. At the time of surgery and 3, 6, 12, and 24 months later, measurements of anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and cartilage metabolism were completed.


RESULTS
At the 2-year follow-up, there was no difference in the increase of anterior knee laxity relative to the baseline values that were obtained immediately after surgery between the 2 groups (2.2-mm vs 1.8-mm increase relative to the normal knee). The groups were similar in terms of clinical assessment, patient satisfaction, activity level, function, and response of the bio-markers. After 1 year of healing, synthesis of collagen and turnover of aggrecan remained elevated in both groups.


CONCLUSIONS
Anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft followed by either accelerated or nonaccelerated rehabilitation produces the same increase of anterior knee laxity. Both programs had the same effect in terms of clinical assessment, patient satisfaction, functional performance, and the biomarkers of articular cartilage metabolism. There is concern that the cartilage biomarkers remained elevated for an extended period.
Beynnon
Bruce D
BD
Department of Orthopaedics & Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont, Stafford Hall Room 438A, Burlington, VT 05405-0084, USA. bruce.beynnon@uvm.edu
Uh
Benjamin S
BS
Johnson
Robert J
RJ
Abate
Joseph A
JA
Nichols
Claude E
CE
Fleming
Braden C
BC
Poole
A Robin
AR
Roos
Harald
H
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D015415:Biomarkers / Q000032:analysis; D002358:Cartilage, Articular / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007593:Joint Instability; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012046:Rehabilitation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers