The effectiveness of a pre-operative home-based physiotherapy programme for chronic anterior cruciate ligament deficiency.
OBJECTIVE
Little evidence supports the prescription of pre-operative rehabilitation in the treatment of chronic anterior cruciate ligament-deficient (ACLD) subjects. The aim of the present study was to assess the effectiveness of a specific six-week pre-operative exercise programme on ACLD knees.


METHODS
A single, masked, controlled study was designed. This comprised two matched groups of 12 chronically ACLD patients awaiting reconstruction and a group of 12 matched uninjured control subjects. Only one ACLD group received a home-based exercise and educational programme. Assessment before and after the exercise intervention included: knee joint stability (clinical and KT1000 evaluation); muscle strength (Cybex II); standing balance and functional performance (agility, [corrected] and subjective tests).


RESULTS
At the time of initial assessment there were no statistically significant differences in any measures for the two ACLD groups but both ACLD groups were significantly different from the uninjured control group as regards quadriceps strength and function. Measures taken after six weeks showed no significant improvement in the untreated ACLD group or in the uninjured control group. The treated ACLD group showed significant improvement in the following measures: quadriceps strength measured at 60 degrees and 120 degrees per second (p < 0.001); single leg standing balance with eyes closed (p < 0.001); instrumented passive stability at 20 lb (89 N) force (p = 0.003); agility and subjective performance (p < 0.001). The incidence of unstable episodes had decreased in the treated ACLD group, reducing further damage to the joint.


CONCLUSIONS
This study leaves little doubt that pre-operative physiotherapy had a positive effect on motor function in ACLD subjects and should be prescribed routinely to maximize muscle stabilizing potential prior to reconstruction. Patients report improved stability and, in certain cases, may avoid surgery. The finding that exercise increased the passive stability of the joint was unexpected and requires further investigation.
Keays
S L
SL
Nambour Selangor Hospital and Division of Physiotherapy, The University of Queensland, Brisbane, Australia. slkeays@optusnet.com.au
Bullock-Saxton
J E
JE
Newcombe
P
P
Bullock
M I
MI
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D006699:Home Care Services; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D053580:Muscle Strength; D004856:Postural Balance; D011300:Preoperative Care; D012421:Rupture; D016896:Treatment Outcome