title: Knee pain after anterior cruciate ligament reconstruction: evaluation of a rehabilitation protocol.
abstract: BACKGROUND
  Anterior knee pain (AKP) is a rare and difficult complication following anterior cruciate ligament (ACL) reconstruction. This disabling pain is persistent with conventional rehabilitation protocols. The aim of this work is to validate a new rehabilitation protocol that may improve the patients and allow return to daily activities including sports.
  
  
  METHODS
  Forty-three patients identified with functional AKP after ACL reconstruction was enrolled in the rehabilitation protocol between 2009 and 2011. The series included twenty-six patients with hamstring grafting and seventeen patients with patellar tendon transplant. This study compares the functional outcomes and pain scores before and after the isokinetic protocol until the last follow-up at an average of 25.7 months after surgery. The evaluation was performed according to the International Knee Documentation Committee (IKDC) and included a pain assessment using the visual analog scale. Statistical analysis used Student's t-test for unpaired data and the Pearson correlation test for the variables. The IKDC scores were compared by the Wilcoxon test.
  
  
  RESULTS
  Functional outcomes and pain are significantly improved (p<0.0001). The average IKDC score improved with 28 points and the pain improved with 3.2 points on the visual analog scale (VAS). The results are correlated with the follow-up time (p=0.008) but not correlated with the delay between the surgery and the beginning of the isokinetic protocol.
  
  
  CONCLUSIONS
  Isokinetic rehabilitation provides a significant improvement in the knee function as measured by the IKDC score and by the VAS, regardless of the painful period preceding the program. The function improvement continues after the end of the protocol, but the pain may not completely disappear. The isokinetic rehabilitation program may resume functional AKP related to muscular deficit and may be used as the starter of other physical therapy protocols.
  
  
  METHODS
  IV.
authors.affiliation: Département d'Orthopédie-Traumatologie I, CHU Trousseau, 37044, Tours Cedex 1, France, gadea.f@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Gadea
authors.forename: D
authors.initials: D
authors.lastname: Monnot
authors.forename: B
authors.initials: B
authors.lastname: Quélard
authors.forename: R
authors.initials: R
authors.lastname: Mortati
authors.forename: M
authors.initials: M
authors.lastname: Thaunat
authors.forename: J M
authors.initials: JM
authors.lastname: Fayard
authors.forename: B
authors.initials: B
authors.lastname: Sonnery-Cottet
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000534:rehabilitation; D018771:Arthralgia / Q000209:etiology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007719:Knee Joint; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D053581:Muscle Strength Dynamometer; D010149:Postoperative Pain / Q000209:etiology / Q000534:rehabilitation; D052097:Quadriceps Muscle / Q000502:physiology; D012189:Retrospective Studies