title: Does the hyperextension maneuver prevent knee extension loss after arthroscopic anterior cruciate ligament reconstruction?
abstract: BACKGROUND
  Disruption of the anterior cruciate ligament (ACL) is one of the most frequent musculoskeletal injuries affecting physically active men and women. In the United States, an estimated 200,000 ACL reconstructions are performed annually. One of the most common complications of ACL reconstruction is loss of extension. The purpose of this study was to assess the effects of the hyperextension maneuver on preventing knee extension loss after arthroscopic ACL reconstruction.
  
  
  METHODS
  In this prospective randomized clinical trial study, 100 adult patients with a documented complete ACL tear were randomized to two groups. All patients underwent arthroscopic ACL reconstruction with quadrupled semitendinosus and gracilis autograft by the senior author based on the same technique and instruments. However, the hyperextension maneuver was only performed in 50 patients during autograft fixation on the tibial side (case group). The postoperative rehabilitation protocol was similar for both groups. The knee range of motion and extension limit was evaluated at 2, 6, 12, and 24 weeks and at 1 year postoperatively.
  
  
  RESULTS
  One hundred patients (88 male and 12 female) aged from 17-36 years (average 26.9 years) were included in our study. The two groups were similar regarding age, sex, and dominant side involvement (P >0.4).The difference between the two groups was significant only at 2 weeks (P <0.02). After 2 weeks, although the rate of limited extension was higher in the control group, no significant difference was seen between the groups.
  
  
  CONCLUSIONS
  Although the hyperextension technique during graft fixation on the tibial side may induce better range of motion in the first 2 weeks after ACL reconstruction surgery, this effect is not significant after 2 weeks.
  
  
  METHODS
  Therapeutic level II.
authors.affiliation: Department of Knee Surgery, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Yazdi
authors.affiliation: Knee Surgery Fellowship, Department of Knee Surgery, Shafa Rehabilitation Hospital, Iran University of Medical Science, Tehran, Iran. Moradi85ortho@yahoo.com.
authors.forename: Amin
authors.initials: A
authors.lastname: Moradi
authors.affiliation: Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran.
authors.forename: Aida
authors.initials: A
authors.lastname: Sanaie
authors.affiliation: Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran.
authors.forename: Armin
authors.initials: A
authors.lastname: Ghadi
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D053587:Arthrometry, Articular; D001182:Arthroscopy; D064592:Autografts; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D013710:Tendons / Q000637:transplantation; D013812:Therapeutics; D016896:Treatment Outcome
keywords: ACL reconstruction; Extension loss; Hyperextension