Research Update Do Early Quadriceps Exercises Affect the Outcome of ACL reconstruction. A randomised controlled trial. Australian Journal of Physiotherapy (2005) 51 (1):9-17 Shaw T, Williams M, Chipchase L
One of the most common injuries to the knee, the loss of an ACL not only produces abnormal kinematics, but also frequently results in major degenerative changes in the knee. Attaching to the posterior aspect of the medial surface of the lateral femoral condyle and distally to the tibial fossa it acts as one of the main stabilisers of the knee. Commonly injured during twisting and hyperextension activities with the knee grounded, patients most commonly complain of episodes of giving way and instability of the knee.
Depending upon the functional and sporting demands of the patient surgical reconstruction of the ACL using either a bone patella-tendon bone or semitendinous hamstring graft may be necessary. Typically physiotherapy commences preoperatively followed with postoperative rehabilitation with the patient usually returning to full function and activity within 9 months. Preoperative physiotherapy commences early during the acute stages and aims to restore ROM, decrease pain and swelling and strength retraining (Lucy 2001). There have been few studies into the effectiveness of early physiotherapy intervention during the early postoperative phases. This particular study investigated whether physiotherapy intervention, specifically quadriceps exercises during the acute post op rehabilitation program, affected the outcome for ACL reconstruction over 6 months.
Researchers from University of South Australia together with Sports Medicine South Australia followed 103 subjects undergoing ACL reconstruction who agreed to participate in the study. Outcome measures used to assess the intervention during the study were ROM, quadriceps lag, limb circumference, pain, knee laxity, hop, Cincinnati Knee rating system (a subjective questionnaire incorporating symptoms, sports activity, problems with sport and occupation) and iso-kinetic strength. Subjects were randomly allocated to one of two treatment regimes (Quadriceps and No Quadriceps exercise group). The exercises were administered via experienced physiotherapists from Sports Medicine South Australia. On follow up at six months there were significant differences between ROM, Cincinnati Knee rating system and knee laxity.
Those in the quadriceps exercise group noted rapid improvement in knee ROM particularly within one month of treatment (early restoration of range, full weight bearing, strength training particularly closed chain exercises are good prognostic factors for recovery and return to function).
Additionally, subjects in the No Quadriceps exercise group also displayed a higher incidence of anterior-posterior laxity when compared to the Quadriceps exercise group. This increased incidence of knee instability can result in ongoing knee pain leading to re-injury, revision surgery and early degenerative changes to the knee. This study highlights the effectiveness of early physiotherapy prescription of exercises that can be safely administered during the early stages of rehab following ACL reconstruction thus assisting in a more rapid and sustainable return to sport and function.
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