Hemstring otogrefti ile ön çapraz bağ rekonstrüksiyonu sonrası progresif eksentrik ve konsentrik egzersiz programının fonksiyonel performansa etkisi

Öz

Amaç:Bu çalışmanın amacı, hemstring otogrefti ile ön çapraz bağ (ÖÇB) rekonstrüksiyonu sonrası klasik rehabilitasyon programına eklenen eksentrik ve konsentrik egzersiz programının fonksiyonel sonuçlar üzerine etkisini incelemekti.

Çalışma planı: ÖÇB rekonstrüksiyonu olan 33 hasta, rastgele olarak çalışma (n=16; yaş ortalaması: 33.87±8.19) ve kontrol (n=17; yaş ortalaması: 32.64±8.21) gruplarına ayrılıp aynı ÖÇB rehabilitasyon programına alındı. Çalışma grubundaki hastalara ilave olarak cerrahiden sonra 3. haftadan başlayarak Monitörize Fonksiyonel Squat Sistemi ile 12 haftalık progresif eksentrik ve konsentrik bir egzersiz programı uygulandı. Gruplar cerrahi öncesi ve 16.hafta sonrasında diz ekstansör ve fleksörlerinin izokinetik kuvveti, fonksiyonel performans (dikey sıçrama, yatay sıçrama testi) ve Lysholm Diz Ölçeği, Ön Çapraz Bağ Yaşam Kalite Anketi (ÖÇB-YKA) skorları açısından karşılaştırıldı.

Bulgular: Dikey sıçrama testi (p=0.012), yatay sıçrama testi (p=0.027), Lysholm diz ölçeği (p=0.002) ve ÖÇB-YKA (p=0.000) sonuçları çalışma grubunda anlamlı derecede fazlaydı. Gruplar arasında diz ekstansör ve fleksör izokinetik kuvveti açısından fark kaydedilmedi (p>0.05).

Çıkarımlar: Hemstring otogrefti ile ön çapraz bağ (ÖÇB) rekonstrüksiyonu sonrası klasik rehabilitasyon programına eklenen eksentrik ve konsentrik egzersiz programı fonksiyonel sonuçları olumlu etkilemektedir.

Anahtar Kelimeler

• Kuvvet; sıçrama performansı; diz fonksiyonu; ön çapraz bağ, yaralanma.

The effect of progressive eccentric and concentric training on functional performance after autogenous hamstring anterior cruciate ligament reconstruction: a randomized controlled study

Öz

Objective:The aim of this study was to assess the functional results of an early onset progressive eccentric and concentric training in patients with autogen hamstring anterior cruciate ligament (ACL) reconstruction.

Methods: Thirty-three patients with autogenous hamstring ACL reconstruction were randomly divided into study (n=16, mean age; 33.87±8.19) and control (n=17, mean age; 32.64±8.21) groups and followed the same ACL rehabilitation program. Additionally, the study group followed a progressive eccentric and concentric training for 12 weeks on the Monitorized Functional Squat System (MFSS) beginning 3 weeks after surgery. The groups were compared according to the isokinetic strength of the knee extensors and flexors, functional performance (the vertical jump test, a single hop for distance test) and the Lysholm knee scale, the Anterior Cruciate Ligament-Quality of Life Questionnaire (ACL-QOL), before and 16 weeks after the surgery.

Results: The functional outcomes in terms of the vertical jump test (p=0.012), a single hop-for-distance test (p=0.027), the Lysholm knee scale (p=0.002) and the ACL-QOL questionnaire (p=0.000) demonstrated significantly greater improvement in the study group. No significant difference was reported between groups for isokinetic strength of the knee extensors and flexors (p>0.05).

Conclusion: Adding progressive eccentric and concentric exercises to the standard rehabilitation protocol may improve the functional results after ACL reconstruction with autogen hamstring grafts

Anahtar Kelimeler

• Strength
• hop performance
• knee function
• anterior cruciate ligament injury

Kaynakça

1. Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 2005;21:791-803. CrossRef
2. Thomeé R, Neeter C, Gustavsson A, Thomeé P, Augustsson J, Eriksson B, et al. Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:1143-51. CrossRef
3. Neeter C, Gustavsson A, Thomeé P, Augustsson J, Thomeé R, Karlsson J. Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 2006;14:571-80. CrossRef
4. Lautamies R, Harilainen A, Kettunen J, Sandelin J, Kujala UM. Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2008;16:1009-16. CrossRef
5. Ageberg E, Roos HP, Silbernagel KG, Thomeé R, Roos EM. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 2009;17:162-9. CrossRef
6. Ageberg E, Thomeé R, Neeter C, Silbernagel KG, Roos EM. Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup. Arthritis Rheum 2008;59:1773-9.
7. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, et al. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2011;19:179880 CrossRef
8. Neuman P, Kostogiannis I, Fridén T, Roos H, Dahlberg LE, Englund M. Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury--a prospective cohort study. Osteoarthritis Cartilage 2009;17:284-90. CrossRef

9. Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, et al. Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 2010;38:2201-10. CrossRef
10. Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364-80. CrossRef
11. Wilk KE, Reinold MM, Hooks TR. Recent advances in the rehabilitation of isolated and combined anterior cruciate ligament injuries. Orthop Clin North Am 2003;34:107-37. CrossRef
12. Majima T, Yasuda K, Tago H, Tanabe Y, Minami A. Rehabilitation after hamstring anterior cruciate ligament reconstruction. Clin Orthop Relat Res 2002;397:370-80.
13. Maffiuletti NA, Bizzini M, Schatt S, Munzinger U. A multi-joint lower-limb tracking-trajectory test for the assessment of motor coordination. Neurosci Lett 2005;384:106-11. CrossRef
14. Ozer D, Senbursa G, Baltaci G, Hayran M. The effect on neuromuscular stability, performance, multi-joint coordination and proprioception of barefoot, taping or preventative bracing. Foot (Edinb) 2009;19:205-10. CrossRef
15. Balci P, Tunay VB, Baltaci G, Atay AO. The effects of two different closed kinetic chain exercises on muscle strength and proprioception in patients with patellofemoral pain syndrome. [Article in Turkish] Acta Orthop Traumatol Turc 2009;43:419-25. CrossRef
16. Tunay VB, Baltacı G, Atay AO. Hospital-based versus home-based proprioceptive and strengthening exercise programs in knee osteoarthritis. Acta Orthop Traumatol Turc 2010;44:270-7. CrossRef
17. Yosmaoğlu HB, Baltacı G, Kaya D, Ozer H, Atay A. Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft. Acta Orthop Traumatol Turc 2011;45:240-7. CrossRef Yosmaoglu HB, Kaya D, Guney H, Nyland J, Baltaci G, Yuksel I, et al. Is there a relationship between tracking ability, joint position sense, and functional level in patellofemoral pain syndrome? Knee Surg Sports Traumatol Arthrosc 2013;21:2564-71. CrossRef
18. Myer GD, Schmitt LC, Brent JL, Ford KR, Barber Foss KD, Scherer BJ, et al. Utilization of modified NFL combine testing to identify functional deficits in athletes following ACL reconstruction. J Orthop Sports Phys Ther 2011;41:377-87. CrossRef
19. Järvelä T, Kannus P, Latvala K, Järvinen M. Simple measurements in assessing muscle performance after an ACL reconstruction. Int J Sports Med 2002;23:196-201. CrossRef Risberg MA, Ekeland A. Assessment of functional tests after anterior cruciate ligament surgery. J Orthop Sports Phys Ther 1994;19:212-7. CrossRef
20. Daniel DM, Malcom L, Stone ML, Perth H, Morgan J, Riehl B. Quantification of knee stability and function. Contemp Orthop 1982;5:83-91.
21. Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 2007;87:337-49. CrossRef
22. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982;10:150-4. CrossRef
23. Celik D, Coşkunsu D, Kiliçoğlu O. Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability. Clin Orthop Relat Res 2013;471:2602-10. CrossRef
24. Mohtadi N. Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency. Am J Sports Med 1998;26:350-9.
25. Bizzini M, Gorelick M, Munzinger U, Drobny T. Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts. Clin J Sport Med 2006;16:4-9. CrossRef de Jong SN, van Caspel DR, van Haeff MJ, Saris DB. Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 2007;23:21-8. CrossRef
26. Augustsson J, Thomeé R, Karlsson J. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2004;12:350-6. CrossRef
27. Eitzen I, Holm I, Risberg MA. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med 2009;43:371-6. CrossRef
28. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007;35:564-74. CrossRef
29. Fitzgerald GK, Lephart SM, Hwang JH, Wainner RS. Hop tests as predictors of dynamic knee stability. J Orthop Sports Phys Ther 2001;31:588-97. CrossRef
30. Petschnig R, Baron R, Albrecht M. The relationship between isokinetic quadriceps strength test and hop tests for distance and one-legged vertical jump test following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 1998;28:23-31. CrossRef
31. Dauty M, Tortellier L, Rochcongar P. Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature. Int J Sports Med 2005;26:599-606. CrossRef
32. Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2012;42:750-9. CrossRef
33. Xergia SA, Pappas E, Zampeli F, Georgiou S, Georgoulis AD. Asymmetries in functional hop tests, lower extremity kinematics, and isokinetic strength persist 6 to 9 months following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2013;43:154-62. CrossRef
34. Lentz TA, Zeppieri G Jr, Tillman SM, Indelicato PA, Moser MW, George SZ, et al. Return to preinjury sports participation following anterior cruciate ligament reconstruction: contributions of demographic, knee impairment, and self-report measures. J Orthop Sports Phys Ther 2012;42:893-901. CrossRef