Medial patellofemoral ligament rekonstrüksiyonu sonrası kalça abduktör kas kuvvetlendirme egzersizlerinin diz fonksiyonu üzerine etkisi

Öz

Amaç: Bu çalışmanın amacı, medial patellofemoral ligament rekonstrüksiyonu geçirmiş hastalarda diz kas kuvvetlendirme egzersiz programına ek olarak yapılan kalça abduktör kuvvetlendirme egzersizlerinin fonksiyonel iyileşme üzerine etkisini araştırmak idi. Yöntem: Çalışmaya 30 hasta dahil edildi. Hastalar randomize olarak diz kas kuvvetlendirme egzersiz grubu ve diz kuvvetlendirme egzersizlerine ek olarak kalça abduktör egzersiz grubuna ayrılarak 12 haftalık egzersiz programına dahil edildi. Hastaların preoperatif, postoperatif 3., 6. ve 12. aylarda diz fonksiyonları Kujala, (International Knee Documentation Committee) Subjektif Diz Değerlendirme Formu, Tegner ve Lysholm skorları ile değerlendirildi. Bulgular: Diz skorları preoperatif dönemde gruplar arasında benzerdi (p>0,05). Kontrol grubuna kıyasla, 6. ve 12. aylarda Kujala (6. ay: p=0,03, 12. ay: p=0,03), International Knee Documentation Committee Subjektif Diz Değerlendirme Formu (3. ay: p=0,01, 6. ay: p=0,01, 12. ay: p=0,03) ve Lysholm (3. ay: p=0,04, 6. ay: p=0,04, 12. ay: p=0,01) skorları çalışma grubunda daha yüksek bulundu. Benzer şekilde, Tegner aktivite skoru çalışma grubunda, cerrahi sonrası 12. ayda daha yüksek idi (p=0,04). Sonuç: Medial patellofemoral ligament rekonstrüksiyonu geçirmiş bireylerde diz kuvvetlendirme egzersiz programına ek olarak yapılan kalça abduktör kuvvetlendirme egzersizleri diz fonksiyonlarının iyileşmesi açısından sadece diz kuvvetlendirme egzersizlerine kıyasla daha etkiliydi. Bu nedenle rehabilitasyon programına kalça abduktör egzersizlerin dahil edilmesi, performansın gelişmesi açısından önemli olacaktır.

Anahtar Kelimeler

• Patellar dislokasyon
• Rehabilitasyon
• Quadriceps kası
• Diz eklemi
• Kalça eklemi

Effect of hip abductor muscle strengthening exercises on knee function after medial patellofemoral ligament reconstruction

Öz

Purpose: The aim of this study was to investigate the effect of hip abductor strengthening exercises in addition to the knee muscle strengthening exercise program on knee functional recovery in patients who had undergone medial patellofemoral ligament reconstruction. Methods: Thirty patients were included in the study. The patients were randomly assigned to the knee muscle strengthening exercise group and the hip abductor exercise group in addition to the knee strengthening exercises group and included in a 12-week exercise program. Kujala, (International Knee Documentation Committee) subjective knee evaluation form, Tegner and Lysholm scores were evaluated preoperatively at 3rd, 6th and 12th months after surgery. Results: Knee scores were similar between the groups (p>0.05) in the preoperative period. Compared to the control group, Kujala (6th months: p=0.03, 12th months: p=0.03), International Knee Documentation Committee subjective knee evaluation form (3rd months: p=0.01, 6th months: p=0.01, 12th months: p=0.03) and Lysholm (3rd month: p=0.04, 6th month: p=0.04, 12th month: p=0.01) scores were higher in the study group at 6th and 12th months after surgery. Similarly, the Tegner activity score was higher in the study group at 12 months after surgery (p=0.04). Conclusion: Hip abductor strengthening exercises in addition to the knee strengthening exercise program was more effective than only knee strengthening exercises in terms of improving knee functions in individuals who have undergone medial patellofemoral ligament reconstruction. Therefore, the inclusion of hip abductor exercises in the rehabilitation program will be important in terms of improving performance.

Anahtar Kelimeler

• Patellar dislocation
• Rehabilitation
• Quadriceps muscle
• Knee joint
• Hip joint

Kaynakça

1. Hsiao M, Owens BD, Burks R, vd. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. The American journal of sports medicine 2010;38(10):1997-2004.
2. MAcNAB I. Recurrent dislocation of the patella. JBJS 1952;34(4):957-76.
3. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. The American journal of sports medicine 1998;26(1):59-65.
4. Stefancin JJ, Parker RD. First-time traumatic patellar dislocation: a systematic review. Clinical Orthopaedics and Related Research® 2007;455:93-101.
5. Nomura E, Horiuchi Y, Inoue M. Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. The Knee 2002;9(2):139-43.
6. Fithian DC, Paxton EW, Stone ML, vd. Epidemiology and natural history of acute patellar dislocation. The American journal of sports medicine 2004;32(5):1114-21.
7. Bicos J, Fulkerson JP, Amis A. Current concepts review: the medial patellofemoral ligament. The American journal of sports medicine 2007;35(3):484-92.
8. Farr J, Schepsis AA. Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. The journal of knee surgery 2006;19(04):307-16.

9. Camp CL, Krych AJ, Dahm DL, vd. Medial patellofemoral ligament repair for recurrent patellar dislocation. The American Journal of Sports Medicine 2010;38(11):2248-54.
10. Zhang F, Wang J, Wang F. Comparison of the clinical effects of open and closed chain exercises after medial patellofemoral ligament reconstruction. Journal of Physical Therapy Science 2014;26(10):1557-60.
11. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. Journal of Orthopaedic & Sports Physical Therapy 2003;33(11):639-46.
12. Fithian DC, Powers CM, Khan N. Rehabilitation of the knee after medial patellofemoral ligament reconstruction. Clinics in sports medicine 2010;29(2):283-90.
13. Sled EA, Khoja L, Deluzio KJ, vd. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Physical therapy 2010;90(6):895-904.
14. Costa RA, de Oliveira LM, Watanabe SH, vd. Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee. Clinics 2010;65(12):1253-59.
15. Creaby M. It's not all about the knee adduction moment: the role of the knee flexion moment in medial knee joint loading. Osteoarthritis and Cartilage 2015;23(7):1038-40.
16. Hinman RS, Wrigley TV, Metcalf BR, vd. Unloading shoes for osteoarthritis of the knee: protocol for the SHARK randomised controlled trial. BMC Musculoskeletal Disorders 2014;15(1):1-7.
17. Mündermann A, Dyrby CO, Hurwitz DE, vd. Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 2004;50(4):1172-78.
18. Chang A, Hayes K, Dunlop D, vd. Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis & Rheumatism 2005;52(11):3515-19.
19. Kujala UM, Jaakkola LH, Koskinen SK, vd. Scoring of patellofemoral disorders. Arthroscopy: The Journal of Arthroscopic & Related Surgery 1993;9(2):159-63.
20. Kuru T, Dereli E, Yaliman A. Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome. Acta orthopaedica et traumatologica turcica 2010;44(2):152-56.
21. Irrgang JJ, Anderson AF, Boland AL, vd. Development and validation of the international knee documentation committee subjective knee form. The American journal of sports medicine 2001;29(5):600-13.
22. Çelik D, Coşkunsu D, Kılıçoğlu Ö, vd. Translation and cross-cultural adaptation of the international knee documentation committee subjective knee form into Turkish. journal of orthopaedic & sports physical therapy 2014;44(11):899-909.
23. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. The American journal of sports medicine 1982;10(3):150-54.
24. Celik D, Coşkunsu D, Kılıçoğlu Ö. Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability. Clinical Orthopaedics and Related Research® 2013;471(8):2602-10.
25. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research (1976-2007) 1985;198:42-49.
26. Moisio K, Chang A, Eckstein F, vd. Varus–valgus alignment: reduced risk of subsequent cartilage loss in the less loaded compartment. Arthritis & Rheumatism 2011;63(4):1002-09.
27. Singh S, Pattnaik M, Mohanty P, vd. Effectiveness of hip abductor strengthening on health status, strength, endurance and six minute walk test in participants with medial compartment symptomatic knee osteoarthritis. Journal of back and musculoskeletal rehabilitation 2016;29(1):65-75.
28. Hinman RS, Hunt MA, Creaby MW, vd. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis care & research 2010;62(8):1190-93.
29. Tevald MA, Murray A, Luc BA, vd. Hip abductor strength in people with knee osteoarthritis: a cross-sectional study of reliability and association with function. The Knee 2016;23(1):57-62.
30. Chang AH, Chmiel JS, Almagor O, vd. Hip muscle strength and protection against structural worsening and poor function and disability outcomes in knee osteoarthritis. Osteoarthritis and cartilage 2019;27(6):885-94.
31. Harput G, Ulusoy B, Akmese R, vd. Comparison of muscle activation levels and knee valgus between individuals with medial patellofemoral ligament reconstruction and healthy individuals during fatiguing step down task. Clinical Biomechanics 2020;78:105067.
32. Lucas KCH, Jacobs C, Lattermann C, vd. Gait deviations and muscle strength deficits in subjects with patellar instability. The Knee 2020;27(4):1285-90.
33. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. journal of orthopaedic & sports physical therapy 2010;40(2):42-51.
34. Ferber R, Kendall KD, Farr L. Changes in knee biomechanics after a hip-abductor strengthening protocol for runners with patellofemoral pain syndrome. Journal of athletic training 2011;46(2):142-49.
35. Hirata RP, Arendt-Nielsen L, Shiozawa S, vd. Experimental knee pain impairs postural stability during quiet stance but not after perturbations. European journal of applied physiology 2012;112(7):2511-21.
36. Bouët V, Gahéry Y. Muscular exercise improves knee position sense in humans. Neuroscience letters 2000;289(2):143-46.
37. Manske RC, Prohaska D. Rehabilitation following medial patellofemoral ligament reconstruction for patellar instability. International journal of sports physical therapy 2017;12(3):494.
38. Katayama M, Higuchi H, Kimura M, vd. Proprioception and performance after anterior cruciate ligament rupture. International orthopaedics 2004;28(5):278-81.