QUALIFICATION OF SAFE RETURN TO PLAY CRITERIA AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Year 2018, , 7 - 18, 01.03.2018

Sabriye Ercan , Hilmi Mustafa Demir Yurdagül Baygül Atalay Ozan Turgay Tolga Atay Cem Çetin

https://doi.org/10.17343/sdutfd.290419

Cited By: 1

Abstract

Anterior
cruciate ligament (ACL) plays an important role in maintaining the function of
the knee. In case of injury declining of the muscle strength and unstability of
the knee occurs which affects the thigh muscle functions in a bad way.
Conservative or/and surgical methods are used as a treatment method. In
literature, different criterias can be found for return to play. Even though
these criterias were fulfilled, in two years time after first ACL
reconstruction, rerupture of the ACL risk is high.

Purpose
of this study is, compare ACL recontructed patients’ data, who have normal knee
functions according to return to play guideline, to their health extremity and
to non-injuered healthy subjects’ data.

14
healthy male subject and 15 unilaterally ACL reconstructed patient enrolled
into the study. Tegner activity scale, Lysholm Knee Score and active range of
motions were evaluated. Single leg hop test, flamingo balance test, isokinetic
test and proprioceptive evaluations were done too.

There
were no statistically significant differecences demographical datas, activity
levels and knee scores between groups (p>0,05). Passive joint sense at 30˚
has statistically significant difference between operated and healthy knee
(p<0,05, operated knee has better result). Between ACL group patients and
healthy subjects, there were statictically significant differences between
functional tests, proprioseptive measurements and operated extremity hasmtring
muscle strength (p<0,05).

Arthrogenic
muscle inhibition occurs bilaterelly after an unilateral ACL rupture. This
event causes a misguiding for gaining a functional symmetrical extremities.
However knee functions can be insuffienct in contrast to healthy subjects. For
this reason at ACL rehabilitation programme, improving lower extremity
functions should be done bilaterally.

Keywords

Anterior Cruciate Ligament, sportive rehabilitation, return to play guideline

ÖN ÇAPRAZ BAĞ REKONSTRÜKSİYONU SONRASI SPORA GÜVENLİ GERİ DÖNÜŞ KRİTERLERİNİN YETERLİLİĞİ

Abstract

Ön
çapraz bağ (ÖÇB) yaralanması, kas kuvvetinin azalmasına ve instabilite
gelişmesine bağlı olarak uyluk kaslarının fonksiyonunu olumsuz yönde etkiler.
Tedavide konservatif ve/veya cerrahi yöntemler tercih edilir. Literatürde spora
geri dönüş için farklı kriterler önerilmiştir. Her ne kadar bu kriterler
sağlanmış olsa da ÖÇB rekonstrüksiyon sonrası ilk iki yılda rerüptür riski
yüksektir.

Bu
çalışmanın amacı; ÖÇB rekonstrüksiyonu sonrası normal diz fonksiyonlarına
dönenlerin opere taraflarına ait fonksiyonel diz verilerinin incelenmesi, bu
verilerin sağlam taraf ve sağlıklı kontrol grubu verileri ile
karşılaştırılmasıdır.

14
sağlıklı erkek ile unilateral ÖÇB rekonstrüksiyonu geçiren 15 erkek hasta
çalışmaya katıldı. Çalışmamızda Tegner aktivite seviyesini, Lysholm diz puanını
ve aktif eklem hareket açıklığını ölçtük; tek bacak hoplama testini, flamingo
denge testini, izokinetik kas kuvveti ve propriosepsiyon testini uyguladık.

Gruplar
arasında demografik veriler, aktivite düzeyi ve diz skorları açısından istatistiksel
anlamlı farklılık yoktu (p>0,05). 30˚’deki pasif eklem pozisyon duyusu
testinde opere ve sağlam diz arasında opere diz lehine istatistiksel anlamlı
farklılık tespit edildi (p<0,05). ÖÇB yaralanması geçiren hastalar ve
kontrol grubu arasında fonksiyonel testlerde, propriosepsiyon ölçümlerinde ve
opere ekstremitenin hamstring kas kuvvetinde istatistiksel anlamlı farklılık
saptandı (p<0,05).

Unilateral
ÖÇB rüptürü sonrası artrojenik kas inhibisyonu bilateral gelişir. Bu durum,
ekstremite simetrisinin sağlandığı yönünde yanıltıcı yorumlara yol açabilir.
Halbuki diz fonksiyonları sağlıklı kontrol grubu ile kıyaslandığında yetersiz
olabilir. Bu sebeple, ÖÇB rehabilitasyon programında bilateral alt ekstremite
fonksiyonlarını geliştirmeye önem vermeliyiz.

Keywords

Ön çapraz bağ, sportif rehabilitasyon, spora geri dönüş kriterleri

References

• 1-Herrington L, Wrapson C, Matthews M, Matthews H. Anterior Cruciate Ligament reconstruction, hamstring versus bone–patella tendon–bone grafts: a systematic literature review of outcome from surgery. The Knee 2005; 12(1): 41-50.
• 2-Tsepis E, Giakas G, Vagenas G, Georgoulis A. Frequency content asymmetry of the isokinetic curve between ACL deficient and healthy knee. J Biomech 2004;37(6): 857-64.
• 3-Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ 2013; 346: 1-12.
• 4-Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, Wei Q. A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament. The Knee 2011;18(5): 287-93.
• 5-Van Ginckel A, Verdonk P, Victor J, Witvrouw E. Cartilage status in relation to return to sports after anterior cruciate ligament reconstruction. AJSM 2013; 41(3):550-9.
• 6-Jang SH, Kim JG, Ha JK, Wang BG, Yang SJ. Functional performance tests as indicators of returning to sports after anterior cruciate ligament reconstruction. The Knee 2014;21(1). 95-101.
• 7-Ayeni OR, Chahal M, Tran MN, Sprague S. Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg, Sports traumatol, Arthrosc 2012;20(4): 767-77.
• 8-Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. AJSM 2013;41(7):1549-58.
• 9-Kong CG, In Y, Kim GH, Ahn CY. Cross pins versus endobutton femoral fixation in hamstring anterior cruciate ligament reconstruction: minimum 4-year follow-Up. Knee Surg relat Res 2012;24(1): 34-9.
• 10-Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg 2014;134(10): 1417-28.
• 11-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. JOSPT 2012;42(9): 750-9.
• 12-Dauty M, Menu P, Fouasson-Chailloux A, Dubois C. Muscular isokinetic strength recovery after knee anterior cruciate ligament reconstruction revision: preliminary study. Ann Réadaptation Méd Phys 2014;57(1): 55-65.
• 13-Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 2010;40(3):250-266.
• 14-Streich NA, Reichenbacher S, Barié A, Buchner M, Schmitt H. Long-term outcome of anterior cruciate ligament reconstruction with an autologous four-strand semitendinosus tendon autograft. Int Orthop 2013;37(2): 279-84.
• 15-Logerstedt D, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, et al. Single-Legged Hop Tests as Predictors of Self-Reported Knee Function After Anterior Cruciate Ligament Reconstruction The Delaware-Oslo ACL Cohort Study. AJSM 2012; 40(10): 2348-56.
• 16-Hrysomallis C. Relationship between balance ability, training and sports injury risk. Sports Med 2007;37(6): 547-56.
• 17-Zaffagnini S, Grassi A, Muccioli GM, Tsapralis K, Ricci M, Bragonzoni L, Villa. SD, et al. Return to sport after anterior cruciate ligament reconstruction in professional soccer players. The Knee 2014;21(3): 731-5.
• 18-Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 2012;22(2): 116.
• 19-Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, McCarty EC, et al. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. AJSM 2012;40(11), 2517-22.
• 20-Laboute E, Savalli L, Puig P, Trouve P, Sabot G, Monnier G, Dubroca B. Analysis of return to competition and repeat rupture for 298 anterior cruciate ligament reconstructions with patellar or hamstring tendon autograft in sportspeople. Ann Réadaptation Méd Phys 2010;53(10): 598-614.
• 21-Myer GD, Martin L, Ford KR, Paterno MV, Schmitt LC, Heidt RS, Colosimo AJ, et al. No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction evidence for objective return-to-sport criteria. AJSM 2012;40(10):2256-63.
• 22-Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, et al. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg, Sports traumatol, Arthrosc 2011;19(11), 1798-1805.
• 23-Roberts D, Ageberg E, Andersson G, Fridén T. Clinical measurements of proprioception, muscle strength and laxity in relation to function in the ACL-injured knee. Knee Surg, Sports traumatol, Arthrosc 2007;15(1), 9-16.
• 24-Chouteau J, Testa R, Viste A, Moyen B. Knee rotational laxity and proprioceptive function 2 years after partial ACL reconstruction. Knee Surg, Sports traumatol, Arthrosc 2012;20(4), 762-6.
• 25-Nagai T, Heebner NR, Sell TC, Nakagawa T, Fu FH, Lephart SM. Restoration of sagittal and transverse plane proprioception following anatomic double-bundle ACL reconstruction. Knee Surg, Sports traumatol, Arthrosc 2013;21(9), 2048-56.
• 26-Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament a prospectıve, longıtudınal study. J Bone Joint Surg British, 2000;82(6), 801-6.
• 27-Arockiaraj J, Korula RJ, Oommen AT, Devasahayam S, Wankhar S, Velkumar S, Poonnoose PM. Proprioceptive changes in the contralateral knee joint following anterior cruciate injury. Bone Joint J 2013;95(2), 188-91.