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Methodist Sports Medicine Center, Indianapolis, Indiana
Methodist Sports Medicine Center, Indianapolis, Indiana
To overcome many of the complications after ACL reconstruction (prolonged knee stiffness, limitation of complete extension, delay in strength recovery, anterior knee pain), yet still maintain knee stability, we devel oped a rehabilitation protocol that emphasizes full knee extension on the first postoperative day and immediate weightbearing according to the patient's tolerance. Of 800 patients who underwent intraarticular ACL patellar tendon-bone graft reconstruction, performed by the same surgeon, the last 450 patients have followed the accelerated rehabilitation schedule as outlined in the protocol. A longer than 2 year followup is recorded for 73 of the patients in the accelerated rehabilitation group. On the 1 st postoperative day, we encouraged these patients to walk with full weightbearing and full knee extension. By the 2nd postoperative week, the patients with a 100° range of motion participated in a guided exercise and strengthening program. By the 4th week, patients were permitted unlimited activities of daily living and were allowed to return to light sports activities as early as the 8th week if the Cybex strength scores of the involved extremity exceeded 70% of the scores of the noninvolved extremity and the patient had completed a sport-specific functional/agility pro gram. The patient database was compiled from fre quent clinical examinations, periodic knee question naires, and objective information, such as range of motion measurements, KT-1000 values, and Cybex strength scores. A series of graft biopsies obtained at various times have revealed no adverse histologic re action. The evidence indicates that in this population, the accelerated rehabilitation program has been more effective than our initial program in reducing limitations of motion (particularly knee extension) and loss of strength while maintaining stability and preventing an terior knee pain.
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M. D. Shaieb, D. M. Kan, S. K. Chang, J. M. Marumoto, and A. B. Richardson A Prospective Randomized Comparison of Patellar Tendon Versus Semitendinosus and Gracilis Tendon Autografts for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., March 1, 2002; 30(2): 214 - 220. [Abstract] [Full Text] [PDF]
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M. C Morrissey, W. I Drechsler, D. Morrissey, P. R Knight, P. W Armstrong, and T. B McAuliffe Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction Physical Therapy, January 1, 2002; 82(1): 35 - 43. [Abstract] [Full Text] [PDF]
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W. B. Kibler and B. Livingston Closed-Chain Rehabilitation for Upper and Lower Extremities J. Am. Acad. Ortho. Surg., November 1, 2001; 9(6): 412 - 421. [Abstract] [Full Text] [PDF]
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A. K. Aune, I. Holm, M. A. Risberg, H. K. Jensen, and H. Steen Four-Strand Hamstring Tendon Autograft Compared with Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction: A Randomized Study with Two-Year Follow-Up Am. J. Sports Med., November 1, 2001; 29(6): 722 - 728. [Abstract] [Full Text] [PDF]
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J. J. Costi, A. J. Kelly, T. C. Hearn, and D. K. Martin Comparison of Torsional Strengths of Bioabsorbable Screws for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., September 1, 2001; 29(5): 575 - 580. [Abstract] [Full Text] [PDF]
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G. K.H. Wu, G. Y.F. Ng, and A. F.T. Mak Effects of Knee Bracing on the Sensorimotor Function of Subjects with Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., September 1, 2001; 29(5): 641 - 645. [Abstract] [Full Text] [PDF]
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E. Tsuda, Y. Okamura, Y. Ishibashi, H. Otsuka, and S. Toh Techniques for Reducing Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft Am. J. Sports Med., July 1, 2001; 29(4): 450 - 456. [Abstract] [Full Text] [PDF]
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Y. Laufer, J. D. Ries, P. M Leininger, and G. Alon Quadriceps Femoris Muscle Torques and Fatigue Generated by Neuromuscular Electrical Stimulation With Three Different Waveforms Physical Therapy, July 1, 2001; 81(7): 1307 - 1316. [Abstract] [Full Text] [PDF]
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J. Kvist and J. Gillquist Sagittal Plane Knee Translation and Electromyographic Activity During Closed and Open Kinetic Chain Exercises in Anterior Cruciate Ligament-Deficient Patients and Control Subjects Am. J. Sports Med., January 1, 2001; 29(1): 72 - 82. [Abstract] [Full Text] [PDF]
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S. S. Reuben and J. Sklar Pain Management in Patients Who Undergo Outpatient Arthroscopic Surgery of the Knee J. Bone Joint Surg. Am., December 1, 2000; 82(12): 1754 - 1754. [Full Text]
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S. L.-Y. Woo, T. M. Vogrin, and S. D. Abramowitch Healing and Repair of Ligament Injuries in the Knee J. Am. Acad. Ortho. Surg., November 1, 2000; 8(6): 364 - 372. [Abstract] [Full Text] [PDF]
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B. C. Fleming, P. A. Renstrom, B. D. Beynnon, B. Engstrom, and G. Peura The Influence of Functional Knee Bracing on the Anterior Cruciate Ligament Strain Biomechanics in Weightbearing and Nonweightbearing Knees Am. J. Sports Med., November 1, 2000; 28(6): 815 - 824. [Abstract] [Full Text] [PDF]
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T K Kakarlapudi and D R Bickerstaff Knee instability: isolated and complex Br. J. Sports Med., October 1, 2000; 34(5): 395 - 400. [Full Text] [PDF]
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J. Kartus, L. Ejerhed, N. Sernert, S. Brandsson, and J. Karlsson Comparison of Traditional and Subcutaneous Patellar Tendon Harvest: A Prospective Study of Donor Site-Related Problems After Anterior Cruciate Ligament Reconstruction Using Different Graft Harvesting Techniques Am. J. Sports Med., May 1, 2000; 28(3): 328 - 335. [Abstract] [Full Text] [PDF]
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J. Kartus, T. Movin, N. Papadogiannakis, L. R. Christensen, S. Lindahl, and J. Karlsson A Radiographic and Histologic Evaluation of the Patellar Tendon after Harvesting Its Central Third Am. J. Sports Med., March 1, 2000; 28(2): 218 - 226. [Abstract] [Full Text] [PDF]
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T. N. LINDENFELD, E. M. WOJTYS, and A. HUSAIN Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Operative Treatment of Arthrofibrosis of the Knee*{{dagger}} J. Bone Joint Surg. Am., December 1, 1999; 81(12): 1772 - 84. [Full Text]
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