Impaction Of Rehabilitations And Strengthening Programs before And after Anterior Cruciate Ligament Reconstruction In Return to the Fitness Level

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Abstract

Objectives

Sports injuries are one of the most common orthopedic injuries particularly in young and active populations. Football is the most popular sport among Saudis, and thus, anterior cruciate ligament (ACL) injuries are common in clinics and emergency rooms in Saudi Arabia. The aim of this study was to evaluate the outcomes of patients six months after ACL reconstruction in both hospitals and gym-based rehabilitation services and its impaction on the patients to return to sports and preinjury fitness levels.

Methods

This is a retrospective case series of patients who underwent arthroscopically assisted ACL reconstruction using a hamstring autograft at our center. Data were gathered from January 2020 to December 2020. Patients were given a questionnaire about their visits to the orthopedic clinic in the 6 ^th month after surgery.

Results

Sixty patients with ACL reconstructions were studied. Noncontact sports were the leading cause of injuries (53.3%). The mean Lysholm score was 84.9 (SD 3.45) out of 100 after six months of follow-up, and the mean Tegner score was 4.77 (SD 1.06) out of 10 points. The Lysholm score was excellent (>90) among 5% ( n= 3), good (84–90) among 60% ( n= 36), and fair (65–83) among 35% ( n= 21). As a result, we observed that the duration of postoperative rehabilitation has a significant relationship with the fitness level ( X2= 18.711; p=0.001).

Conclusion

The Lysholm knee scoring scale and the Tegner activity scale showed that arthroscopically assisted ACL reconstruction using hamstring autograft has a successful and functional outcome after which the patient returns to sports or regains the preinjury level of fitness level depends on the rehabilitation.The period and types of preoperative and postoperative rehabilitation have a direct impact on the return to fitness levels and normal daily life activities.

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Most cited references 16

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Rating systems in the evaluation of knee ligament injuries.

Y Tegner, J Lysholm (1985)

Many different methods of evaluating disability after knee ligament injury exist. Most of them differ in design. Some are based on only patients' symptoms. Other include patients' symptoms, activity grading, performance in a test, and clinical findings. The rating in these evaluating systems can be either numerical, as in a score, or binary, with yes/no answers. Comparison between a symptom-related score and a score of more complex design showed that the symptom-related score gave a more differentiated picture of the disability. It was also shown that the binary rating system gave less detailed information than a score and that differences in a binary rating can depend on at what level the symptoms are regarded as "significant." A new activity grading scale, where work and sport activities were graded numerically, was constructed as complement to the functional score. When evaluating knee ligament injuries, stability testing, functional knee score, performance test, and activity grading are all important. However, the relative importance varies during the course of treatment, and therefore they should not all be included in one and the same score.

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The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later.

Karen Briggs, Jack Lysholm, Yelverton Tegner … (2009)

In 1982, the Lysholm score was first published as a physician-administered score in the American Journal of Sports Medicine. The Tegner activity scale was published in 1985. The Lysholm and Tegner scores are valid as patient-administered scores and responsive at early time points after treatment of anterior cruciate ligament tears. Cohort study (Diagnosis); Level of evidence, 1. All patients were treated for an anterior cruciate ligament tear. For responsiveness, the Lysholm score (n = 1075) and Tegner activity level (n = 505) were measured preoperatively and 6, 9, 12, and 24 months postoperatively. For test-retest (n = 50), scores were measured at 2 years postoperatively and again within 4 weeks by questionnaire. For criterion validity (n = 170), patients completed the Short Form-12 and the International Knee Documentation Committee score in addition to Lysholm and Tegner instruments. For all other analyses, preoperative Lysholm score (n = 1783) or Tegner activity levels (n = 687) were collected. There was acceptable test-retest reliability for both the Lysholm (intraclass correlation coefficient = 0.9) and Tegner (intraclass correlation coefficient = 0.8) scores. The minimum detectable change for Lysholm was 8.9 and for Tegner was 1. The Lysholm demonstrated acceptable internal consistency. The Lysholm correlated with the International Knee Documentation Committee (r = .8) and the Short Form-12 (r = .4), and Tegner correlated with the Short Form-12 (r = .2). Both scores had acceptable floor and ceiling effects and all hypotheses were significant. The Lysholm and Tegner were responsive to change at each of the time points. After 25 years of changes in treatment of anterior cruciate ligament injuries, the Lysholm knee score and the Tegner activity scale demonstrated acceptable psychometric parameters as patient-administered scores and showed acceptable responsiveness to be used in early return to function after anterior cruciate ligament treatment.

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Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee.

Karen Briggs, Mininder S. Kocher, William Rodkey … (2006)

A torn meniscus is one of the most common indications for knee surgery. The purpose of this study was to determine the psychometric properties of the Lysholm knee score and the Tegner activity scale when used for patients with a meniscal injury of the knee. Test-retest reliability, content validity, criterion validity, construct validity, and responsiveness to change were determined for the Lysholm score and the Tegner activity scale. Test-retest reliability was measured in a group of 122 patients at least two years after they had undergone surgery for a meniscal lesion. This group completed a follow-up form and then completed it again within four weeks. The other tests were performed in a group of 191 patients who had only a meniscal lesion at the time of the surgery and a group of 477 patients who had a meniscal lesion and other intra-articular lesions. The overall Lysholm score showed acceptable test-retest reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change. There were unacceptable ceiling effects (>30%) for the Lysholm domains of limp, instability, support, and locking. The Tegner activity scale showed acceptable test-retest reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change. Overall, the Lysholm knee score and the Tegner activity scale demonstrated acceptable psychometric performances as outcome measures for patients with a meniscal injury of the knee. Some domains of the Lysholm score showed suboptimal performance, and the Tegner scale had only a moderate effect size. Psychometric testing of other condition-specific knee instruments for patients with a meniscal lesion of the knee would be helpful to allow comparison of the properties of the various knee instruments.

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Author and article information

Contributors

Abdulwahab Ahmed Alzahrani:

ORCID: https://orcid.org/0000-0002-2102-5819

Journal

Journal ID (nlm-ta): J Environ Public Health

Journal ID (iso-abbrev): J Environ Public Health

Journal ID (publisher-id): jeph

Title: Journal of Environmental and Public Health

Publisher: Hindawi

ISSN (Print): 1687-9805

ISSN (Electronic): 1687-9813

Publication date Collection: 2022

Publication date (Electronic): 9 July 2022

Volume: 2022

Electronic Location Identifier: 7906341

Affiliations

Surgery Department, Faculty of Medicine, Albaha University, Pediatric Orthopedic & Deformities Fellow (WIEN), Consultant Orthopedic. Director of Orthopedic Resident Training Program, Albaha 65561, Saudi Arabia

Author notes

Academic Editor: Sivakumar Pandian

Author information

Abdulwahab Ahmed Alzahrani https://orcid.org/0000-0002-2102-5819

Article

DOI: 10.1155/2022/7906341

PMC ID: 9288282

SO-VID: b684a84f-e467-4b2a-9336-8ec91c3a1de9

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 14 May 2022

Date revision received : 4 June 2022

Date accepted : 10 June 2022

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