F. Forelli1,2,3,4, W. Barbar1,2, G. Kersante1,2, A. Vandebrouck5, P. Duffiet5, L. Ratte5, T. Hewett6, A. Rambaud4,7
1Orthosport, Domont, France, 2Clinique de Domont, OrthoLab, Domont, France, 3CDFAS, Medical and Research Center for Sports Performance, Eaubonne, France, 4SFMKS Lab, Pierrefitte sur Seine, France, 5Clinique de Domont, Knee Surgery, Domont, France, 6Marshall University, Department of Orthopaedic Surgery, Huntington, United States, 7University Hospital of Saint Etienne, Department of Clinical and Exercise Physiology, Saint Etienne, France
Background: After anterior cruciate ligament reconstruction (ACLR), open kinetic chain (OKC) strengthening appears to be safe and improves quadriceps strength.
Purpose: The main objective of this study was to determine whether the early associated use of OKC and closed kinetic chain (CKC) improved quadriceps and hamstring strength in the rehabilitation after ACLR. The secondary objective was to assess whether the early use of OKC had an influence on graft laxity at 3 and 6 postoperative months.
Methods: This non randomized controlled study included 103 patients with hamstring graft, 70 males and 33 females (29,1 ± 7,6 years old, Marx score = 11,9 ± 3,2, Tegner score = 6,75 ± 1,5). Two groups were formed OKC+CKC group (n = 51) vs CKC group (n = 52).
OKC protocol which included exercises for quadriceps and hamstrings muscles, were introduced at 4 weeks after ACLR (31,4 days ± 7,6). The OKC protocol included 10 series of 8 repetitions on isokinetic device at 60°.s-1and 8 series of 8 repetitions at 60% of the maximum resistance 3 times per week. At 3 months (101,9 days ± 18,4) and 6 postoperative months (199,2 days ± 28,1), an evaluation of muscle strength by isokinetic dynamometer was performed, to calculate peak torque-to-body weight ratio (PT/BW) for the quadriceps and hamstrings. The laxity measurement was performed by comparative measurements performed by GNRB.
OKC protocol which included exercises for quadriceps and hamstrings muscles, were introduced at 4 weeks after ACLR (31,4 days ± 7,6). The OKC protocol included 10 series of 8 repetitions on isokinetic device at 60°.s-1and 8 series of 8 repetitions at 60% of the maximum resistance 3 times per week. At 3 months (101,9 days ± 18,4) and 6 postoperative months (199,2 days ± 28,1), an evaluation of muscle strength by isokinetic dynamometer was performed, to calculate peak torque-to-body weight ratio (PT/BW) for the quadriceps and hamstrings. The laxity measurement was performed by comparative measurements performed by GNRB.
Results: At 3 and 6 postoperative months, quadriceps strength in the OKC+CKC group was higher than in CKC group for LSI (76,1 % ± 0,21 vs 46,9 % ± 0,21, p < 0,001, Cohen’s d = 1,34 et 91 % ± 0,17 vs 61,8 % ± 0,26, p < 0,001, Cohen’s d = 1,29, respectively)and PT/WB (1,81 Nm.kg-1± 0,75 vs 0,85 Nm.kg-1± 0,50, p < 0,001, Cohen’s d = 1,5 and 2,40 Nm.kg-1± 0,73 vs 1,39 Nm.kg-1± 0,70, p < 0,001, Cohen’s d = 1,41, respectively). There were similar findings for the hamstring strength:LSI (86,1 % ± 0,21 vs 64,3 % ± 0,24, p < 0,001, Cohen’s d = 0,94 et 91,9 % ± 0,17 vs 82,4 % ± 0,24, p < 0,001, Cohen’s d = 0,45, respectively) andPT/BW (1,09 Nm.kg-1± 0,36 vs 0,69 Nm.kg-1± 0,39, p < 0,001, Cohen’s d = 1,06and 1,41 Nm.kg-1± 0,41 vs 1,06 Nm.kg-1± 0,39, p < 0,001, Cohen’s d = 0,87, respectively).
At 3 months no difference was observed for laxity between OKC+CKC and CKC group (0,38 mm ± 1,19 vs 0,38 mm ± 1,90, p = 0,48). At 6 months the laxity was greater in CKC group (0,58 mm ± 1,65 vs 0,44 mm ± 1,20, p = 0,31).
At 3 months no difference was observed for laxity between OKC+CKC and CKC group (0,38 mm ± 1,19 vs 0,38 mm ± 1,90, p = 0,48). At 6 months the laxity was greater in CKC group (0,58 mm ± 1,65 vs 0,44 mm ± 1,20, p = 0,31).
Conclusions: The results indicate that early associated use of OKC and CKC allow for enhanced correction of quadriceps and hamstrings strength deficits and readiness to return to sport without increasing graft laxity.
Implications: Quadriceps and hamstring training with OKC early introduction should be utilized in rehabilitation programs to improve strength for return to sport after ACLR.
Funding acknowledgements: This research and authors have received no funding
Keywords:
Return to sport
Early open kinetic chain
Anterior cruciate ligament reconstruction
Return to sport
Early open kinetic chain
Anterior cruciate ligament reconstruction
Topics:
Sport & sports injuries
Musculoskeletal: lower limb
Sport & sports injuries
Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: Clinique de Domont
Committee: Clinique de Domont
Ethics number: PCE-05.32-122
All authors, affiliations and abstracts have been published as submitted.
