The main objective was to determine whether quadriceps and hamstring strengthening in a rehabilitation program involving early OKC and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3 and 6 after ACLR with a hamstring tendon graft. The secondary objective was to assess whether the early use of OKC exercise affects intrinsic graft laxity between 1 and 6 months postoperatively. The third objective was to determine whether the early associated use of OKC and CKC improved quadriceps and hamstring strength
This study included a total of 53 patients. The intervention group that performed OKC and CKC exercises in combination (n= 25), and the control group that performed only CKC exercises (n=28). OKC exercises were introduced 2 weeks after surgery without resistance, and were progressed at 4 weeks with resistance.
Anterior knee laxity was measured using the GNRB device on the operated limb, and compared to the contralateral control limb. Three evaluations were performed at 1, 3 and 6 months after the ACLR. The difference between both limbs was calculated and used to determine the variation in anterior laxity throughout the first 6 months after surgery.
No differences were observed in knee laxity at 1, 3 and 6 months follow up between intervention group and control group (difference at 1 month : 0.4 mm ± 0.6 vs 0.7 mm ± 0.9, p = 0.263, respectively ; difference at 3 months : 0.5 mm ± 0.7 vs 0.5 ± 0.7, p = 0.256, respectively ; difference at 6 months : 0.6 mm ± 0.9 vs 0.6 ± 0.9, p = 0.321, respectively). No differences were observed in within-group graft laxity between 1 and 6 months after ACLR in intervention group (+ 0.1 mm ± 0.8 ; p = 0.155) and control group (- 0.3 mm ± 0.7; p = 0.690). The intervention group exhibited significantly greater quadriceps strength at 3 months (p = 0.041), though this difference was not significant at 6 months. Hamstring strength was significantly higher in the intervention group at both 3 and 6 months (p = 0.047 and p = 0.042, respectively)
The early initiation of OKC exercises doesn’t seem to increase the ACLR graft laxity as compared to the rehabilitation program with only CKC exercises. he inclusion of OKC exercises seems to offer a significant advantage in improving hamstring and, to a lesser extent, quadriceps strength in the early postoperative period.
This study highlights the potential benefits of incorporating OKC exercises early in the rehabilitation process following ACLR. By demonstrating that OKC exercises do not compromise graft integrity and contribute to improved muscle strength, these findings could shift current rehabilitation practices toward more aggressive early-stage interventions
Open Kinetic chain
Graft Laxity
