Objective: To compare results of aggressive method of rehabilitation after reconstruction of anterior cruciate ligament against results of standard braced method of rehabilitation, and to determine prognostic factors. This is a retrospective comparative study with statistical analysis.
Methods: In this study, 85 patients were operated in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between December 1998 and December 2001, and underwent rehabilitation with a minimum follow up of 2 years. The patients were split into 2 groups. Group A consist of 32 patients and they underwent the standard rehabilitation program according to established braced programs. Group B is the subsequent 53 consecutive patients who were subjected to aggressive brace-free rehabilitation program. All knees were measured for Tegner and Lysholm scores as the main indicator of assessment in the preinjury hindsight appraisal, and compared with scores obtained 4 months and 2 years post reconstruction.
Results: Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group A, there was a mean loss of 1.9 and 14 constituting 26% and 22.2% (p=0.015), range 1.07-3.5 and 9.8-23.5. Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group B, there was a mean loss of 1.1 and 9.0 constituting 15.4% and 13.6% (p=0.012), range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to the 2 years follow up scores for group A, there was a mean loss of 1.0 and 8.0 constituting 13.6% and 11.6% (p=0.024), range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to 2 years follow up scores for group B, there was a mean loss of 0.4 and 1.0 constituting 5.5% and 1.5% (p=0.015), range 0.1-1.5 and 6.8-13.5. Appraisal of the aggregate data of 2 groups has shown that the loss from preinjury Tegner and Lysholm scores was 20.7% versus 16.9% lower at 4 months (p=0.013), but only 12.6% versus 3.55% lower at 2 years (p=0.036).
Conclusion: Results of aggressive rehabilitation after anterior cruciate ligament reconstruction both subjectively and clinically are superior to that of the standard braced rehabilitation. A better prognostic result with aggressive rehabilitation can be predicted for patients with high preinjury scores compared to patients with a low preinjury score. The result of this study support the use of accelerated brace free rehabilitation in autogenous patellar tendon graft, and has shown that intensive rehabilitation facilitate return to sport activities at 4 months postoperatively.