Functional monitoring during rehabilitation following anterior cruciate ligament reconstruction☆

Abstract 

Objective. It was hypothesized that testing of ambulatory function and more demanding activities were more appropriate predictors of dynamic knee function before and after reconstruction of the anterior cruciate ligament than conventional measures of functional evaluation. It was assumed that assessment of dynamic plantar pressure distribution would represent a practical tool for guidance of the rehabilitation process after anterior cruciate ligament reconstruction.

Design. In a prospective study, 10 patients with isolated anterior cruciate deficiency were examined before and after replacement of the anterior cruciate (6, 12, 24 weeks) in a standardized technique.

Background. Today, functional assessment following anterior cruciate ligament reconstruction relies on clinical examination supplemented by instrumented testing of knee laxity and on isokinetic evaluation of muscle performance. Gait analysis has not been used as a quantitative measure of rehabilitation progress after surgery.

Methods. All patients were subjected to the same physiotherapy protocol. The clinical results were documented using the International Knee Documentation Committee (IKDC) protocol and the degree of knee laxity by an instrumented anterior drawer test. Muscular performance was evaluated by isokinetic testing. Dynamic pedography (EMED-SF 4) was performed to compare the non-injured and the operated leg during level walking and while descending stairs.

Results. Gait performance six weeks after surgery tended to be inferior to preoperative and late postoperative values. While the slight increase of maximum knee extensor torque in the operated leg and the improvement of the IKDC score during the rehabilitation period were not statistically significant, a significantly decreased gait asymmetry could be observed 12 weeks after surgery. The descending stairs test revealed functional deficits better than level walking. The latter test exhibited a strong correlation with the preoperative IKDC level and the maximum knee extensor deficit at 60°/s.

Conclusions. Dynamic pedography during level walking and while descending stairs is a valuable tool for monitoring the rehabilitation process after anterior cruciate ligament reconstruction.

Relevance

Due to the better resolution of functional deficits compared with indirect measures of function (isokinetic testing) assessment of the plantar pressure distribution may provide a more individualized adaptation for the rehabilitation program.

Keywords:  Anterior cruciate ligament, Functional assessment, Isokinetic testing, Dynamic plantar pressure distribution, Rehabilitation