Integrated enhanced rehabilitation model promotes early functional rehabilitation after anterior cruciate ligament reconstruction

Abstract

Objective To explore the safety and efficacy of comprehensive management model of enhanced rehabilitation for patients with acute anterior cruciate ligament (ACL) injury after knee injury. Methods From September 2014 to June 2015 120 patients with acute ACL injury due to trauma in sports medicine clinic of West China Hospital of Sichuan University, who were confirmed by arthroscopy and needed ACL reconstruction were included in this study. The patients who combined with multiple knee ligament injuries, bone injury, or chronic ACL injury were excluded. The patients were randomly assigned to the experimental group (60 pateints) and the control group (60 patients). The experimental group were treated with the combination steps of enhanced rehabilitation. The control group took the traditional perioperative management model. The general conditions, the preoperative and postoperative knee range of motion (ROM) and Lysholm score, the rehabilitation time for ROM of 90 ° and 120 °, short form-36 (SF-36) quality of life score were all compared between the two groups. These patients were followed up to 12 months after the surgery. The measurement data were expressed as (±s), and t-test was used for comparison between groups. The count data were expressed as ratio, and the two groups were compared using χ2 test or Fisher test. Results A total of 111 patients were followed up, 54 in the experimental group and 57 in the control group. There was no statistically significant difference in age, sex ratio, body mass index (BMI), or preoperative Lysholm score. Compared with the control group, the experimental group showed the fewer complications (14.8% vs 27.3%, χ2=8.33, P<0.01); better ROM [(73±17)° vs. (51±23)°, t=5.64, P<0.01; (94±23)° vs. (78±25)°, t=3.51, P<0.01; (130±18)° vs. (118±21)°, t=3.23, P<0.01] and higher Lysholm score (t=3.29, P<0.01; t=2.69, P=0.01; t=5.23, P<0.01) in two weeks, one month and three months postoperatively. The time required for the knee ROM reaching 90 ° and 120 ° was shorter in the experimental group than that in the control group [90°, (23±4) vs (35±4), t=15.53, P<0.01; 120°, (37±15) vs (54±13), t=6.16, P<0.01]. The levels of SF-36 in the experimental group were higher than those in the control group (PF, t=3.55, P<0.01; RP, t=5.88, P<0.01; BP, t=2.86, P=0.01; GH, t=2.07, P=0.04; VT, t=2.86, P<0.01; SF, t=2.69, P<0.01; RE, t=2.29, P=0.02; MH, t=2.42, P=0.01). Conclusion The comprehensive management model of enhanced rehabilitation technology could accelerate the early postoperative functional rehabilitation, reduce postoperative complications, shorten the length of stay and improve the quality of life in the acute ACL injure patients. Key words: Rehabilitation; Perioperative period; Anterior cruciate ligament injury

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