RESUMEN
BACKGROUND: Despite rehabilitation training, deficiency in knee joint position sense, muscular performance, postural control, and functional ability is common after anterior cruciate ligament reconstruction (ACLR). Whole-body vibration therapy (WBVT), which is initiated from 3 months postoperatively, has proven benefits. However, the effect of earlier WBVT is unknown. PURPOSE: To investigate the effect of early WBVT on neuromuscular control after ACLR. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 48 patients with unilateral complete isolated ACL tears were recruited. Single-bundle hamstring ACLR was performed in all patients. After surgery, they were randomly assigned to either the reference or treatment group. Reference group patients received conventional ACL rehabilitation, while treatment group patients received 8 weeks of WBVT in addition to conventional rehabilitation, starting from 1 month postoperatively. Joint position sense, postural control, and knee isokinetic performance were assessed before surgery and at 1, 3, and 6 months postoperatively using the Biodex dynamometer, Biodex Stability System, and Cybex NORM, respectively. Knee range of motion (ROM), stability (manual testing and KT-1000 arthrometer), and functional ability (single-legged hop test, triple hop test, shuttle run test, and carioca test) were also examined. Two-way repeated-measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. RESULTS: There was no complication throughout the rehabilitation. All patients achieved full knee ROM and stable knee joints at 6 months after surgery. The WBVT group demonstrated significantly better postural control, muscle performance, single-legged hop, and shuttle run (P < .05) than the reference group, but there was no significant difference in knee joint position sense, triple hop, carioca, ROM, and stability (P > .05). CONCLUSION: Early WBVT started from 1 month postoperatively was an effective training method without compromising knee ROM and stability. It improved postural control, isokinetic performance, single-legged hop, and shuttle run but not knee joint position sense, triple hop, and carioca.
Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior , Traumatismos de la Rodilla/rehabilitación , Articulación de la Rodilla/fisiología , Equilibrio Postural , Vibración/uso terapéutico , Adulto , Femenino , Humanos , Traumatismos de la Rodilla/cirugía , Masculino , Cooperación del Paciente , Torque , Resultado del Tratamiento , Adulto JovenRESUMEN
Our purpose was to determine the relationship between tibiofemoral translation on magnetic resonance imaging and clinical instability of the knee following anterior cruciate ligament (ACL) injury. Within 66 patients (43 males, 23 females, mean age 30.25 years), 15 of 19 patients (80%) with an intact ACL had a demonstrable normal screw home movement, while 24 of 47 patients (51%) with an ACL tear had absence of the screw home movement. Patients with clinical instability had greater tibial translation and excursion at the lateral compartment (P=.0001). Following ACL injury, there is demonstrable absence of the normal screw-home movement with anterior tibial translation and excursion related to presence of clinical instability.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/patología , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/patología , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/patología , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVE: To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears. MATERIALS AND METHODS: The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance. RESULTS: Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05). CONCLUSION: The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL.