The purpose of this study was to investigate the responses elicited during aquatic and land rehabilitation to establish the comparison among parameters such as, range of motion (ROM), muscle strength, circumference of muscle mass and swelling. Thirteen individuals with an anterior reconstruction ligament with a concomitant meniscal injury participated in the study who established 2 groups: the land rehabilitation (LR), patients who were followed by a land program and the water rehabilitation (WR) whose patients had an aquatic program. Clinical evaluations were applied in the 0, 3, 6 and 9 weeks measuring the parameters. The patients from the WR reached the best results for all parameters which were evaluated. We concluded the aquatic rehabilitation allowed earlier function recuperation than the land program.
Introduction. The number of arthroscopic reconstructions of the anterior cruciate ligament (ACL) has been increasing not only among competitive athletes, but also among recreational athletes. The monitoring of the rehabilitation process in order to determine a safe time to return to the pre-injury activity is thus of great practical importance. The aim of this paper is to analyse the changes in selected biomechanical variables which occur after the therapeutic training following an anterior cruciate ligament reconstruction. Materials and methods. Twenty nine males (age 27.3 ± 5.7 years) after the anterior cruciate ligament reconstruction participated in the study. A quadruple-stranded semitendinosus/gracilis graft was used for the reconstruction. The biomechanical evaluation of the rehabilitation process was provided by an isokinetic dynamometer Biodex System Pro-3 working at speeds of 60 deg/s and 180 deg/s during testing the knee extensor and flexor muscles. In the case of an injured limb, the absolute peak torque, relative peak torque, average power and hamstring/ quadriceps (H/Q) ratio were determined. In addition, the values of flexor and extensor torques for healthy and injured limbs were compared. The study was carried out in four stages: before the surgery, three, six and twelve months after the surgery. Results and analyses. The results showed significant differences in each value between various stages of the biomechanical rehabilitation process of the knee. The applied therapeutic training influenced significantly the changes in the values of the tested variables. The results have confirmed that the biomechanical measurements can be treated as a supplementation to the clinical evaluation of the patient after ACL reconstruction. They may also be used for the optimisation of the therapeutic training.
Purpose. The aim of the study was threefold: to determine the active rotation range of a healthy and post-traumatic knee joint; to evaluate the torque of muscles responsible for internal and external rotation of a healthy and post-traumatic knee joint; and to determine differences between a healthy knee joint and knee joint with the ruptured anterior cruciate ligament (ACL). Differences between active axial rotation and muscular strength of rotators in the healthy and post-traumatic knee joints of 40 hospitalized patients were examined. Basic procedures. The static torque evaluation of the shank rotating muscles included 40 patients of the Endoscopic Surgery Clinic in Żory, with the ruptured ACL of the right knee, qualified for surgery (ACL reconstruction). On the basis of a medical interview, the ACL ruptures were found to have occurred during football games. Main findings. ACL damage leads to an increased rotation range, with a subsequent decrease of the rotators' strength and increased joint instability. The patients examined showed a substantial level of thigh quadriceps atrophy - a typical symptom associated with an ACL rupture. Our findings indicate that the internal and external rotators in intact knees were stronger than the rotators in post-traumatic knees (p < 0.05). Conclusions. The analysis of the torque of the shank rotating muscles at two knee joint flexion angles was an attempt to proceed with a laboratory diagnosis of the condition of the motor system in 40 patients following severe trauma (such as the ACL rupture of the right knee) prior to surgical intervention, and, in a longer perspective, after treatment completion. The results obtained will supposedly be useful as indicators for future rehabilitation pathways, and of the condition of the motor system following treatment completion.
The term “proprioception” is defined as the conduction of sensory information deriving from proprioceptors that have an impact on conscious sensations, posture and trans-segmental sense. An ACL injury may lead to functional knee joint instability. According to research, this may result in impaired movement sensation and joint position. The purpose of this study was to evaluate the joint position sense (JPS) in patients before arthroscopic ACL reconstruction and 5 months after the surgery. The examinations were conducted in a group of twelve specifically selected male patients. The examination procedure consisted of JPS measurement in both lower limbs (the operated and the healthy one) during active extension in a range of angles: 30, 45, 60°. The level of significance was: p < 0.05. The analysis of variance performed for repeated measurements (ANOVA) did not indicate any statistically significant differences of JPS in comparisons made between the operated and the healthy limb. Statistical values for the absolute, relative, and variable errors were p = 0.7684, p = 0.1546, p = 0.5694 respectively. The obtained results do not indicate any limitation of proprioception in patients with ACL injury before the intervention or half a year later.
Athletes with non-contact anterior cruciate ligament tears have common features in the sagittal plane; namely, the body’s center of mass (COM) is located posterior to the base of support, the trunk and knee joints are extended, and the hip angle is flexed. However, the relationships among these variables have not been assessed in field-based movements. This study sought to determine relationships between distances from the COM to the base of support and the trunk, hip, and knee positions in women while playing soccer. Sixty events (29 single-leg landing and 31 single-leg stopping events) were analyzed using two-dimensional video analysis. The relationships among the measurement variables were determined using the Pearson’s product-moment correlation coefficient, and stepwise multiple linear regression models were used to explore the relationships between the COM position and the kinematic variables. The distance from the COM to the base of support displayed a moderate negative relationship with the trunk angle (r = - 0.623, p < .0001, r2 = 0.388) and a strong positive relationship with the limb angle (r = 0.869, p < .0001, r2 = 0.755). The limb, knee, and trunk angles were selected in the best regression model (adjusted r2 = 0.953, p < .0001, f2 = 20.277). These findings suggest that an increased trunk angle and a decreased limb angle at initial contact are associated with a safer COM position. Neuromuscular training may be useful for controlling the trunk and lower limb positions during dynamic activities.
A non-contact anterior cruciate ligament (ACL) injury is both a serious and very common problem in volleyball. The aim of the study was to determine the association between stick, step-back, and run-back landings after a block and select risk factors of ACL injuries for female professional volleyball players. The research sample involved fourteen female professional volleyball players. Two force plates were used to determine ground reaction forces. Eight infrared cameras were employed to collect the kinematic data. The one-factor repeated-measures analysis of variance, where the landing type was the factor, was used for comparing the valgus moment and ground reaction force on the right lower limb. ANOVA showed that the type of landing has a main effect on the valgus moment on the right lower limb (F) = 5.96, p = 0.019df = 1.18, partial ƞ2 = 0.239 and SP = 0.693). Furthermore, it did not show a main effect on the vertical reaction force on the right lower limb ((F)=2.77, p=0.090, df=1.55, partial ƞ2= 0.128 and SP=0.448). The highest valgus moment occurred during the run-back landing. This moment, however, did not have any effect within the first 100 ms after initial contact with the ground, but rather upon the subsequent motion carried out when stepping back off the net. A comparison between a run-back landing and a step-back landing showed relevant higher values of vertical ground reaction forces during the run-back landing.
Aim of the study: Ultrasound examination is widely used in orthopedic diagnostics, however sonographic evaluation of traumatic anterior cruciate ligament insufficiency is still inadequate. Aim of this study is to evaluate diagnostic capability of a new sonographically- guided test for diagnosing complete anterior cruciate ligament insufficiency. Material and methods: In 47 patients, with suspicion of unilateral anterior cruciate ligament injury (based on magnetic resonance imaging), the sonographically-guided test for anterior instability was performed. The translation of the intercondylar eminence against the patellar tendon was measured in both knees. Afterwards all patients underwent arthroscopy. Results: In 37 patients, with arthroscopically confirmed complete anterior cruciate ligament insufficiency, the mean anterior knee translation was 8.3 mm (SD = 2.8) in affected knee vs. 3 mm (SD = 1.1) in uninjured knee (p < 0.001). In 10 patients with no anterior cruciate ligament insufficiency the difference between body sides was not significant (2.6 mm, SD = 1.4 in injured knee vs. 2.5 mm, SD = 1.1 in uninjured joint; p < 0.7753). Conclusions: The proposed test supports the clinician with fast and non- invasive examination that can facilitate evaluation of anterior knee instability.
PL
Cel pracy: Badanie ultrasonograficzne jest powszechnie stosowane w diagnostyce ortopedycznej, jednakże w ocenie przedniej niestabilności stawu kolanowego wykorzystuje się je w ograniczonym stopniu. Celem pracy jest ocena przydatności diagnostycznej nowego testu przeprowadzonego pod kontrolą ultrasonografii, który pomaga diagnozować całkowitą niewydolność więzadła krzyżowego przedniego. Materiał i metody: U 47 pacjentów z podejrzeniem jednostronnego urazu więzadła krzyżowego przedniego (zdiagnozowanego na podstawie badania rezonansu magnetycznego) wykonano test niestabilności przedniej kolana pod kontrolą ultrasonografii. Oceniano przesunięcie wyniosłości międzykłykciowej do przodu względem więzadła rzepki w obu stawach kolanowych. Każdy pacjent został następnie poddany artroskopii stawu kolanowego. Wyniki: U 37 pacjentów z artroskopowo potwierdzonym całkowitym uszkodzeniem więzadła krzyżowego przedniego średnie przesunięcie wyniosłości międzykłykciowej wynosiło 8,3 mm (SD = 2,8) w kolanach po urazie – w porównaniu z 3 mm (SD = 1,1) w kolanach bez urazu (p < 0,001). W grupie 10 pacjentów bez niewydolności więzadła krzyżowego przedniego różnice w przesunięciu wyniosłości międzykłykciowej były nieistotne (2,6 mm, SD = 1,4 w kolanie po urazie, w porównaniu z 2,5 mm i SD = 1,1 w kolanie bez urazu, p < 0,7753). Wnioski: Zaprezentowany test to szybki i nieinwazyjny sposób mogący ułatwić diagnozowanie całkowitej niewydolności więzadła krzyżowego przedniego.
Urazy stawu kolanowego często powodują uszkodzenia jego więzadeł. Szczególnie predysponowane do ulegania urazom jest więzadło krzyżowe przednie. W większości przypadków leczenie urazu wymaga połączenia technik operacyjnych polegających na rekonstrukcji uszkodzonego więzadła oraz starannie zaplanowanej fizjoterapii uwzględniającej technikę zabiegu, zwyczaje ruchowe poszkodowanego, jego wiek oraz aktywność zawodową. Fizjoterapia przebiega w kilku etapach, w których czas i rodzaj stosowanych procedur podyktowany jest stanem klinicznym pacjenta. Każdy uraz stawu kolanowego, a szczególnie taki, w którym doszło do uszkodzenia więzadeł kolana, wymaga wnikliwej analizy oraz indywidualnie dobranego pod względem tempa procesu usprawniania.
EN
Injuries of the knee joint frequently cause damage to its ligaments. The anterior cruciate ligament is particularly predisposed towards such traumas. In most cases the treatment requires a combination of surgical procedures consisting in reconstruction of the damaged ligament and carefully planned physiotherapy considering the technique of the procedure, motor habits of the patient, their age and professional activity. The physiotherapy includes a number of stages whose duration time and techniques used are adjusted to the clinical condition of the patient. All injuries of the knee joint and especially the ones where the knee ligaments get damaged require thorough analysis and individually chosen rehabilitation process.
Introduction In the majority of cases, anterior cruciate ligament (ACL) injuries require specialist surgical and physiotherapeutic treatment. The fact that the patient regains a full range of flexion and extension in the knee joint as well as the reduction or elimination of pain is a significant determinant of successful physiotherapy. Material and methods The study included 72 randomly selected individuals with a complete ACL tear who were qualified for its surgical reconstruction. The research group included 37 patients aged 18-60 (mean age 37±10.3 years). All the participants from this group underwent physiotherapy based on recognised schemes of rehabilitation and performed for 4 weeks before the reconstruction surgery. The control group included 35 patients aged 18-60 (mean age 34±10.0 years) who did not undergo any presurgical physiotherapy programme. Results Both in the research group and in the control group, subsequent measurements revealed a statistically significant improvement in the range of flexion and extension (p<0.05). Statistical analysis revealed a significantly better extension 1 week and 6 weeks after the ACL reconstruction (p<0.05) in the research group. Statistically significant differences in the level of pain in patients from both groups were noted in subsequent measurements (p<0.05). Also, a statistically significant difference concerning pain assessment 12 weeks after the reconstruction was noted in the research group (p<0.05). Conclusions A quicker recovery of the range of extension in the operated knee joint and lower intensity of pain in the final measurement noted in the research group may indicate a certain therapeutic value of presurgical physiotherapy.
PL
Wstęp Uszkodzenia ACL w większości przypadków wymagają specjalistycznego leczenia operacyjnego i fizjoterapeutycznego. Ważnym wyznacznikiem powodzenia działań fizjoterapeutycznych jest odzyskanie pełnego zakresu ruchu zgięcia i wyprostu stawu kolanowego oraz ograniczenie lub wyeliminowanie dolegliwości bólowych. Materiał i metody Do badania włączono w sposób losowy 72 osoby z rozpoznanym całkowitym zerwaniem ACL, zakwalifikowanych do jego operacyjnego odtworzenia. Do Grupy Badanej włączono 37 chorych w wieku od 18 do 60 lat (średnia 37±10,3 lat). Wszyscy badani z tej grupy poddani zostali modelowi fizjoterapii, opartemu o uznane schematy leczenia usprawniającego, przez 4 tygodnie poprzedzające zabieg rekonstrukcyjny. Do Grupy Kontrolnej włączono 35 chorych w wieku od 18 do 60 lat (średnia 34±10,0 lat), którzy nie realizowali programu fizjoterapii przedoperacyjnej. Wyniki Zarówno w grupie Badanej, jak i Kontrolnej w kolejnych punktach pomiarowych zaobserwowano istotną statystycznie poprawę zakresu ruchu zgięcia i wyprostu (p<0,05). Analiza statystyczna wykazała znamiennie lepszy wyprost w Grupie Badanej w pierwszym i po 6 tygodniach od rekonstrukcji WKP (p<0,05). Zaobserwowano istotne statystycznie różnice w poziomie bólu u pacjentów z Grupy Badanej i Kontrolnej w kolejnych punktach pomiarowych (p<0,05). Zaobserwowano istotną statystycznie różnicę w ocenie poziomu bólu po 12. tygodniu od operacji dla Grupy Badanej (p<0,05). Wnioski Obserwowany szybszy powrót zakresu ruchu wyprostnego w operowanym stawie kolanowym, mniejsze natężenie bólu w końcowym, odległym punkcie pomiarowym w Grupie Badanej, mogą wskazywać na pewną wartość terapeutyczną przedoperacyjnej fizjoterapii.
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