Physiotherapy Rehabilitation for Accelerating the Recovery of Patient with Anterior Cruciate Ligament Total Reconstruction and Meniscal Repair: A Case Report
DOI:
https://doi.org/10.26911/theijmed.2023.08.04.04Abstract
Background: The Anterior Cruciate Ligament (ACL) is a ligament that functions to limit the movement of the tibia toward the anterior and excessive rotation, while the meniscus serves as shock absorption, load transmission, and the stabilizer of the knee joint. About 22% to 86% meniscal tear incidences occurring along with ACL injuries is. The study aims to determine the role of physiotherapists in the postoperative rehabilitation process of patients of ACL Reconstruction (ACLR) and meniscal repair in preventing postoperative complications and functional abilities of patients.
Case Report: The patient was a 35-year-old adult male who suffered a complete tear in the ACL and meniscus of the left knee. The patient underwent ACLR and meniscal repair with arthroscopic surgery 2 years after injury with Bone-Pattelar tendon-bone autograph. 2 weeks post-surgery the patient visited the physiotherapy polyclinic with medical conditions of difficulty in bending and straightening the knee, still feeling pain and thick in the knee area.
Results: The physiotherapist program was conducted three times and it was a home program-based exercise. The physiotherapist program and outcomes used in the first phase focused on exercises to improve ROM (Goniometer), oedema management (Medline), pain reduction (Numerical Rating Scale), activation exercises, and surrounding muscle strength (Sphygmomanometer), and improve functional ability (Tegner Lysholm Knee Scale) as well as the provision of home programs Performed by regular monitoring of exercise intensity using isometric, isotonic, and isokinetic exercises, which were given according to the concept of progressive loading.
Conclusion: This case study shows that surgery combined with a comprehensive physiotherapy program plan in ACLR and meniscal repair cases, as well as adding home-based exercise programs with intense monitoring, generate more effective results.
Keywords: physiotherapy rehabilitation, anterior cruciate ligament total, meniscal repair
Correspondence: Suryo Saputra Perdana. Physiotherapist Profession Education Department, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Sukoharjo, Central Java, Indonesia. Email: suryo.saputra@ums.ac.id. Mobile: +6281298563988.
References
Adams D, logerstedt D, Giordano A, Axe M, Mackler L (2012). Current concepts for anterior cruciate ligament reconstruction: A criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 42(7): 601–614. doi: 10.2519/jospt.2012.3871.
Bustam IG (2023). Pengaruh NMES dan Treadmill Exercise Terhadap Lower Extremity Functional pada Kondisi Post Operasi Rekonstruksi Anterior Cruciate Ligament. FISIO MU. 4(1): 51–56.
Cerulli G, Placella G, Sebastiani E, Tei M, Speziali A, Manfreda F (2013). ACL reconstruction: Choosing the graft. Joints. 1(1): 18–24.
Filbay SR, Grindem H (2019). Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture, Best Practice and Research: Clinical Rheumatology. 33(1): 33–47. doi: 10.1016/j.berh.20-19.01.018.
Forogh B, Aslanpour H, Fallah E, Babaei-ghazani A (2017). Adding high-fre-quency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone : a randomized single-blind clinical trial. Disability and Rehabilitation. 1–9. doi: 10.1080/09638288.2017.1399294.
Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A (2021). Ligament, and Bone e Soft Tissue Healing in. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 37(7): 2318-2333.e3. doi: 10.-1016/j.arthro.2021.02.019.
Luomajoki J, Wilhelmsen J, Whiteley R (2023). Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. 1–15. Doi: 10.1136/bjsports-2022-1061-58.
Lippert LS (2011). Clinical kinesiology and anatomy. 5th ed. Philadelphia: F. A. Davis Company.
Magee DJ (2021). Orthopedic Physical Assessment. 7th ed. St. Louis: Elsevier.
Melani Y, Munawwarah M, Maratis J (2021). Penambahan Lower Extremity Strengthening Exercise Pada Core Stability Exercise Dalam Mengurangi Risiko Jatuh Pada Lansia’, FISIO MU: Physiotherapy Evidences. 2(2): 107–116. doi: 10.23917/fisiomu.v2i2.14204.
Mohanakrishnan J, Mohanakrishnan B, Rajendiran, Balaji G (2016). Sphygmomanometer as biofeedback in acute anterior cruciate ligament reconstruction rehabilitation : A cost-effective technique. Int J Clin Exp Physiol. doi:10.4103/2348-8093.18-5210.
Mueller BT, Moulton SG, O'brien L, LaPrade RF (2016). Rehabilitation Following Meniscal Root Repair: A Clinical Commentary. J Orthop Sports Phys Ther. 46(2): 104–113. doi: 10.2519/jospt.2016.6219.
Panagopoulos A, Billis E, Floros G, Stav-ropoulos T, Kaparounaki E, Moucho M, Paskou A (2020). Cross-Cultural Adaptation of the Greek Versions of the Lysholm Knee Scoring Scale and Tegner Activity Scale. 12(7). doi: 10.7759/cureus.9372.
Salem HS, Shi WJ, Tucker BS, Dodson CC, Ciccotti MG, Freedman KB, Cohen SB (2018). Contact Versus Noncontact Anterior Cruciate Ligament Injuries: Is Mechanism of Injury Predictive of Concomitant Knee Pathology?. J. Ar-throsc. Relat. Surg. 34(1) pp. 200–204. doi:10.1016/j.arthro.2017.07.039.
Sanford H (2022). General Guidelines/Pre-cautions: ACL Reconstruction Rehabilitation Guideline. (947-556–403). Available at: sanfordhealth.org.
Sim K, Rahardja R, Zhu M, Young SW (2022). Optimal Graft Choice in Athle-tic Patients with Anterior Cruciate Lig-ament Injuries: Review and Clinical Insights. OAJSM.
Singh N (2018). International Epidemiology of Anterior Cruciate Ligament Injuries. Orthop. Res. Online J 1(5): 94–96. doi:10.31031/oproj.2018.01.000525.
Teyhen DS, Robertson J (2018). Optimizing Recovery After Knee Meniscal or Cartilage Injury. J. Orthop. Sports. Phys. Ther. 48(2): 125. doi:10.2519/-jospt.2018.0301.
Van Ost L (2013). Goniometry and Muscle Testing: A Handbook for Students & Clinicians. 13: 55–67. doi:10.2147/oaj-sm.s340702.
