Reconstruction of the anterior cruciate ligament

Abstract

The clinical results in 29 patients who had undergone ACL reconstruction with quadriceps-patellar tendon graft over-the-top were studied at an average of 28 months postoperatively. Postoperative immobilization was at either 30° (N = 17) or 70° (N = 12) of knee flexion for 6 weeks. All patients then followed a com mon preparatory training program for 8 weeks. In the 14th postoperative week the patients were put on either progressive resistance training (N = 12) or isokinetic training (N = 17) for 6 weeks, after which all had identical training. Independent of primary knee immobilization angle or training regimens, no differences could be demon strated with respect to stability, range of motion, func tion, or isokinetic mechanical output. For all patients, Lysholm knee function score improved from 60.5 to 93.6 (P < 0.001) and activity level from 3.9 to 6.3 (P < 0.001). Isokinetic peak torque, contractional work, and mean power of the quadriceps at 30, 90, and 180 deg/ sec were lower in the injured compared to the nonin jured leg (78% to 90%; P < 0.01) both preoperatively and at followup, and there were no significant differ ences between the preoperative and follow-up values. Clinical stability improved (P < 0.001) in 19 of the 29 patients (66%) and in 11 of those 17 patients with early isokinetic training (65%). Performance tests were nor mal in 23 of 29 patients (79%), with minor abnormalities in the rest. We conclude that immobilization at a higher tension of the quadriceps or early isokinetic training did not results in any advantages in the long run, and that patients with early isokinetic training did not show any increased incidence of remaining instability.