Non-concurrent strength and endurance rehabilitation improves short-term functional, neuromuscular and sensorimotor outcomes following both autologous chondrocyte implantation (ACI) repair of chondral lesions and anterior cruciate ligament (ACL) reconstruction.
Gleeson NP 1&4, Bailey AK 2, Rees D 2, Roberts SNJ 2, Richardson JB 3, Eston R 4, Minshull C 5
1 School of Health Sciences, Queen Margaret University, Edinburgh, UK 2 National Centre for Sports Injury Surgery, Robert Jones & Agnes Hunt Orthopaedic and District NHS Trust, Oswestry, UK 3 Institute of Orthopaedics, Robert Jones & Agnes Hunt Orthopaedic and District NHS Trust, Oswestry, UK 4 School of Sport & Health Sciences, University of Exeter, UK 5 School of Sport & Health Science & Technology, Nottingham Trent University, UK
PURPOSE: To assess the effectiveness of a new formulation of rehabilitation following ACI surgery or ACL-reconstruction, involving segregation of strength and endurance exercises to minimise physiological inhibition to conditioning. DESIGN & METHODS: RCT - Neuromechanical, sensorimotor, musculoskeletal and functional capabilities were assessed in knee extensor and flexor musculature of involved and contralateral control limbs prior to either unilateral ACI or ACL-reconstruction surgery; and intermittently to 48 weeks post-surgery in participants randomly assigned into three groups: (i) CONTROL A, (n=7), accelerated programme of exercise rehabilitation used in current practice, (ii) CONTROL B, (n=7), quantifying the influence of the test administrator/assessment procedures, and (iii) EXPERIMENTAL, (n=8) involving a modified programme of rehabilitation specific phasing of strength and endurance exercises. RESULTS: Results from mixed-model ANOVA (0 – 12 weeks post-surgery) suggest that whereas the neuromechanical performance associated with the involved limb of the control group (CONTROL A) showed relatively large deficits compared to baseline (up to 72%, 65% and 82% reduction, respectively in peak force, electromechanical delay, rate of force development, the performance capabilities of the EXPERIMENTAL group were preserved more effectively during this period of rehabilitation (up to 35%, 42% and 36% reduction, respectively; F[5, 65] = 3.4; p<0.05). Similarly, sensorimotor performance capabilities were re-established more rapidly (F[5, 65] = 3.6; p<0.05). Accumulating data suggest similar short-term enhancements to patterns of recovery following ACI surgery. CONCLUSION: The findings show that segregation of strength and endurance exercises within early phases of rehabilitation programmes may minimise attenuation of performance capabilities following surgery and facilitate optimised recovery.
Support
Institute of Orthopaedics, Robert Jones & Agnes Hunt Orthopaedic and District NHS Trust, Oswestry, UK School of Sport & Health Sciences, University of Exeter, UK
References
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