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Long-term results of complex medical rehabilitation of patients after reconstruction of the anterior cruciate ligament performed at different times after injury
- Authors: Radysh I.I.1, Kruglova L.S.2, Boyarintsev V.V.1, Nagornev S.N.2
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Affiliations:
- Central State Medical Academy of Department of Presidential Affairs
- Clinical hospital 1 of the Department of Presidential Affairs of the Russian Federation
- Issue: Vol 22, No 1 (2023)
- Pages: 41-50
- Section: Original studies
- URL: https://rjpbr.com/1681-3456/article/view/115249
- DOI: https://doi.org/10.17816/rjpbr115249
- ID: 115249
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Abstract
BACKGROUND: Despite the overall success of arthroscopic anterior cruciate ligament reconstruction, the scientific literature contains studies reporting high recurrence rates (up to 30%), often accompanied by other lesions such as meniscal tears and cartilage damage. The main reasons for this development of events are considered: repeated injury of the anterior cruciate ligament, possible technical errors during surgery, as well as the timing of reconstructive operations after injury.
AIM: Assessment of long-term (after 1 year) results of complex medical rehabilitation of patients after reconstruction of the anterior cruciate ligament, performed at different times after injury.
MATERIALS AND METHODS: The study involved 175 patients aged 18–55 years with an isolated rupture of the anterior cruciate ligament of the knee joint, who underwent rehabilitation measures after arthroscopic reconstruction of the anterior cruciate ligament. Using the stratification method, all patients were divided into two groups depending on the time of arthroscopic reconstruction of the anterior cruciate ligament. In the group with early reconstruction (88 patients), anterior cruciate ligament reconstruction was performed early after the injury, from the 2nd to the 6th week inclusive. Patients of the second group (delayed reconstruction of the anterior cruciate ligament, 87 patients) were operated on late after the injury from the 7th week to 1 year. Each of these stratification groups was divided into two groups using a simple fixed randomization method: control (with a basic rehabilitation complex) and main (with the additional inclusion of high-frequency magnetic therapy and hydrocortisone ultraphonophoresis). The basis of the follow-up study was the results of questionnaires for subjective assessment of the functional state of joints, as well as an assessment of the level of quality of life of patients obtained using MOS SF-36.
RESULTS: A comparative comparison of long-term results obtained in groups where arthroscopic reconstruction of the anterior cruciate ligament was performed early after injury made it possible to establish the advantage of the proposed complex of medical rehabilitation based on high-frequency magnetic therapy and hydrocortisone ultraphonophoresis. This was manifested by a significantly low level of pain according to visual analog scale and a statistically significant excess on scales of subjective assessment of the functional state of the knee joint.
CONCLUSION: The obtained results of positive dynamics of the condition of the knee joint of patients 1 year after reconstruction of the anterior cruciate ligament and rehabilitation indicate the restoration of stability and kinematics of the knee joint. However, comparison of the results obtained between the main groups with different periods of reconstruction of the anterior cruciate ligament made it possible to establish that the assessed parameters differed favorably in patients with early reconstruction of the anterior cruciate ligament.
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About the authors
Ivan I. Radysh
Central State Medical Academy of Department of Presidential Affairs
Email: dr-ivo@yandex.ru
ORCID iD: 0000-0002-1585-5402
SPIN-code: 4780-5985
Russian Federation, 19/1A Marshal Timoshenko street, 121359 Moscow
Larisa S. Kruglova
Clinical hospital 1 of the Department of Presidential Affairs of the Russian Federation
Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-code: 1107-4372
MD, Dr. Sci. (Med.), Professor
Russian Federation, 19 Marshala Timoshenko street, 121359 MoscowValery V. Boyarintsev
Central State Medical Academy of Department of Presidential Affairs
Email: wpx@mail.ru
ORCID iD: 0000-0001-9707-3262
SPIN-code: 2491-7199
MD, Dr. Sci. (Med.), Professor
Russian Federation, 19/1A Marshal Timoshenko street, 121359 MoscowSergey N. Nagornev
Clinical hospital 1 of the Department of Presidential Affairs of the Russian Federation
Author for correspondence.
Email: drnag@mail.ru
ORCID iD: 0000-0002-1190-1440
SPIN-code: 2099-3854
MD, Dr. Sci. (Med.), Professor
Russian Federation, 19 Marshala Timoshenko street, 121359 MoscowReferences
- Anastasieva EA, Simagaev RO, Kirillova IA. Current issues in surgical treatment of anterior cruciate ligament injuries (literature review). Genii ortopedii. 2020;26(1):117–128. (In Russ). doi: 10.18019/1028-4427-2020-26-1-117-128
- Sonesson S, Gauffin H, Kvist J. Early knee status affects self-reported knee function 1 year after non-surgically treated anterior cruciate ligament injury. Phys Ther Sport. 2021;(50):173–183. doi: 10.1016/j.ptsp.2021.05.007
- Von Essen C, Eriksson K, Barenius B. Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofbrosis. Knee Sur Sports Traumat Arthrosc. 2020;28(7):2036–2043. doi: 10.1007/s00167-019-05722-w
- Ferguson D, Palmer A, Khan S, et al. Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis. Eur J Orthopaedic Sur Traumatology. 2019;29(6):1277–1289. doi: 10.1007/s00590-019-02442-2
- Silvers-Granelli H. Why female athletes injure their acl’s more frequently? What can we do to mitigate their risk? IJSPT. 2021;16(4):971–977. doi: 10.26603/001c.25467
- Marmura H, Bryant DM, Getgood AM. Infographic. Sex differences and ACL injuries. Br J Sports Med. 2021;55(22):1313–1314. doi: 10.1136/bjsports-2021-104134
- Parsons JL, Coen SE, Bekker S. Anterior cruciate ligament injury: Towards a gendered environmental approach. Br J Sports Med. 2021;55(17):984–990. doi: 10.1136/bjsports-2020-103173
- Shi H, Jiang Y, Ren S, et al. Sex differences in the knee orthopaedic injury patterns among recreational alpine skiers. BMC Sports Sci Med Rehabil. 2020;12(1):74–81. doi: 10.1186/s13102-020-00224-6
- Magnitskaya NE, Ryazantsev MS, Maisigov MN, et al. Translation, validation and cultural adaptation of the orthopedic questionnaire IKDC 2000 for assessing the condition of the knee joint. Genii ortopedii. 2019;25(3):348–354. (In Russ). doi: 10.18019/1028-4427-2019-25-3-348-354
- Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33–47. doi: 10.1016/j.berh.2019.01.01
- Aksenov SYu. Analysis of long-term results of plastic surgery of the anterior cruciate ligament using autografts from the tendons of the popliteal flexors and the patellar ligament with different types of fixation [dissertation abstract]. Moscow; 2015. 18 p. (In Russ).
- Diquattro E, Jahnke S, Traina F, et al. ACL surgery: Reasons for failure and management. EFORT Open Rev. 2023;8(5):319–330. doi: 10.1530/EOR-23-0085
- Vrmeeijden HD, Yang XA, van der List JP, et al. Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2020;28(11):3666–3675. doi: 10.1007/s00167-020-06160-9
- Mironov SP, Tsykunov MB, Builova TV. Rehabilitation for damage to the capsular-ligamentous apparatus of the knee joint (surgical treatment): Clinical recommendations. Bulletin Restorative Med. 2017;(4):72–79. (In Russ).
- Rehabilitation for damage to the capsular ligamentous apparatus of the knee joint (conservative treatment): Federal clinical recommendations. Moscow 2015. 39 p. (In Russ).
- Korolev AV, Ryazantsev MS, Magnitskaya NE, et al. Long-term results of meniscus suturing during arthroscopic anterior cruciate ligament repair. Traumatology Orthopedics Russia. 2016;22(3):44–53. (In Russ). doi: 10.21823/2311-2905-2016-22-3-44-53
- Gudz YuV, Vetoshkin AA. Specialized medical care for patients with pathology of the cartilage of the knee joint: Educational manual. Saint-Petersburg; 2020. 58 p. (In Russ).
- Bentley G, Biant LC, Carrington RW, et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85(2):223–230. doi: 10.1302/0301-620x.85b2.13543
- Lysholm J, Tegner Y. Knee injury rating scales. Acta Orthopaedica. 2007;78(4):445–453. doi: 10.1080/17453670710014068
- Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43–49.
- Ware JE, Kosinski M, Grandek B. SF-36 Health Survey: Manuаl and interpretation guide. Lincoln, RI: Quality Metric Inc.; 2000. 150 p.
- Ware JE, Kosinski M, Grandek B. SF-36 Health Survey: Manuаl and interpretation guide. Lincoln, RI: Quality Metric Inc.; 2005. 238 p.
- Kaerova EV, Shestera AA, Zhuravskaya NS, et al. Analysis of indicators of the quality of life of neurological patients in the process of physical rehabilitation. Modern Problems Sci Education. 2020;(2):114. (In Russ). doi: 10.17513/spno.29625
- Płocki J. Quality of life of patients after anterior cruciate ligament reconstruction using LARS synthetic graft and autogenous ST/GR graft. Medical Studies. 2017;33(3):208–213. doi: 10.5114/ms.2017.70347
- Amirdzhanova VN, Goryachev DV, Korshunov NI, et al. Population indicators of quality of life according to the SF-36 questionnaire (results of the multicenter study of the quality of life "MIRAG"). Sci Practic Rheumatol. 2008;(1):6–15. (In Russ).
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