Does an Accelerated Program Give Equivalent Results in Both Elite Athletes and Nonathletes?

in Journal of Sport Rehabilitation
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Context: Although many researchers have investigated the functional outcomes of different accelerated rehabilitation programs after anterior cruciate ligament reconstruction (ACLR), the functional results of the same accelerated rehabilitation program following ACLR applied for both elite athletes and nonathletes have not yet been investigated. Objective: To examine the effects of the same accelerated anterior cruciate ligament rehabilitation program on pain and functionality of elite athletes and nonathletes. Design: Prospective preintervention–postintervention design. Setting: Physiotherapy department. Participants: Fifteen elite athletes and 15 nonathletes who underwent unilateral ACLR with autologous hamstring tendon graft. Intervention: All participants received the same protocol for 6 weeks (5 sessions in a week). Main Outcome Measures: Primary measurements were pain intensity, which was measured by visual analog scale, range of motion measurement using universal goniometer, and functionality, which was detected by Lysholm score. Secondary measurements were short form-36 and Beck Depression Inventory. Results: Higher Lysholm (P = .001) and Beck Depression Inventory (P = .03) scores were observed in the elite athlete group, and higher pain (P = .001) was observed in the nonathlete group at baseline assessments. Significant improvement detected for pain (P < .05), knee flexion range (P < .05), Lysholm score (P < .05), and Beck Depression Inventory (P < .05) compared with preintervention for both groups. Finally, after comparing the mean change values, the nonathlete group displayed greater decrease in pain level (P = .01) and participants in the elite athlete group further showed a greater decrease in depression level (P = .001). Conclusions: This study found that the same accelerated rehabilitation protocol provides significant improvements for pain, functionality, and depression in both elite athletes and nonathletes after ACLR. Clinicians should consider our results when applying an anterior cruciate ligament rehabilitation program for nonathlete groups.

Feyzioğlu and Öztürk are with the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. Feyzioğlu is also with the Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey. Sirmen is with the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey. Muğrabi is with Fulya Foot Surgery Center, Istanbul, Turkey.

Feyzioğlu (ozlem.feyzioglu@acibadem.edu.tr) is corresponding author.
  • 1.

    Manandhar RR, Chandrashekhar K, Kumaraswamy V, Sahanand S, Rajan D. Functional outcome of an early anterior cruciate ligament reconstruction in comparison to delayed: are we waiting in vain? J Clin Orthop Trauma. 2018;9(2):163166. PubMed ID: 29896021 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Stevenson JH, Beattie CS, Schwartz JB, Busconi BD. Assessing the effectiveness of neuromuscular training programs in reducing the incidence of anterior cruciate ligament injuries in female athletes: a systematic review. Am J Sports Med. 2015;43(2):482490. PubMed ID: 24569703 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Bogunovic L, Matava MJ. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review. Phys Sportsmed. 2013;41(4):3340. PubMed ID: 24231595 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Owusu-Akyaw KA, Kim SY, Spritzer CE. Determination of the position of the knee at the time of an anterior cruciate ligament rupture for male versus female patients by an analysis of bone bruises. Am J Sports Med. 2018;46(7):15591565. PubMed ID: 29667852 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Van Grinsven S, van Cingel RE, Holla CJ, van Loon CJ. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):11281144. PubMed ID: 20069277 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Frańczuk B, Fibiger W, Kukiełka R, Jasik-Tyrkalska B, Trabka R. Early rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament. Ortop Traumatol Rehabil. 2004;6(4):416422.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):752762. PubMed ID: 24126701 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Nwachukwu BU, Anthony SG, Lin KM, Wang T, Altchek DW, Allen AA. Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review. Phys Sportsmed. 2017;45(3):303308. PubMed ID: 28449611 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair—past, present and future. J Exp Orthop. 2018;5(1):20. PubMed ID: 29904897 doi:

  • 10.

    Oztekin HH, Boya H, Ozcan O, Zeren B, Pinar P. Pain and affective distress before and after ACL surgery: a comparison of amateur and professional male soccer players in the early postoperative period. Knee. 2008;15(5):368372. PubMed ID: 18635361 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Cozzi AL, Dunn KL, Harding JL, Valovich McLeod TC, Welch Bacon CE. Kinesiophobia after anterior cruciate ligament reconstruction in physically active individuals. J Sport Rehabil. 2015;24(4):434439. PubMed ID: 25365598 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Atwi H, Mansour A, Karaki H, Abbes Y, Hassan KH. Evaluation of rehabilitation parameters after anterior cruciate ligament reconstruction. Int J Physiother Res. 2017;5(3):21192126. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Janssen RP, van Melick N, van Mourik JBA, Reijman M, van Rhijn LW. ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes. BMJ Open Sport Exerc Med. 2018;4(1):e000301. PubMed ID: 29682311 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Christensen JC, Goldfine LR, West HS. The effects of early aggressive rehabilitation on outcomes after anterior cruciate ligament reconstruction using autologous hamstring tendon: a randomized clinical trial. J Sport Rehabil. 2013;22(3):191201. PubMed ID: 23579334 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2012;42(3):153171. PubMed ID: 22382825 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Rambaud AJ, Ardern CL, Thoreux P, Regnaux JP, Edouard P. Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review. Br J Sports Med. 2018;52(22):14371444. PubMed ID: 29720478 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009;37(5):890897. PubMed ID: 19261899 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short form (KOOS‐PS), Knee Outcome Survey Activities of Daily Living scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011;63(S11):S208S228. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Webster KE, Feller JA. Use of the short form health surveys as an outcome measure for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):11421148. PubMed ID: 23708380 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Kapci EG, Uslu R, Turkcapar H, Karaoglan A. Beck depression inventory II: evaluation of the psychometric properties and cut‐off points in a Turkish adult population. Depress Anxiety. 2008;25(10):E104E110. PubMed ID: 17876817 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601614. PubMed ID: 22402434 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Zhu W, Wang D, Han Y, Zhang N, Zeng Y. Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures. Eur J Orthop Surg Traumatol. 2013;23(8):939943. PubMed ID: 23412233 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Pereira M, Vieira NS, Brandão ER, Ruaro JA, Grignet RJ, Fréz AR. Physiotherapy after reconstruction of anterior cruciate ligament. Acta Ortop Bras. 2012;20(6):372375. PubMed ID: 24453634 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy. 2001;17(9):971980. PubMed ID: 11694930 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Kobayashi A, Higuchi H, Terauchi M, Kobayashi F, Kimura M, Takagishi K. Muscle performance after anterior cruciate ligament reconstruction. Int Orthop. 2004;28(1):4851. PubMed ID: 12942198 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Mikkelsen C, Werner S, Eriksson E. Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study. Knee Surg Sports Traumatol Arthrosc. 2000;8(6):337342. PubMed ID: 11147151 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Gadea F, Monnot D, Quélard B, et al. Knee pain after anterior cruciate ligament reconstruction: evaluation of a rehabilitation protocol. Eur J Orthop Surg Traumatol. 2014;24(5):789795. PubMed ID: 23744093 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Dworkin RH, Turk DC, Wyrwich KW, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105121. PubMed ID: 18055266 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Cupido C, Peterson D, Sutherland MS, Ayeni O, Stratford PW. Tracking patient outcomes after anterior cruciate ligament reconstruction. Physiother Can. 2014;66(2):199205. PubMed ID: 24799759 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Rosso F, Bonasia DE, Cottino U, Cambursano S, Dettoni F, Rossi R. Factors affecting subjective and objective outcomes and return to play in anterior cruciate ligament reconstruction: a retrospective cohort study. Joints. 2018;6(1):2332. PubMed ID: 29675503 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Haillotte G, Hardy A, Granger B, Noailles T, Khiami F. Early strength recovery after anterior cruciate ligament reconstruction using the fascia lata. Orthop Traumatol Surg Res. 2017;103(7):10211025. PubMed ID: 28899822 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45(7):596606. PubMed ID: 21398310 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Herrington L. Functional outcome from anterior cruciate ligament surgery: a review. OA Orthopaedics. 2013;1(2):1219. doi:

  • 34.

    Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors associated with psychological readiness to return to sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2018;46(7):15451550. PubMed ID: 29718684 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Sonesson S, Kvist J, Ardern C, Österberg A, Silbernagel KG. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):13751384. PubMed ID: 27562372 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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