Rehabilitation following ACL reconstruction focuses on treatment of impairments and functional limitations. Clinical pathways that have been developed for rehabilitation of the knee are useful for identifying and classifying impairments and functional limitations following ACL reconstruction. Application of these clinical pathways will enable the physical therapist or athletic trainer to select the most appropriate treatment for an individual. Knowledge of secondary pathology and concomitant surgery allows the clinician to modify application of the clinical pathway. The purpose of this manuscript is to describe modifications for rehabilitation of individuals following ACL reconstruction, based on knowledge of secondary pathology and/or concomitant surgery.
James J. Irrgang and Christopher D. Harner
David J. Pezzullo, James J. Irrgang and Susan L. Whitney
Patellar tendonitis is a common pathology seen in athletes involved in activities requiring forceful eccentric muscle contractions or repeated flexion and extension of the knee. This article reviews the related anatomy, biomechanics, mechanism of injury, and diagnosis of patellar tendonitis. It also presents several treatment approaches and suggestions to help identify athletes at risk.
Emily D. Cox, Scott M. Lephart and James J. Irrgang
The purpose of this study was to provide normative data on postural sway by comparing the mean gain score between two balance training groups and a control group. Twenty-seven recreational collegiate athletes (14 females, 13 males, 18-36 years old) with no past documented lower extremity injury or lesion of the vestibular system were randomly placed into three groups: control (nontraining), foam surface training, or hard surface training. The Chattecx Dynamic Balance System (CDB) was utilized for objective post-and pretraining recordings. CDB tests were performed on the training and nontraining extremities with subjects' eyes open and eyes closed. Results revealed no significant post to pre mean gain score differences within any group, nor was any significance revealed between group differences. Although no significant differences were revealed, trends indicated specificity of training toward testing mode. These data should assist clinicians in preventing ankle injury or compensating for ankle instability with balance training.
Paul A. Borsa, Scott M. Lephart and James J. Irrgang
We compared the outcome measures of three knee scoring systems currently used to measure disability in anterior cruciate ligament (ACL)–deficient athletes. Twenty-nine ACL-deficient athletes completed three scoring systems (the Lysholm Knee Scoring System, a modified version of the Cincinnati Knee Scoring System, and the Knee Outcome Survey). Results demonstrate statistically significant mean differences and linear relationships between the outcome measures for the three scoring systems. The Knee Outcome Survey appears to provide valid measures of disability and indicates that our subjects functioned well with activities of daily living but became symptomatic and functionally limited with sports. The outcome measures also indicate that the Lysholm system is more specific to activities of daily living, while the modified Cincinnati is more specific to sports. We recommend that standard scoring systems be developed to provide measures of functional disability in athletes who experience knee injuries.
James J. Irrgang, Susan L. Whitney and Christopher D. Harner
Shoulder pain in throwing athletes is reviewed. The anatomy and function of the rotator cuff and the biomechanics of the throwing mechanism are described. Physical examination for rotator cuff injuries, treatment considerations, and a protocol are presented. Failure to recognize glenohumeral instability may limit the success of nonoperative management of rotator cuff injuries in throwing athletes. This article provides a comprehensive review of some of the underlying causes of rotator cuff pathology in throwing athletes. Rotator cuff injuries in throwing athletes are closely associated with glenohumeral instability. The role of glenohumeral instability in the pathogenesis of rotator cuff injuries is described.
James J. Irrgang, Susan L. Whitney and Emily D. Cox
Recently there has been emphasis on including balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. It is believed that injury to joint and musculotendinous structures results in altered somatosensory information that adversely affects motor control. This may result in increased risk for recurrent injury, decreased performance, or both. Balance and proprioceptive training have been advocated to restore motor control to the lower extremity. This paper will review the current scientific rationale for use of balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. Additionally, guidelines for training to improve balance and proprioception will be discussed.
James J. Irrgang, Christopher D. Harner, Freddie H. Fu, Mark B. Silbey and Robbie DiGiacomo
The purpose of this study was to determine the effects of preoperative, intraoperative, and postoperative intervention on the incidence of loss of motion (LOM) following ACL reconstruction. A retrospective review of patients undergoing ACL reconstruction between 1990 and 1991 was conducted to identify those with LOM. Factors potentially related to loss of motion were recorded. The results were compared to the findings of a similar group of patients who underwent ACL reconstruction between 1987 and 1989. In 1990 to 1991, less concomitant ligament surgery was performed, the incidence of loss of extension was significantly reduced, and the incidence of loss of flexion was significantly increased. It appears the risk for loss of extension can be minimized by delaying surgery following acute injury, performing less concomitant ligament surgery, paying meticulous attention to notchplasty and anatomic placement of the graft, and placing early emphasis on restoration of full extension following surgery.
Gerald McGinty and James J. Irrgang
Susan L. Whitney, Larry Mattocks, James J. Irrgang, Pamela A. Gentile, David Pezzullo and Abdulazeem Kamkar
The purpose of this two-part study was to determine if lower extremity girth measurements are repeatable. Sixteen males and 14 females participated in the intra- and intertester reliability portion of this study. Girth was assessed at five different lower extremity sites by two physical therapists using a standard tape measure. Thirty measures (15 by each examiner) were collected on the subject's right leg, and a mean of the three measures was used in the analysis. The measurements were repeated 7 days later. It was found that by using a simple standardized procedure, girth measurements in the clinic can be highly repeatable in experienced clinicians. Part 2 of the study involved testing the right and left legs of 22 subjects to determine if girth of the right and left legs was similar. All subjects had their girth assessed at five sites on their right and left legs during one session. It was found that girth measures on the right and left lower extremities are comparable. In an acutely injured lower extremity, it might be assumed that the girth of both lower extremities is similar.