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Pier Paolo Mariani, Luca Laudani, Jacopo E. Rocchi, Arrigo Giombini, and Andrea Macaluso

knee joint. Even if ACL reconstruction (ACLr) has shown good results in terms of knee stability, residual and persistent quadriceps strength deficit is reported as one of the limiting factors in return to preinjury level of function and activity, 1 – 4 and this deficit can persist for more than 2

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Melissa DiFabio, Lindsay V. Slater, Grant Norte, John Goetschius, Joseph M. Hart, and Jay Hertel

.1177/036354658601400406 3728779 6. Bryant AL , Kelly J , Hohmann E . Neuromuscular adaptations and correlates of knee functionality following ACL reconstruction . J Orthop Res . 2008 ; 26 ( 1 ): 126 – 135 . PubMed doi:10.1002/jor.20472 10.1002/jor.20472 17676614 7. Petersen W , Taheri P , Forkel P , Zantop

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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.

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Jamie L. Shapiro, Britton W. Brewer, Allen E. Cornelius, and Judy L. Van Raalte

The purposes of this study were to investigate patterns of emotional response to reconstructive surgery of the anterior cruciate ligament (ACL) of the knee following sport injury and to examine the extent to which neuroticism differed across patterns of adjustment. Participants were 73 patients (51% recreational athletes, 46% competitive athletes, 3% nonathletes) who had ACL reconstruction surgery and who had low levels of negative mood before surgery. Participants completed measures of personality and negative mood before surgery and completed daily assessments of negative mood for 6 weeks postsurgery. The negative mood of participants was classified into three patterns for two different time periods. Participants with patterns of resilience outnumbered those with patterns of disturbance. Participants with patterns involving mood disturbance one week after surgery had significantly higher presurgery neuroticism levels. Practitioners should target individuals with high neuroticism before surgery for emotion management interventions to prevent mood disturbance following ACL surgery.

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Johanna M. Hoch, Cori W. Sinnott, Kendall P. Robinson, William O. Perkins, and Jonathan W. Hartman

Approximately 250,000 anterior cruciate ligament (ACL) injuries occur each year in the United States and ACL reconstruction (ACLR) is common after injury. 1 There are a number of consequences that occur as a result of an ACL injury and subsequent reconstruction, such as re-injury and the

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Christopher Kuenze, Lisa Cadmus-Bertram, Karin Pfieffer, Stephanie Trigsted, Dane Cook, Caroline Lisee, and David Bell

sport. 2 , 3 Following ACL injury, it is common for patients to opt for surgical ACL reconstruction (ACLR) to restore joint stability with the goal of a safe return to physical activity. 4 Despite this goal, 33% to 45% of competitive athletes will not return to the same level of competition following

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Luke M. Mueller, Ben A. Bloomer, and Chris J. Durall

Clinical Scenario:

Anterior cruciate ligament (ACL) injuries are associated with a lengthy recovery time, decreased performance, and an increased rate of reinjury. To improve performance of the injured knee, affected athletes often undergo surgical reconstruction and rehabilitation. Determining when an athlete is ready to safely return to play (RTP), however, can be challenging for clinicians. Although various outcome measures have been recommended, their ability to predict a safe RTP is questionable.

Focused Clinical Question:

Which outcome measures should be used to determine readiness to return to play after ACL reconstruction?

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Carlan K. Yates, Michael R. McCarthy, Howard S. Hirsch, and Mark S. Pascale

This study examined the benefits and possible risks of immediate continuous passive motion after autogenous patellar tendon reconstruction of the anterior cruciate ligament. Thirty patients scheduled to undergo ACL reconstruction were prospectively randomized into two groups, CPM and non-CPM. Postoperatively, those in the non-CPM group wore a hinged knee brace. Those in the CPM group were kept on a CPM machine 16 hrs a day while in the hospital and they used it 6 hrs a day for the first 2 weeks postoperatively. After surgery the patients were assessed for hemovac drainage, range of motion, swelling, effusion, subjective pain, and use of pain medication. The CPM group had significantly less swelling and effusion, required less pain medication, and had greater knee flexion. No differences were found in hemovac drainage, passive knee extension, or subjective pain reports despite a significantly greater use of pain medication in the non-CPM group. The results suggest that immediate CPM after ACL reconstruction is safe and facilitates early range of motion by decreasing the amount of pain medication, effusion, and soft tissue swelling.

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J. Allen Hardin, John A. Guido, and Christopher J. Hughes

Due to the likelihood of hamstring dysfunction associated with anterior cruciate ligament (ACL) injury, it is clinically significant to determine if a hamstring weakness exists preoperatively. The purpose of this study was to determine if a hamstring muscle deficit existed at the time of surgery and to determine the time necessary to achieve hamstring strength equal to preoperative measures of the uninvolved extremity during postoperative rehabilitation. Twelve patients who underwent ACL reconstruction using a patellar tendon autograft participated. Each subject underwent a preoperative isometric knee strength evaluation at 60° of knee flexion. Each subject underwent postoperative rehabilitation including hamstring muscle strengthening. Repeat isometric testing was performed on each subject at 21 and 42 days postoperative. There was no statistical difference in hamstring muscle strength, as measured by isometric peak torque, either preoperatively or postoperatively. Therefore, maintaining rather than increasing hamstring strength postoperatively should be emphasized as an integral part of rehabilitation.

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Michael R. McCarthy, Barton P. Buxton, and Carlan K. Yates

Continuous passive motion (CPM) is a modality used in the treatment, management, and rehabilitation of a variety of orthopedic problems. Recently, CPM devices have been therapeutically employed immediately after autogenous patellar tendon reconstruction of the anterior cruciate ligament (ACL). Whereas the concept of early motion is indicated, there is a concomitant concern that the implementation of immediate passive motion may stretch or rupture the graft. Twenty subjects scheduled to undergo ACL reconstruction were randomized into two groups (10 CPM and 10 non-CPM). All subjects performed the same postoperative rehabilitation with the exception of the CPM. Objective anterior tibial translation measurements were recorded with a KT-1000 for a 30-1b (133.5-N) Lachman test at 1 year postreconstruction. The results of this study indicated that the implementation of immediate continuous passive motion did not have any deleterious effects on the stability of the ligament reconstruction.