Date of Award

2020

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this selective EBM review is to determine whether or not eccentric training in combination with traditional ACL rehabilitation programs is more effective than traditional ACL rehabilitation programs alone at improving overall knee function in post-ACL reconstruction patients.

Study Design: A systematic review of three randomized control trials (RCTs) published between 2009 and 2018. The studies were all written in the English language and located in peer reviewed journals.

Data Sources: Three randomized controlled trials (RCTs) which evaluated the effectiveness of eccentric exercise as better rehabilitation in combination with traditional ACL rehabilitation for post-ACL reconstruction patients as compared to control groups only completing traditional ACL rehabilitation. All studies were found using PubMed.

Outcomes Measured: The primary outcome of all three studies was overall knee function which was measured using patient self-reported questionnaires based on their level of knee function. The scales included questions regarding symptoms, activities of daily living, quality of life, and disabilities. The questionnaires used were the Lysholm Knee Scale, Anterior Cruciate Ligament- Quality of Life Questionnaire (ACL-QOL), and International Knee Document Committee (IKDC).

Results: The study by Harput et al. (Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA. 2018;1-8. doi: 10.1007/s00167-018-5040-1) shows no significant difference between IKDC scores between the group completing eccentric exercise in combination with traditional ACL rehabilitation compared to the group performing traditional ACL rehabilitation alone (p>0.05). The study by Kinikli et al. (Acta Orthopaedica et Traumatologica Turcica. 2014;48(3):283-289. doi:10.3944/AOTT.2014.13.0111) shows a significant difference in overall knee function between patients in the study group who completed eccentric exercise and traditional ACL rehabilitation compared to those in the control group (p=0.002 for the Lysholm Knee Scale and p=0.000 for the ACL-QOL scale). The study by Papandreou et al. (J Orthop Surg Res. 2009;4(1):2. doi: 10.1186/1749-799X-4-2) also found statistical difference between the study and control group in Lysholm Knee Scale scores (p=0.03).

Conclusion: Although the results of these three studies vary, eccentric training has the potential to be beneficial in post-ACLR rehabilitation. However, further research is needed to evaluate if eccentric exercise could improve knee stability, overall knee function, and decrease re-injury rates.

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