To see role of knee barce after anterior cruciate ligament surgery

Recruiting

• Conditions: Sprain of cruciate ligament of knee,

• Registration Number: CTRI/2019/07/020426
• Lead Sponsor: Government Medical College And Hospital

Brief Summary

The anterior cruciate ligament  (ACL) helps in controlling motion at the knee joint in the transverse plane. It provides passive stability to the joint by guiding it during internal and external rotation and also during abduction and adduction movements. In sports activities, injury to ACL is common. ACL injury can occur in various ways like  changing direction rapidly, stopping suddenly, landing from a jump incorrectly, slowing down while running or direct contact such as a football tackle. Healing of ACL does not occur on its own, therefore many methods have been designed to treat the ACL-injured knee. The current gold standard treatment for a skeletally mature patient is an ACL reconstruction with a tendon graft. Common grafts that can be used for ACL reconstruction are patellar tendon, hamstring tendon, and quadriceps tendons. Rehabilitation following Anterior Cruciate Ligament Reconstruction (ACLR) is an important  part of a full recovery. There are 3  phases of graft healing-  Early  graft  healing  phase (0–4 weeks)  in  which  there  is  graft  necrosis,  hypocellularity  and  overall  collagen  structure  is maintained.  Proliferative  phase (4–12 weeks)  in which there is cellular repopulation and  revascularization. Ligamentization phase (12 weeks–≥1 year) -Graft approaches normal ACL in this phase. The primary aim is to withstand first 6-9 weeks with a graft that remains intact and tight with near full knee extension and minimum swelling. Following ACL surgery, many different rehabilitation options have been explored but no clear consensus on the best rehabilitation strategy has been reached. Some surgeons recommended immobilization for 6-8 weeks with brace and subsequent use of crutches for next 3-4 month. Some surgeons advised against the use of quadriceps immediately in the post-operative period to  protect  the  reconstructed  knee.Shelbourne  and  Nitz  gave  the  system  of  aggressive accelerated  rehabilitation. They  concluded  that  patients  who  were  managed  with  this aggressive rehabilitation protocol had better functional outcome. After the work of Shelbourne and  Nitz,  rehabilitation  protocols  focused  more  on  immediate  post-operative  mobilization, muscle strengthening, full weight bearing and full passive extension. The  application  of  post-operative  bracing  of  the  knee  after  ACL reconstruction is a controversial topic. Palm et al concluded that patients who were given brace post operatively experienced better postural control/stability as compared to patients who were not given knee brace. It  has  also  been  observed  that  knee  brace  reduces  pain  and  early  post-operative complications and offer increased protection to implanted graft. On the contrary, it has been observed that knee bracing causes joint stiffness, collagen degeneration and also cause muscle atrophy. The  other  disadvantages  of  brace  include  decrease  in  patient’s  perception  of  maximal performance, increase in fatigability during exercise and daily activities, discomfort and additional cost . Recently there are reports that have shown that non bracing has similar functional outcome after ACL reconstruction as compared to bracing. Due to scant literature of high-level evidence comparison studies, the issue of use /non-use of brace is still unresolved. Further, there is no study from India which has compared the use of bracing with non-bracing. The purpose of this study is to evaluate the effects of bracing during post-operative rehabilitation on functional outcome in patients undergoing ACL reconstruction.

Detailed Description

Not available

Study Timeline

• Study Start: 2019-07-29
• Last Update Posted: 2019-07-29

Recruitment & Eligibility

• Status: Open to Recruitment
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• ACL injury during sports activity.
• Age between 18-40 years.

Exclusion Criteria

• Previously operated upon the same knee.
• Previous infective pathology of the same knee.
• Any other ligament injury in ipsilateral/ contralateral knee presently or in the past.

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
rehabilitation on functional outcome in patients undergoing ACL reconstruction.	1 year and 6 months
To compare the effects of knee bracing and non-knee bracing during post-operative	1 year and 6 months

Secondary Outcome Measures

Name	Time	Method
To see the functional outcome in the respect of return to sports, mechanical stability and Lysholm score	1 year 6 months

Trial Locations

Locations (1)

Government Medical College and Hospital, Chandigarh; 🇮🇳 Chandigarh, CHANDIGARH, India

Government Medical College and Hospital, Chandigarh

🇮🇳Chandigarh, CHANDIGARH, India

Dr Keshav Jindal

Principal investigator

08814094929

drkeshavjindal@gmail.com