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Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Open kinetic chain (OKC) knee extensor resistance training has lost favour in ACLR rehabilitation due to concerns that this exercise is harmful to the graft and will be less effective in improving function. In this randomized, single-blind clinical trial OKC and closed kinetic chain (CKC) knee extensor training were compared for their effects on knee laxity and function in the middle period of ACLR rehabilitation. The study subjects were 49 patients recovering from ACLR surgery (37 M, 12 F; mean age=33 years). Tests were carried out at 8 and 14 weeks after ACLR with knee laxity measured using a ligament arthrometer and function with the Hughston Clinic knee self-assessment questionnaire and single leg, maximal effort jump testing (post-test only). Between tests, subjects trained using either OKC or CKC resistance of their knee and hip extensors as part of formal physical therapy sessions three times per week. No statistically significant (one-way ANOVA, p>0.05) differences were found between the treatment groups in knee laxity or leg function. OKC and CKC knee extensor training in the middle period of rehabilitation after ACLR surgery do not differ in their effects on knee laxity or leg function. Exercise dosages are described in this study and further research is required to assess whether the findings in this study are dosage specific.

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Acknowledgements

This study was supported by Action Medical Research, The Special Trustees of the Royal London Hospitals Trust and Technogym, UK. The authors would like to thank orthopaedic surgeons Messrs T. Bucknill, A. Davies, P. Earnshaw, M. El-Zebdeh, D. Goodier, M. Lamba, A. Lang-Stevenson, T.B. McAuliffe, D. Sweetnam and P. Thomas and physiotherapists M. Brown, W. Drechsler, J. Dredge, J. Jones, P. Knight, I. Man, B. Paton, R. Vauhnik and M. Yeboah for their support of this study.

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Correspondence to Matthew C. Morrissey.

Appendices

Appendix 1: Page from the diary for recording of activities undertaken outside therapy

Subject Number: —————

Date: ———

Please complete the following tables on a daily basis (you should have been given enough of these sheets so you have one for each day of the study period):

Table 8 Stairs
Table 9 Sports (first three rows of data are examples for your instruction)
Table 10 Walking and other physical activities (please indicate your best estimate of the total number of minutes you have walked today as well as the type and duration of other activities)

Appendix 2: Questionnaire for detecting patient bias resulting from communication with their clinician

Date: ———-

Please note that this questionnaire is anonymous. Any responses you make will be kept in the strictest confidence. Your clinician will not be told of your specific responses. The responses will help us better understand the results from this study. Please answer the following questions as accurately as possible.

  1. 1.

    Please tick which one of these two exercises you performed during the study:

    • leg press (lying on back and pushing against plate)

    • knee extension (sitting on a bench and lifting a weight placed against your shin)

  2. 2.

    During the study, were you ever given the impression that these two exercises differed in terms of how good they were?

    • Yes (please answer all the following questions)

    • No (please answer questions 5 and 6 only)

  3. 3.

    Which of the two exercises was the so-called ‘better’ one?

    • leg press ((lying on back and pushing against plate)

    • knee extension (sitting on a bench and lifting a weight placed against your shin)

  4. 4.

    Please describe who or what gave you the impression that one exercise was better than the other

  5. 5.

    Please tick the hospital where you had physiotherapy:

    • Mile End   The Whittington   Whipps Cross   St Thomas’s

  6. 6.

    Please state the name(s) of the physiotherapist(s) who treated you during the study:——————————–

Thank you for taking the time to complete this questionnaire.

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Perry, M.C., Morrissey, M.C., King, J.B. et al. Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13, 357–369 (2005). https://doi.org/10.1007/s00167-004-0568-7

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  • DOI: https://doi.org/10.1007/s00167-004-0568-7

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