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Non-operative anterior cruciate ligament rehabilitation for individuals participating in high level physical activity
Dissertation

Non-operative anterior cruciate ligament rehabilitation for individuals participating in high level physical activity

G. Kelley Fitzgerald
Doctor of Philosophy (Ph.D.), Allegheny University of the Health Sciences
30 Oct 1998
DOI:
https://doi.org/10.17918/00009453
pdf
Fitzgerald_G_19986.22 MB
PDF Access upon request, Email title, URL, or DOI to archives@drexel.edu

Abstract

Non-operative anterior cruciate ligament rehabilitation programs have not been successful in returning physically active individuals to pre-injury physical activity levels. Two reasons for poor success of these programs are: (1) inadequate criteria for selecting appropriate patients for non-operative management, and, (2) lack of emphasis in rehabilitation programs on neuromuscular control of dynamic knee stability. The purpose of this project was to improve the success of non-operative anterior cruciate ligament management of physically active individuals by addressing the issues of patient selection and emphasis of neuromuscular control of dynamic knee stability in rehabilitation. Two studies were conducted in an effort to meet the project objectives. The first study was done to develop and test a clinical screening examination that could distinguish patients who were good candidates for non-operative management, from those who were not, after anterior cruciate ligament rupture. The results of this study indicated that the incidence of episodes of giving way at the knee, the score on a self report knee function survey, a self report rating of global knee function, and the score on a single leg, timed hop test could distinguish patients who were good candidates for non-operative management, from those who were not, after anterior cruciate ligament rupture. The second study was a randomized clinical trial to test the effectiveness of a treatment program designed to improve neuromuscular control of dynamic knee stability (perturbation training) in returning highly active individuals to pre-injury levels of function, after anterior cruciate ligament rupture. Only subjects who met the criteria for participation in non-operative management, based on the screening examination developed in the first study, participated in the randomized clinical trial. The results of the randomized clinical trial indicated that subjects receiving the perturbation training were almost five times more likely to succeed in returning to pre-injury activity levels than those who did not receive the perturbation training. Incorporating the screening examination and perturbation training procedures in non-operative anterior cruciate ligament rehabilitation programs significantly improved treatment success compared to previously reported non-operative treatment outcomes in physically active individuals with anterior cruciate ligament rupture. New treatment guidelines were established for non-operative management of anterior cruciate ligament rupture in physically active individuals, based on the results of this project.

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