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Rehabilitation of Anterior Cruciate Ligament Deficiency
501
Gait Analysis in Patients with Anterior Knee Pain
score) were taken before and after a 12-week course of physiotherapy.
Michael J Callaghan GradDZpPhgs MCSP
Results demonstrated that there was a net improvement
Forty-three patients were included in the data analysis.
Anterior knee pain is a frustrating and difficult problem for physiotherapists and patients alike. Physiotherapy modalities are the mainstay of conservative treatment. These may be more effectively applied if further evidence is established about the relationship between foot and ankle biomechanics and the patellofemoral joint. The purpose of this study was to examine the kinematic and kinetic parameters of the gait of patients with anterior knee pain. Fifteen female symptomatic patients and 15 female control subjects were asked to perform ten barefoot walks along a 10-metre walkway. Ground reaction force data were collected using an AMTI force platform. Rearfoot motion data were collected using a video kinematic analysis system. The results showed that the controls exerted a higher lateral force compared to patients (P < 0.01). There was also a significant difference (P < 0.05) between controls and patients in the amount of time taken to maximum lateral force and in the time taken to achieve maximum angle between the axis of the calcaneus and axis of the tendo Achilles. These results indicate that extended time to maximum lateral force rather than excessive lateral force is a discriminating factor in the gait of female patients with anterior knee pain who have a low recreational status. This contradicts previous studies using running analysis on athletes with this condition and suggests that in terms of diagnosis and treatment, care must be taken when comparing results from groups of different recreational status.
Rehabilitation of Anterior Cruciate Ligament Deficiency A Randomlsed Controlled Trial ~~
David J Beard MSc MCSP
in reflex hamstring contraction latency and functional score in both groups. The improvement in contraction latency and functional score was significantly greater in the proprioceptive enhancement group than in the traditional group (p < 0.05 and p < 0.005 respectively). A positive significant correlation was identified between the improvement in reflex hamstring contraction latency and functional gain for the entire sample (p < 0.05).
Early Active Mobilisation of Flexor Tendon Injuries Pam Gratton MSCP The management and rehabilitation of flexor tendon injuries has undergone a radical change in the last 20 years. In zone I1 injuries particularly, the problems of tendon tethering were approached by Kleinerts’ dynamic traction system, but other centres found proximal interphalangeal joint contractures to be a complication. In Belfast at the Ulster Hospital, a pilot study was set up in 1985 to treat patients with early active mobilisation of the repaired tendon. Patients underwent full passive movements on all joints, into flexion, but more importantly, were instructed to undergo full active movement of the repaired tendon into flexion from 48 hours, with an emphasis on a differential glide between flexor digitorum superficialis and flexor digitorum profundis to reduce adhesion formation. Initial speculation concerning an increased rupture rate proved to be unfounded, and the need for secondary surgery decreased by 75%. In 1986 I moved to Sheffield where this method of treatment became known as the ‘Belfast regime of early active mobilisation’ and in 1988 Windsor also adopted this scheme, as have other centres. The rehabilitation routine and results from three studies will be discussed in this paper.
A pilot study investigating the efficacy of two different regimes of rehabilitation for anterior cruciate ligament deficient (ACLD) patients was completed using a double-blind randomised clinical trial. Fifty ACLD patients were randomly allocated to one of two treatment groups. One regime of treatment was a traditional strengthening programme with no proprioceptive or dynamic stability element, the other a programme designed to enhance proprioception. Measures of reflex hamstring contraction latency, an indirect measure of proprioceptive ability, and a validated knee function scoring system (the Lysholm
Physiotherapy, July 1993, vol79, no 7
Gait Analysis in Patients with Anterior Knee Pain
score) were taken before and after a 12-week course of physiotherapy.
Michael J Callaghan GradDZpPhgs MCSP
Results demonstrated that there was a net improvement
Forty-three patients were included in the data analysis.
Anterior knee pain is a frustrating and difficult problem for physiotherapists and patients alike. Physiotherapy modalities are the mainstay of conservative treatment. These may be more effectively applied if further evidence is established about the relationship between foot and ankle biomechanics and the patellofemoral joint. The purpose of this study was to examine the kinematic and kinetic parameters of the gait of patients with anterior knee pain. Fifteen female symptomatic patients and 15 female control subjects were asked to perform ten barefoot walks along a 10-metre walkway. Ground reaction force data were collected using an AMTI force platform. Rearfoot motion data were collected using a video kinematic analysis system. The results showed that the controls exerted a higher lateral force compared to patients (P < 0.01). There was also a significant difference (P < 0.05) between controls and patients in the amount of time taken to maximum lateral force and in the time taken to achieve maximum angle between the axis of the calcaneus and axis of the tendo Achilles. These results indicate that extended time to maximum lateral force rather than excessive lateral force is a discriminating factor in the gait of female patients with anterior knee pain who have a low recreational status. This contradicts previous studies using running analysis on athletes with this condition and suggests that in terms of diagnosis and treatment, care must be taken when comparing results from groups of different recreational status.
Rehabilitation of Anterior Cruciate Ligament Deficiency A Randomlsed Controlled Trial ~~
David J Beard MSc MCSP
in reflex hamstring contraction latency and functional score in both groups. The improvement in contraction latency and functional score was significantly greater in the proprioceptive enhancement group than in the traditional group (p < 0.05 and p < 0.005 respectively). A positive significant correlation was identified between the improvement in reflex hamstring contraction latency and functional gain for the entire sample (p < 0.05).
Early Active Mobilisation of Flexor Tendon Injuries Pam Gratton MSCP The management and rehabilitation of flexor tendon injuries has undergone a radical change in the last 20 years. In zone I1 injuries particularly, the problems of tendon tethering were approached by Kleinerts’ dynamic traction system, but other centres found proximal interphalangeal joint contractures to be a complication. In Belfast at the Ulster Hospital, a pilot study was set up in 1985 to treat patients with early active mobilisation of the repaired tendon. Patients underwent full passive movements on all joints, into flexion, but more importantly, were instructed to undergo full active movement of the repaired tendon into flexion from 48 hours, with an emphasis on a differential glide between flexor digitorum superficialis and flexor digitorum profundis to reduce adhesion formation. Initial speculation concerning an increased rupture rate proved to be unfounded, and the need for secondary surgery decreased by 75%. In 1986 I moved to Sheffield where this method of treatment became known as the ‘Belfast regime of early active mobilisation’ and in 1988 Windsor also adopted this scheme, as have other centres. The rehabilitation routine and results from three studies will be discussed in this paper.
A pilot study investigating the efficacy of two different regimes of rehabilitation for anterior cruciate ligament deficient (ACLD) patients was completed using a double-blind randomised clinical trial. Fifty ACLD patients were randomly allocated to one of two treatment groups. One regime of treatment was a traditional strengthening programme with no proprioceptive or dynamic stability element, the other a programme designed to enhance proprioception. Measures of reflex hamstring contraction latency, an indirect measure of proprioceptive ability, and a validated knee function scoring system (the Lysholm
Physiotherapy, July 1993, vol79, no 7