Accelerated rehabilitation after anterior cruciate ligament reconstruction: comparison of closed kinetic chain [CKC] versus open kinetic [OKC] exercises

Anterior cruciate ligament [ACL] is one of the most commonly injured ligaments of the knee. ACL reconstruction [ACL-R] is the treatment of choice in cases of severe knee instability to avoid recurrent knee injuries and subsequent degenerative changes. Accelerated rehabilitation after ACL-R greatly affects the healing response and significantly helps patients to gain dynamic stability in the knee joint. Much debate surrounds the difference between open kinetic chain [OKC] and closed kinetic chain [CKC] exercises during ACL-R rehabilitation. It was the aim of this study to compare the effects of a comprehensive rehabilitation program with quadriceps strengthening in closed kinetic chain [CKC] exercises with the same rehabilitation program with quadriceps strengthening in open kinetic chain [OKC] exercises in patients with ACL reconstruction and to evaluate the effects on knee function. Forty consecutive patients with ACL reconstruction for isolated in injury were included ACL this study. They were subjected to a rehabilitation program for 4 months supplemented with OKC exercises in one group and CKC exercises in the second group. Patients in CKC exercise group showed at the end of the four months' rehabilitation programs, a statistically significant increase in passive range of motion [PROM] [p < 0.001], in Lysholm score [p = 0.002] and a significant decrease in number of patients with extension deficit >/= 5° [p = 0.008], all indicating improvement in knee functions, while OKC group only showed improvement in PROM as regards knee functions [p = 0.049]. Comparing both groups-as regards the outcome of rehabilitation program on knee functions showed that there was a non significant difference between the two groups concerning PROM, Lysholm score or improvement of extension deficit and thigh atrophy [p = 0.463, p = 0.757, p = 0.085, p = 0.430 respectively]. At the end of the 4 months, there was statistically significant more improvement of knee pain in CKC group than OKC groups [p = 0.018] and more number of patients who gave a response of "satisfied" in CKC group than OKC groups [p=0.027]. We conclude that both CKC and OKC exercises appear to be suitable for rehabilitation after ACL reconstruction; however, CKC exercises showed better outcome after rehabilitation than OKC exercises as regards knee function, knee pain and patient satisfaction

Role of mRNA and serum soluble cytotoxic T-lymphocyte-associated antigen-4 molecule [sCTLA-4] in systemic lupus erythematosus

SLE is a chronic inflammatory systemic autoimmune disease characterised by sustained abnormal immune activation and autoantibody production. A defect in the inhibitory molecules including CTLA-4 is one possibility of the many different mechanisms that may contribute to the pathogenesis. A soluble CTLA-4 protein was found to be present in human serum. The presence of this soluble costimulatory molecule in human serum may provide a means for T-lymphocytes to either enhance or inhibit their biologic effects through additional crossing-linking or competitive blocking to their cell-bound counterparts, thereby influencing the T cell-mediated immune responses. Is to investigate the expression of sCTLA-4 molecule in patients with systemic lupus erythema-tosus [SLE], and correlate its level with disease activity. Thirty-four SLE patients and twelve age- and sex-matched healthy individuals were enrolled in the study. Blood samples from patients and controls were subjected to the following: Quantitative detection of sCTLA-4 levels in sera measured by enzyme-linked immunosorbent assay, detection of sCTLA-4 mRNA expression in selected patients and controls detected in their peripheral blood mononuclear cells [PBMCs] by reverse transcriptase-polymerase chain reaction [RT-PCR] method, and detection of CTLA-4 gene polymorphism in promoter region detected by PCR-restriction fragment length polymorphism [RFLP] method. The serum level of sCTLA-4 in the patients with active SLE was statistically much higher than that in the healthy controls and patients not in activity [p<0.001]. The mean intensity of sCTLA-4 mRNA expression was significantly higher in SLE patients when compared to the control group [p<0.001]. There was no statistically significant difference between patients and controls regarding the mean intensity of in CTLA-4 mRNA expression. CTLA-4 gene polymorphism in promoter region at position -318 did not affect levels of sCTLA-4. We couldn't establish a statistically significant difference between patients and controls regarding the frequency of CTLA-4 polymorphism. To exclude the possible effect of corticosteroids on the expression of sCTLA-4, a comparison of sCTLA-4 mRNA as well as serum sCTLA-4 level was done between patients with and without steroid treatment, which revealed no statistically significant difference. Patients with SLE have increased sCTLA-4 expression. However the mechanism and role of increased sCTLA-4 in the pathogenesis of SLE remains tube elucidated