Tegner and Lysholm scores in brace-free rehabilitation

To compare results of aggressive method of rehabilitation after reconstruction of anterior cruciate ligament against results of standard braced method of rehabilitation, and to determine prognostic factors. This is a retrospective comparative study with statistical analysis. In this study, 85 patients were operated in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between December 1998 and December 2001, and underwent rehabilitation with a minimum follow up of 2 years. The patients were split into 2 groups. Group A consist of 32 patients and they underwent the standard rehabilitation program according to established braced programs. Group B is the subsequent 53 consecutive patients who were subjected to aggressive brace-free rehabilitation program. All knees were measured for Tegner and Lysholm scores as the main indicator of assessment in the preinjury hindsight appraisal, and compared with scores obtained 4 months and 2 years post reconstruction. Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group A, there was a mean loss of 1.9 and 14 constituting 26% and 22.2% [p=0.015], range 1.07-3.5 and 9.8-23.5. Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group B, there was a mean loss of 1.1 and 9.0 constituting 15.4% and 13.6% [p=0.012], range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to the 2 years follow up scores for group A, there was a mean loss of 1.0 and 8.0 constituting 13.6% and 11.6% [p=0.024], range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to 2 years follow up scores for group B, there was a mean loss of 0.4 and 1.0 constituting 5.5% and 1.5% [p=0.015], range 0.1-1.5 and 6.8-13.5. Appraisal of the aggregate data of 2 groups has shown that the loss from preinjury Tegner and Lysholm scores was 20.7% versus 16.9% lower at 4 months [p=0.013], but only 12.6% versus 3.55% lower at 2 years [p=0.036]. Results of aggressive rehabilitation after anterior cruciate ligament reconstruction both subjectively and clinically are superior to that of the standard braced rehabilitation. A better prognostic result with aggressive rehabilitation can be predicted for patients with high preinjury scores compared to patients with a low preinjury score. The result of this study support the use of accelerated brace free rehabilitation in autogenous patellar tendon graft, and has shown that intensive rehabilitation facilitate return to sport activities at 4 months postoperatively

effect of low incidence of primary osteoarthritis of the hip on the volume and nature of joint replacement surgery

Of the 5,330 routine operations performed in a general orthopaedic theatre in central Saudi Arabia between 1988-1993, only 68 total hip replacements were done. Osteoarthritis was not the most common indication and the majority of patients were below 60 years of age, indicating that the possibility of future revision is high. This paper studies the practical consequences of the low incidence of hip osteoarthritis in Saudi Arabia and makes the suggestion that total hip replacements and revision arthroplasties should be confined to a limited number of hospitals

effect of low incidence of primary osteoarthritis of the hip on the volume and nature of joint replacement surgery

Of the 5330 routine operations performed in a general orthopaedic theatre in central Arabia in five years, only sixty eight total hip replacements were done. Osteoarthritis was not the most common indication and the majority of patients were below sixty years of age; therefore, the possibility of future revision will be high. This paper studies the practical consequences of the low incidence of hip osteoarthritis in Arabia and makes suggestions that total hip replacements and revision arthroplasties should be confined to a limited number of hospitals