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

ABSTRACT

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