Similar views on rehabilitation following hip arthroscopy among physiotherapists and surgeons in Scandinavia: a specialized care survey.

PURPOSE: The rising number of hip arthroscopies (HA) is leading to increasing numbers of patients requiring post-surgical rehabilitation; however, evidence regarding post-operative rehabilitation is currently limited. The purpose of the study was to describe and compare current rehabilitation strategies and views among surgeons and physiotherapists in Scandinavia. METHODS: Scandinavian surgeons and physiotherapists experienced with HA and post-surgical rehabilitation were asked to complete an online survey. Ninety clinicians (28 surgeons, 62 physiotherapists) responded. RESULTS: Both professions mostly rated physiotherapy as very or extremely important in the rehabilitation process. The majority advocated criteria-based or combined criteria- and time-based progression. Expected rehabilitation timelines were reported with large intra-professional variation but general inter-professional agreement. However, compared with physiotherapists surgeons expected fewer weeks on crutches and faster return to competitive sport. Surgeons more often reported use of evidence-based self-reported outcomes while physiotherapists more often evaluated readiness for return to play. CONCLUSIONS: Among surgeons and physiotherapists, physiotherapy is considered very important following HA. Generally, very similar views were held between professions. Surgeons expected reduced time on crutches and to return to competitive sports than physiotherapists. Surgeons also used evidence-based self-reported outcomes to a higher degree than physiotherapists. Being the first study to provide an overview on currently applied rehabilitation strategies following HA, results of this study may guide much needed, future research on the rehabilitation process following HA. LEVEL OF EVIDENCE: IV.

Rehabilitation after anterior cruciate ligament injury influences joint loading during walking but not hopping.

OBJECTIVE: The purpose of this study was to identify changes in clinical outcome and lower extremity biomechanics during walking and hopping in ACL-injured subjects before and after a 20-session neuromuscular and strength training programme. STUDY DESIGN: Pre and post experimental design. SETTING: Outpatient clinic, primary care. PATIENTS: 32 subjects with unilateral ACL injury, mean 60 (SD 35) days after injury, with a mean age of 26.2 (5.4) years. INTERVENTION: The rehabilitation programme consisted of neuromuscular and strength exercises. MAIN OUTCOME MEASUREMENTS: Outcome measurements assessed before and after a 20-session rehabilitation programme were: self-assessment questionnaires (KOS-ADL, IKDC2000, Global function), four single-leg hop tests, and isokinetic muscle strength tests. Lower extremity kinematics and kinetics were captured during the stance phase of gait and landing after a single leg hop, synchronised with three force plates. RESULTS: These ACL-injured individuals significantly improved their clinical outcome after rehabilitation. Gait analysis disclosed a significantly improved knee extension moment after rehabilitation, but no change in hip or knee excursions. During landing after hop no change in knee excursion or knee moment was recorded. CONCLUSION: After rehabilitation the ACL-injured subjects showed a significantly improved clinical outcome, but lower extremity biomechanics were still significantly impaired during both walking and hopping. The rehabilitation programme influenced knee joint loading during walking, but not during hopping. Longer rehabilitation should be considered before ACL-injured individuals return to jumping activities.

Performance-based functional evaluation of non-operative and operative treatment after anterior cruciate ligament injury.

Highly active anterior cruciate ligament (ACL)-injured patients are usually recommended surgical treatment as the primary intervention. The objective of this study was to compare the functional outcome in a cohort of individuals after non-operative treatment to individuals after surgical treatment at a 1-year follow-up. One hundred and twenty-five subjects with a mean age of 27.2 years (+/-8.6 years), and participating in level I or II activities were included. Baseline and 1-year follow-up examination included four single-legged hop tests, IKDC 2000, KOS-ADLS, KT-1000 knee arthrometer measurement, VAS, episodes of giving way, and activity level. Fifty-one percent went through non-operative treatment. Non-operated subjects performed significantly better on two of the four single-legged hop tests compared with the ACL-reconstructed subjects at the 1-year follow-up. No other differences were observed. Both groups performed an average >90% compared with their uninjured leg on all single-legged hop tests at the 1-year follow-up. The IKCD 2000 scores in the non-operated and ACL-reconstructed group were on average 86 and 87. ACL-injured subjects should be informed of the possibility of success after non-operative treatment, but future studies are needed to determine significant predictive factors for success for non-operative and surgically treated individuals.