The effects of remnant-preserving anterior cruciate ligament reconstruction on proprioception: A prospective comparative study.

OBJECTIVE: The aim of this study was to investigate the effects of anterior cruciate ligament reconstruction performed by preserving remnant tissue on proprioception and to assess the effects it has on isokinetic quadriceps and hamstring muscle strength, as well as on range of motion and functional scores. METHODS: A prospective study was conducted with 44 patients who underwent either anterior cruciate ligament reconstruction with remnant preservation (study group, n=22) or with remnant excision (control group, n=22) with the use of a 4-strand hamstring allograft. The mean follow-up time was 20.2 ± 1.4 months after surgery. Using an isokinetic dynamometer, proprioception was evaluated with passive joint position perception at 150, 450, and 600, and quadriceps femoris, and hamstring muscle strength were evaluated at speeds of 900, 1800, and 2400 per second. Range of motion was measured using a goniometer. Functional outcomes were assessed using International Knee Documentation Committee subjective knee evaluation score and Lysholm knee scoring questionnaires. RESULTS: It was only at 15° of knee flexion that there was a statistically significant difference in proprioception; the median of the difference in the amount of deviation from the target angle between the healthy knee and the operated side was 1.7 (range, 0.7-20.7) in those with remnant preserved, and 2.7 (range, 1-26) in those with remnant excised (P=.016). At 2400/s speed, the mean quadriceps femoris strength was 77.2 ± 24.3 Nm in those with remnant preserved and 67.6 ± 24.2 Nm in those with remnant excised. (P=.048) There was no difference between the 2 groups in terms of range of motion, International Knee Documentation Committee, and Lysholm knee scoring. (P > .05) Conclusion: The present study has demonstrated that better proprioception and higher quadriceps femoris muscle strength can be obtained by remnant-preserving anatomical single-bundle anterior cruciate ligament reconstruction using a hamstring autograft. LEVEL OF EVIDENCE: Level II, Therapeutic study.

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study.

OBJECTIVE: To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. DESIGN: Randomized controlled trial. SETTING: Training and research hospital. PARTICIPANTS: Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). INTERVENTIONS: Both groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5 d/wk, for 2 to 4 h/d. The mirror therapy group received an additional mirror therapy program for 30 min/d. MAIN OUTCOME MEASURES: We evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. RESULTS: After 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. CONCLUSIONS: In patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy.