Comparison of Outcomes of Stiffness of Knee Joint after Anterior Cruciate Ligament Reconstruction Surgery between The Routine Postoperative Range of Motion Exercise and The Progressive Limited Range of Motion Exercise

Abstract

BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction with routine post-operative care allows for 0-90 degree range of motion exercise, but researchers have found an incidence of knee stiffness of 12.5%. When attempting a wide range of motion exercise immediately after an operation, patients cannot exercise the entire range of motion due to the knee’s limited range of motion, or knee stiffness. Therefore, the researcher has created a new post-operative exercise, named the Progressive Limited Range of Motion exercise (PLROM), to ensure clarity and consistency of knee exercise with a reduced chance of knee stiffness after ACL reconstruction surgery.

OBJECTIVES: To compare the outcomes of stiffness of the knee joint after anterior cruciate ligament reconstruction surgery between the routine postoperative range of motion exercise and the Progressive Limited Range of Motion exercise.

METHODS: This retrospective cohort study, collected from data of patients undergoing arthroscopic ACL reconstruction surgery at Rayong Hospital in Honor of Her Royal Highness Princess Maha Chakri Sirindhorn from 1 October 2019 to 30 June 2021, consisted of a sample of 74 patients divided into two groups: 36 subjects were patients receiving routine post-operative care after surgery, and 38 subjects were patients receiving the PLROM exercise for postoperative care. The two groups were compared through means of knee extension and knee flexion range of motion on the 2^nd, 4^th, 6^th, and 8^th week post-operation, respectively. An independent sample t-test was used for the comparative test.

RESULTS: Patients undergoing the PLROM exercise for post-operative care were able to perform knee motion exercises significantly better than the routine post-operative care group. At the 6^th and 8^th week post-operation, patients in the PLROM group could flex their knee significantly more than patients receiving routine post-operative care.

CONCLUSIONS: A postoperative PLROM exercise can reduce the incidence of knee stiffness after ACL reconstruction surgery. Patients were able to flex their knee at a significantly greater range of motion in both the 6^th and 8^th week post-operation better than through routine post-operative care. Therefore, the PLROM exercise should be used as a clinical practice to improve a patient's knee motion after ACL reconstruction surgery.

Thaiclinicaltrials.org number, TCTR20220427006