Knee extensors kinetic chain training in anterior cruciate ligament deficiency

Abstract

Open kinetic chain (OKC) knee extensor resistance training has lost favour in rehabilitation of patients with knee ACLD due to concerns that this exercise is harmful to the remaining portion of the ACL and its secondary stabilizers, and will be less effective in improving function. In this randomized, single-blind clinical trial, closed and OKC knee extensor training were compared for their effects on knee laxity and function in patients with ACLD knees. Sixty-four patients with a diagnosis of knee ACLD (49 M, 15 F; mean age=30 years) were measured for knee laxity, using a ligament arthrometer, and function with the Hughston Clinic knee self-assessment questionnaire and maximal effort single leg jump testing. Between the above tests and identical tests carried out 6 weeks later, subjects trained using either open or closed kinetic chain resistance of their knee and hip extensors as part of formal physical therapy sessions three times per week for 6 weeks. The groups exhibited no statistically significant differences (p<0.083) in outcome. These results indicate that knee extensor OKC training, as used in this study, can be safely applied to patients with knee ACL deficiency, and shows no superiority to CKC training.

Appendices

Appendix 1

Page from the diary for recording activities undertaken outside therapy

Subject Number:____ Date: ____ Please complete the following tables on a daily basis (you should have been given enough of these sheets so you have one for each day of the study period):

Table a Stairs

Table b Sports (first 3 rows of data are examples for your instruction)

Table c Walking and other physical activities (please indicate your best estimate of the total number of minutes you have walked today as well as the type and duration of other activities)

Appendix 2

Questionnaire for detecting patient bias resulting from communication with their clinician

Date: ____ Please note that this questionnaire is anonymous. Any responses you make will be kept in the strictest confidence. Your clinician will not be told of your specific responses. The responses will help us better understand the results from this study. Please answer the following questions as accurately as possible.

• 1. Please tick which one of these two exercises you performed during the study:

  • leg press (lying on back and pushing against plate)

  • knee extension (sitting on a bench and lifting a weight placed against your shin)

• 2. During the study, were you ever given the impression that these two exercises differed in terms of how good they were?

  • Yes (please answer all the following questions)

  • No (please answer questions 5 and 6 only)

• 3. Which of the two exercises was the so-called “better” one?

  • leg press ((lying on back and pushing against plate)

  • knee extension (sitting on a bench and lifting a weight placed against your shin)

• 4. Please describe who or what gave you the impression that one exercise was better than the other: ____________ ____________ ________

• 5. Please tick the hospital where you had physiotherapy: Mile End The Whittington Whipps Cross St Thomas’s

• 6. Please state the name(s) of the physiotherapist(s) who treated you during the study: ____________ Thank you for taking the time to complete this questionnaire.