weight-bearing-standing training for lower limb recovery after anterior cruciate ligament reconstruction

Plano de Tratamento de Reabilitação para Pacientes com RLCA

Enhanced Recovery after Surgery (ERAS) is a concept that promotes the early initiation of postsurgery rehabilitation care units, particularly after orthopedic operations, when conditions are appropriate1. This approach seeks to shift the clinical focus from treating the disease to functional rehabilitation promptly with the goal of reducing hospital stays, minimizing postoperative complications, improving patient prognosis and satisfaction, and enhancing overall rehabilitation outcomes. Since the introduction of ERAS, Chinese orthopedic rehabilitation specialist, Zhou Mouwang, has advocated for the active application of accelerated recovery protocols to further progress perioperative rehabilitation practices within the realm of Chinese orthopedics2. Internationally recognized consensus guidelines have also been established to facilitate enhanced surgical recovery for orthopedic conditions such as joint replacement and spine surgery3. Nonetheless, while considerable advancements have been made in implementing ERAS in recent years, the primary application has been in major operations, such as joint replacement surgeries4. As a result, there is a pressing need to further investigate and expand the application of ERAS within the rehabilitation of other orthopedic conditions.
The anterior cruciate ligament (ACL) plays a pivotal role in maintaining knee joint stability. ACL injuries are among the most prevalent sports-related injuries, with approximately 2 million cases occurring worldwide annually5. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment approach, aiming to restore normal knee anatomy and stability, prevent secondary injuries, and enable patients' return to sport. Rehabilitation following ACL injury has been an active research area. It is widely accepted that post ACLR rehabilitation is integral for optimizing surgical outcomes and facilitating patients' recovery of sports-related function6,7. However, early weight-bearing (EWB) rehabilitation protocols after ACLR remain understudied, leading to a lack of consensus among clinicians.
The latest research in 2021 supports allowing immediate weight-bearing and full knee range of motion within tolerance after ACL autograft reconstruction surgery7. However, a consensus has not yet been reached in clinical practice. The authoritative British Journal of Sports Medicine published in 2016 also advocates for immediate weight-bearing post ACLR, finding it does not increase knee joint laxity. If gait is proper without increased pain or effusion during/after walking, immediate weight-bearing is considered acceptable6. In contrast, a review in 2022 summarizes that accelerated weight-bearing rehabilitation following ACLR may increase risks of knee joint laxity and bone tunnel widening compared to delayed weight-bearing protocols, advising cautious selection of postoperative regimens8. Additional concerns with EWB include knee pain, swelling, effusion, wound healing, and fall risks after ACLR. Although substantial literature endorses EWB after ACLR, clinical practices still vary. A study in 20209 found that surgeon experience influences post ACLR weight-bearing timelines in France; more experienced surgeons were more likely to favor EWB rehabilitation.
Under the guidance of the ERAS concept, EWB is an important factor affecting patient function and quality of life. However, whether the EWB program could impair wound healing, increase pain and swelling, or impact knee stability remains a key concern for orthopedic and rehabilitation clinicians. In view of the current dilemma of clinicians and inconsistent research results, this study aims to explore the safety and feasibility of EWB after ACLR.

Autor em destaque: Implementando o conceito de recuperação aprimorada após cirurgia na reabilitação após reconstrução do ligamento cruzado anterior

Protocolo de Reabilitação Precoce com Sustentação de Peso Após Reconstrução do Ligamento Cruzado Anterior

Treinamento de Sustentação de Peso para Recuperação de Membros Inferiores Após Reconstrução do Ligamento Cruzado Anterior

Após realizar a reconstrução do ligamento cruzado anterior, informe o paciente sobre o processo de reabilitação. Eleve o membro inferior afetado a um ângulo de 30 graus em relação à linha horizontal. Coloque uma compressa fria no joelho afetado por 20 minutos, três vezes ao dia.Quando acordado, execute exercícios de bomba de tornozelo por cinco minutos a cada hora. Peça a um terapeuta que mobilize a patela em quatro direções, massageie o quadríceps e os isquiotibiais para soltar a patela e o tecido circundante. Realize o treinamento de contração isométrica do quadríceps com 10 séries de 10 repetições diárias.Em seguida, estenda e flexione a articulação do joelho. Instrua o paciente a ficar de pé com ou sem andador. Em seguida, peça aos pacientes que fiquem de pé com os pés afastados na largura dos ombros.Faça com que o terapeuta fique do lado afetado do paciente e dê-lhe instruções verbais. Observe a postura corporal em um espelho e ajuste a postura de forma independente ou sob a orientação do terapeuta. Coloque a perna afetada no pesador corporal eletrônico e aumente gradualmente a intensidade de sustentação do peso da perna afetada para 25%50%75%e 100%do peso corporal.

weight-bearing-standing-training-for-lower-limb-recovery-after

Research

JoVE Journal

Medicine

Weight-Bearing-Standing Training for Lower Limb Recovery After Anterior Cruciate Ligament Reconstruction

42 visualizações. Após realizar a reconstrução do ligamento cruzado anterior, informe o paciente sobre o processo de reabilitação. Eleve o membro inferior afetado a um ângulo de 30 graus em relação à linha horizontal. Coloque uma compressa fria no joelho afetado por 20 minutos, três vezes ao dia.Quando acordado, execute exercícios de bomba de tornozelo por cinco minutos a cada hora. Peça a um terapeuta que mobilize a patela em quatro direções, massageie o quadríceps e os isquiotibiais par...

Vídeo: Treinamento de Sustentação de Peso para Recuperação de Membros Inferiores Após Reconstrução do Ligamento Cruzado Anterior

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment for ACL injury, aiming to regain normal anatomical structure and stability of the knee joint and promote the patient's return to sports. Under the guidance of the concept of enhanced recovery after surgery, early weight-bearing rehabilitation (EWB) is an important factor affecting patient function and quality of life. However, there is no consensus on whether EWB rehabilitation can be performed after ACL surgery. 
This study aims to explore the safety and feasibility of EWB after ACL surgery. The study implemented a gradual EWB rehabilitation program in the experimental group, including weight-shifting training, balance training, and gait training on the affected lower limb, and assessed wound healing and stability of the knee joint. The study found that EWB after ACLR is safe and feasible. EWB rehabilitation not only does not pose a negative effect on the patient's knee pain, swelling, wound healing, and stability, but also helps to improve knee active flexion and quality of life faster and better. The EWB program in this study is simple, safe, and effective, and it provides strong theoretical guidance and practical demonstration for accelerated rehabilitation after ACLR.

Based on the safety and feasibility, this article presents an early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction. The protocol is clear and easy to operate, which is helpful to promote its use in clinical practice and accelerate the functional recovery of patients.

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment ...