Open AccessUnilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft: A Randomized Controlled Trial
Author(s) -
Márcio Rogério de Oliveira,
Paulo Lobo Júnior,
Aline Mizusaki Imoto,
Tácio Santos,
José Humberto Souza Borges,
Pedro Nunes,
Fabrício Reichert Barin,
Meire Damando,
Maria Stella Peccin
Publication year - 2022
Publication title -
orthopaedic journal of sports medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 35
ISSN - 2325-9671
DOI - 10.1177/23259671221088830
Subject(s) - medicine , range of motion , anterior cruciate ligament , randomized controlled trial , anterior cruciate ligament reconstruction , rehabilitation , surgery , physical therapy
Background: Lower limb muscle strength symmetry has been suggested as an essential criterion for the safe return to sports after anterior cruciate ligament (ACL) reconstruction. Limited evidence is available regarding the most effective intervention to achieve symmetry after reconstruction with contralateral bone–patellar tendon–bone (BPTB) graft.Purpose: To verify whether unilateral isotonic resistance exercise is more effective than bilateral exercise for obtaining postoperative functional and muscular strength symmetry between the donor limb and reconstructed limb for patients who received BPTB graft.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A total of 88 patients were randomly divided into a control group (n = 44) and an intervention group (n = 44). All participants performed an 8-week exercise program starting at the beginning of the fourth postoperative month and were evaluated before and after the program. The control group performed bilateral exercises, and the intervention group performed unilateral exercises for the donor limb only (the limb with the greatest disability). The primary outcome was muscle strength (peak torque and hamstrings to quadriceps [H:Q] ratio), and the secondary outcomes were range of motion (ROM; goniometry), KT-1000 arthrometer side-to-side difference in anteroposterior knee laxity, and objective (single-leg hop test) and subjective (Lysholm score) functionality.Results: Both groups improved significantly from before to after the exercise program. The improvements were significantly greater in the intervention group regarding peak torque, H:Q ratio, flexion ROM, single-leg hop test, and Lysholm score in the donor limb ( P 0.80) except for the H:Q ratio.Conclusion: Although postoperative, bilateral, isotonic resistance exercise provided better strength gains to the reconstructed limb, unilateral exercise was more effective in obtaining functional and muscle strength between-limb symmetry in patients who underwent ACL reconstruction with contralateral BPTB graft.Registration: Brazilian Registry of Clinical Trials (number RBR-22rnjh).