Accelerated Rehabilitation after Anterior Cruciate Ligament Reconstruction: Comparison of Closed Kinetic Chain (CKC) Versus Open Kinetic Chain (OKC) Exercises
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- Category: Vol. 77, June 2009
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Accelerated Rehabilitation after Anterior Cruciate Ligament Reconstruction: Comparison of Closed Kinetic Chain (CKC) Versus Open Kinetic Chain (OKC) Exercises,SAMIA M.H. FADDA, NOHA A. AZAB, HALA A. RAAFAT and AHMAD M. KHOLEIF
Abstract
Background: Anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. ACL reconstruction (ACL-R) is the treatment of choice in cases of severe knee instability to avoid recurrent knee injuries and subsequent degenerative changes. Accelerated rehabilitation after ACL-R greatly affects the healing response and signifi-cantly helps patients to gain dynamic stability in the knee joint. Much debate surrounds the difference between open kinetic chain (OKC) and closed kinetic chain (CKC) exercises during ACL-R rehabilitation.
Objective: It was the aim of this study to compare the effects of a comprehensive rehabilitation program with quad-riceps strengthening in closed kinetic chain (CKC) exercises with the same rehabilitation program with quadriceps strength-ening in open kinetic chain (OKC) exercises in patients with ACL reconstruction and to evaluate the effects on knee func-tions.
Subjects and Methods: Forty consecutive patients with ACL reconstruction for isolated ACL injury were included in this study. They were subjected to a rehabilitation program for 4 months supplemented with OKC exercises in one group and CKC exercises in the second group.
Results: Patients in CKC exercise group showed at the end of the four months’ rehabilitation programs, a statistically significant increase in passive range of motion (PROM) (p<0.001), in Lysholm score (p=0.002) and a significant decrease in number of patients with extension deficit ³5º (p= 0.008), all indicating improvement in knee functions, while OKC group only showed improvement in PROM as regards knee functions (p=0.049). Comparing both groups - as regards the outcome of rehabilitation program on knee functions-showed that there was a non significant difference between the two groups concerning PROM, Lysholm score or improve-ment of extension deficit and thigh atrophy (p=0.463, p= 0.757, p=0.085, p=0.430 respectively). At the end of the 4 months, there was statistically significant more improvement of knee pain in CKC group than OKC groups (p=0.018) and more number of patients who gave a response of "satisfied" in CKC group than OKC groups (p=0.027).
Conclusion: We conclude that both CKC and OKC exer-cises appear to be suitable for rehabilitation after ACL recon-
struction; however, CKC exercises showed better outcome after rehabilitation than OKC exercises as regards knee function, knee pain and patient satisfaction.