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Överskrift Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults
Upplaga Issue 3
Sidor CD005961.pub2
Överskrift Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults
Beskrivning BACKGROUND: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. The ACL may be damaged in isolation but often other ligaments and menisci are implicated. The injury may be managed surgically or conservatively. Injury causes pain, effusion and inflammation leading to alteration in muscle function. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation. OBJECTIVES: To present the best evidence for effectiveness of exercise used in the treatment of ACL injuries in combination with collateral ligament and meniscal damage to the knee in adults, on return to work and pre-injury levels of activity. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1996 to October 2006), EMBASE (1980 to October 2006), other databases and reference lists of articles. SELECTION CRITERIA: We included randomised controlled trials and quasi-randomised trials testing exercise programmes designed to treat adults with ACL injuries in combination with collateral ligament and meniscal damage. Included trials randomised participants to receive any combination of the following: no care, usual care, a single-exercise intervention, and multiple-exercise interventions. The primary outcome measures of interest were returning to work and return to pre-injury level of activity post treatment, at six months and one year. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. MAIN RESULTS: Five trials (243 participants) evaluated different exercise programmes following ACL reconstruction and one trial (100 participants) compared supervised with self-monitored exercises as part of conservative treatment. No study compared the effect of exercise versus no exercise. Methodological quality scores varied considerably across the trials; participant and assessor blinding were poorly reported. Pooling of data was rarely possible due to the wide variety of comparisons, outcome measures and time points reported, and lack of appropriate data. Insufficient evidence was found to support the efficacy of one exercise intervention over another. AUTHORS' CONCLUSIONS: This review has demonstrated an absence of evidence to support one form of exercise intervention over another. Further research should be considered in the form of large scale well-designed and well-reported randomised controlled trials with suitable outcome measures and surveillance periods. Suitable outcome measures should include a measure of functional outcome relevant to the individual. PLAIN LANGUAGE SUMMARY: Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adultsThe anterior cruciate ligament of the knee provides stability of the lower leg bone (tibia) relative to the thigh bone (femur) and guides knee extension. Injury to this ligament, and the supporting ligaments (collaterals) and shock absorbers (menisci) is most common, especially when playing sport, through rapid stopping with a twisting movement. Injuries consist of partial or total tears in the ligament itself or where it attaches to bone. The resulting pain, fluid on the knee and inflammation limit movement and make it difficult to return to normal function and sporting activities. If the knee is unstable, reconstruction surgery may be needed otherwise the injury is treated conservatively (without an operation). For both groups of patients (those who have surgery and those treated conservatively) rehabilitation programmes are an important part of treatment as return to full knee function may limit future degenerative changes in the knee.We identified six randomised controlled trials involving 343 people (predominantly male) aged 15 to 49 years. Length of follow up varied from 6 weeks to 24 months. One trial used conservative treatment and five trials evaluated treatment following reconstruction surgery. Included trials compared muscle strengthening in weight bearing and non-weight bearing positions; exercise at home or under supervision; early rehabilitation and delayed rehabilitation and adding balance and proprioception exercises to a standard rehabilitation programme.This review found no evidence to support one form of exercise programme over another in managing recovery from the injury looking at return to daily activities, work and sporting activities.Limited conclusions in this review are a consequence of the small number of trials, non-standardised exercise programmes and methods of measuring their effectiveness, and poor quality reporting of the results.
Källa Cochrane Database of Systematic
Publicerad 2007
Författare Farias F., Garcia RM, Grant M, Gray HG, Horta AL, Howe TE, Trees AH

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