Knee Joint Accessory Motion Following Anterior Cruciate Ligament Allograft Reconstruction
Abstract & Commentary
Synopsis: Following ACL allograft reconstruction, KT-2000 scores for each patient in the braced group improved while the scores for those in the unbraced group became worse or stayed the same.
Source: Jenkins WL, et al. Knee joint accessory motion following anterior cruciate ligament allograft reconstruction: A preliminary report. J Orthop Sports Phys Ther 1998;28(1):32-39.
After treating patients following allograft reconstruction of torn anterior cruciate ligaments (ACL) for six years, Jenkins and colleagues believed that they were seeing a difference in knee joint accessory motion, as measured by KT-2000 results, in patients who had worn functional braces postoperatively as compared to patients who did not. "The purpose of this retrospective study was to investigate the effect of functional bracing on knee joint accessory motion with ligament arthrometer testing during the first year postoperative." Jenkins et al performed a retrospective chart review and found eight patients whose KT-2000 results had changed during the postoperative period. Five subjects (3 males and 2 females; mean age, 21.2) had not worn braces and three subjects (2 males and 1 female; mean age, 31.3) had received a functional brace called the "Donjoy Defiance Brace" (Smith & Nephew Donjoy, Inc., Carlsbad, CA) during the postoperative period. This knee brace supposedly limits anterior tibial translation throughout the full range of motion with a particular emphasis on limiting it at knee extension. The same physical therapist performed all of the rehabilitation and performed the KT-2000 studies. This examiner had established reliability using this technique in a previous study. The testing procedure was the traditional "manual maximum" done with the KT-2000. The reported results were the differences between the involved and the uninvolved extremity. The important finding of the study was that the KT-2000 scores in each subject in the braced group improved while the scores for the subjects in the unbraced group became worse or stayed the same.
Comment by Clayton F. Holmes, EdD, PT, ATCJenkins et al found only eight subjects who met their criteria. This indicates that perhaps other allograft reconstruction patients had similar results with KT-2000. In addition, they do not discuss in great detail the rehabilitation and other variables (such as reinjury) in the patients’ lives relative to differences in activities post-surgery. They do imply that the patients were actually treated differently in their rehabilitation post-surgery when they state that the control groups were "limited in rehabilitation to activities of daily living and closed kinetic chain activities using only body weight until they had three consecutive months in which their KT-2000 scores were unchanged." Later, they state that subjects in the treatment group "were limited in their rehabilitation to activities of daily living and closed kinetic change activities using only body weight until they received a functional brace." Thus, those in the functional brace may have been rehabilitated more aggressively. However, it is difficult to know exactly what the subjects went through post-surgery. In addition, it is possible that instead of allowing patients to be more aggressive, the brace actually made patients more conscious of their condition and they were actually more conservative in their activity. I would caution the reader not to apply the conclusions of this study to the general population of post-ACL reconstruction patients. In my experience, KT-2000 results are similar to the authors’ findings in allograft cases when autografts are used. Also, in my experience, the effect of a post-surgical brace has been negligible. This is supported by the paucity of information in the literature indicating the actual biomechanical effects of a post-surgical brace.
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