Brendan Joss

Do Postoperative Platelet-Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair? A Randomized Controlled Trial

Background: Tendon-bone healing after rotator cuff repair directly correlates with a successful outcome. Biological therapies that elevate local growth-factor concentrations may potentiate healing after surgery. Purpose: To ascertain whether postoperative and repeated application of platelet-rich plasma (PRP) to the tendon repair site improves early tendon healing and enhances early functional recovery after double-row arthroscopic supraspinatus repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 60 patients underwent arthroscopic double-row supraspinatus tendon repair. After randomization, half the patients received 2 ultrasound-guided injections of PRP to the repair site at postoperative days 7 and 14. Early structural healing was assessed with MRI at 16 weeks, and cuff appearances were graded according to the Sugaya classification. Functional scores were recorded with the Oxford Shoulder Score; Quick Disability of the Arm, Shoulder and Hand; visual analog scale for pain; and Short Form–12 quality-of-life score both preoperatively and at postoperative weeks 6, 12, and 16; isokinetic strength and active range of motion were measured at 16 weeks. Results: PRP treatment did not improve early functional recovery, range of motion, or strength or influence pain scores at any time point after arthroscopic supraspinatus repair. There was no difference in structural integrity of the supraspinatus repair on MRI between the PRP group (0% full-thickness retear; 23% partial tear; 77% intact) and the control group (7% full-thickness retear; 23% partial tear; 70% intact) at 16 weeks postoperatively (P = .35). Conclusion: After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery.

Randomized Trial Investigating the Efficacy of Manual Lymphatic Drainage to Improve Early Outcome After Total Knee Arthroplasty

OBJECTIVE To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion. DESIGN Prospective randomized controlled trial. SETTING Private hospital and functional rehabilitation clinic. PARTICIPANTS Consecutive sample of patients (N=43; 53 knees) scheduled for TKA. INTERVENTION MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy. MAIN OUTCOME MEASURES Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score. RESULTS A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes. CONCLUSIONS MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care.

Guidelines for the Early Restoration of Active Knee Flexion After Total Knee Arthroplasty: Implications for Rehabilitation and Early Intervention

OBJECTIVES To investigate the association between active knee flexion at initial (1-2 wk) and final (7 wk) outpatient visits after total knee arthroplasty (TKA), and to develop a guide for the expected progression of knee flexion in the subacute postoperative phase. DESIGN Prospective case series. SETTING Rehabilitation clinic. PARTICIPANTS Consecutive sample of patients (N=108) who underwent TKA between December 2007 and August 2012. INTERVENTION TKA followed by a standardized, 5-week outpatient rehabilitation program (2 sessions per week) immediately after hospital discharge. MAIN OUTCOME MEASURE Active knee flexion was recorded on the patients first outpatient visit (1-2 wk) and then biweekly throughout the patients 5-week outpatient rehabilitation program. RESULTS Active knee flexion at initial (1-2 wk) and final (7 wk) outpatient visits were significantly correlated (r=.86, P<.001). Mean active knee flexion significantly improved (P<.001) across all patients from 90.4° at initial outpatient visit to 110° at final outpatient visit. At 7 weeks postsurgery, a value of 100° was determined as the cut-off point for an acceptable active knee flexion, which corresponded with 80° of active knee flexion at initial outpatient presentation at 1 to 2 weeks. CONCLUSIONS Active knee flexion at the initial outpatient visit exhibits a strong correlation with knee flexion at 7 weeks after TKA. These knee flexion guidelines may allow for the provision of individualized rehabilitation, allow practitioners to provide patients with realistic goals of progression throughout the subacute phase, and allow the early identification of patients at risk for poor long-term outcomes who may benefit from further intensive care or other early intervention.

Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation

Background: Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these factors influence return to sport is unclear. Purpose: To investigate factors predictive of return to sport 12 months after ACLR. The factors specifically evaluated were strength, hop function, self-reported knee function, patient age, and quality of postoperative rehabilitation. Study Design: Case-control study; Level of evidence, 3. Methods: This study evaluated 113 patients approximately 12 months after ACLR using a rehabilitation grading tool, the subjective International Knee Documentation Committee (IKDC) form, and a return-to-sport battery consisting of maximal isokinetic quadriceps and hamstring strength and 4 functional hop tests. Mann-Whitney U tests and chi-square analyses were used to determine differences between patients who had or had not returned to sport. A subsequent binary logistic hierarchical regression determined the factors predictive of a patient’s return to sport. In those patients who had returned to sport, relationships between either age or level of rehabilitation and passing the return-to-sport battery were also investigated. Results: Complete rehabilitation (adjusted odds ratio [OR], 7.95; P = .009), age ≤25 years (adjusted OR, 3.84; P = .024), and higher IKDC scores (P < .001) were predictive of return to sport at 12 months. In participants who had returned to sport, 21% passed the return-to-sport battery compared with only 5% who did not. Of those who had returned to sport, 37% who underwent complete rehabilitation passed the return-to-sport battery as opposed to 5% who underwent incomplete rehabilitation. In patients aged ≤25 years, only 48% underwent complete rehabilitation, despite having returned to sport. Additionally, in this group of patients, 40% underwent complete rehabilitation and passed the physical performance battery as opposed to only 4% who did not undergo complete rehabilitation. Conclusion: Younger patients and higher subjective IKDC scores were predictive of return to sport. Patients who completed 6 months of rehabilitation incorporating jumping and agility tasks had a higher rate of return to sport, suggesting that postoperative rehabilitation is important in predicting return to sport. Specialists and physical therapists alike should stress the importance of thorough postoperative rehabilitation and adequate neuromuscular strength and function to patients whose goals are to return to sport.