Research Articles - ACL/Knee

An exercise and education program before knee and hip surgery
leads to better outcomes for patients

Osteoarthritis (OA) is a condition in which cartilage that normally protects the ends of bones gradually wears away, leading to pain and disability. It can occur in just about any joint, but is most common in the knees and hips. Although non-surgical treatment is recommended first for this condition, many patients go on to have surgery when their condition does not improve, and the number of individuals having surgery is rapidly increasing. Before surgery, a rehabilitation program - or "prehabilitation" - led by a physical therapist may be used to educate patients and improve their chances of a successful outcome, but research to support this type of program is limited.  With this in mind, researchers decided to review 35 high-quality studies to evaluate the effectiveness of prehabilitation. Results showed that the prehabilitation programs led to a number of improvements in patient outcomes following surgery, particularly in pain and function.  Participating in such a program before having knee or hip surgery may therefore be a smart way to experience better results and a quicker return to normalcy after the procedure.

Five years after an ACL tear, patients who had surgery experience
similar outcomes as those treated non-operatively

ACL tears are extremely common in sports that involve lots of cutting movements, and after a tear occurs, patients must decide between having surgery and rehabilitating the injury through a course of physical therapy. Many choose surgery and go into the procedure expecting to eventually return to their prior level of activity, but a large proportion of patients end up being unable to meet these goals. To get a better sense of how long-term outcomes compare between patients treated surgically and non-surgically, a study was conducted on 105 athletes over five years. At the five-year follow-up, patients in both groups experienced positive outcomes, and the results between the two groups were found to be very similar. Researchers concluded that the results suggested surgery is not mandatory for all individuals with ACL tears, and that positive results are still very possible with non-surgical treatment like physical therapy, too.

Improvements from a physical therapy program
for knee pain are maintained by patients for three years

Patellofemoral pain syndrome, or runner's knee, is a condition particularly common in active individuals that causes a dull ache behind or around the kneecap. The initial treatment is usually conservative (non-surgical) and may consist of a physical therapy program with various exercises that target the quadriceps muscles in the front of the thigh. While many studies have shown that this type of treatment is effective in the short term, long-term results are not as clearly understood. For this reason, researchers conducted a follow-up study to investigate if improvements from a one-month physical therapy program in patients with patellofemoral pain syndrome were maintained three years later. Overall, results were positive, as all patients reported an improvement in knee pain scores and 82% of them were able to fully resume their sport of choice.

Guidelines recommend non-surgical treatments like exercise
instead of surgery for meniscus tears

The meniscus is a crescent-shaped piece of cartilage located between the thighbone and shinbone, and it stabilizes the knee joint and absorbs shock. Damage to the meniscus often leads to a lesion and eventually a tear of this structure, and many patients have surgery to address it. New research, however, is questioning if surgery is best for individuals over the age of 40 with meniscus tears. Instead, non-surgical treatments like physical therapy and exercise may be a smarter and safer approach. With this in mind, researchers performed a review of the available literature on the topic to investigate meniscus tears and determine the best methods for diagnosing and treating these injuries. The review identified moderate evidence that there were no differences between patients who were treated with physical compared to those who had meniscus surgery. Surgery also did not lead to any added benefits when combined with these exercises. Patients who experience a meniscus tear are therefore encouraged to see a physical therapist first and attempt a comprehensive exercise program before considering surgery for their injury.

Adding hip strengthening exercises to knee strengthening exercises
leads to the greatest benefits for patients with knee pain

Patellofemoral pain syndrome, or runner's knee, is a painful condition that’s very prevalent in physically active individuals like runners. Physical therapy is commonly recommended for these patients, and treatment typically includes various strengthening exercises as well as other interventions. Exercises to strengthen muscles that support the injured knee are most common, but some physical therapists also recommend exercises to strengthen muscles surrounding the hip. Research to support the effectiveness of these exercises, however, is lacking, which led a team of investigators to perform a large-scale review and analysis. From this, they were able to find evidence that both hip and knee strengthening exercises were effective for patients with runner's knee. In addition, the studies revealed that combining hip- and knee-strengthening exercises resulted in a greater decrease in pain and improvement in activity compared to knee strengthening alone. With these findings, physical therapists may be more likely to include both hip- and knee-strengthening exercises into your treatment program for runner's knee.

Hand-delivered therapy reduces pain and
stiffness in patients with knee arthritis

Joints are where two bones come together, and a protective layer called articular cartilage surrounds the end of each joint. This cartilage cushions your bones and protects them from rubbing against one another, but when it diminishes, a condition called osteoarthritis develops. Osteoarthritis can occur in any joint in the body, but is most common in the knees and hips. Manual therapy is a frequently-used treatment for knee osteoarthritis in which a physical therapist applies various movements and manipulations to the knee to reduce pain and other symptoms. Although manual therapy is commonly used for knee osteoarthritis, it's not completely clear how effective it is. For this reason, a powerful review of 14 appropriate studies on the topic was conducted. Results showed that manual therapy significantly reduced pain, alleviated stiffness and improved physical function in patients with knee osteoarthritis. These positive effects occurred with less than four weeks of treatment, but treatment lasting longer led to even greater benefits. This suggests that manual therapy may be a beneficial treatment for patients dealing with knee osteoarthritis.

Having physical therapy after knee replacement surgery
leads to improvements and speeds recovery

Knee osteoarthritis is a condition in which cartilage that normally protects the knee joint gradually wears away, which goes on to cause pain and disability. Physical therapy is commonly recommended to treat this condition at first, but surgery may be necessary for patients that fail to improve. After surgery, most patients follow a course of physical therapy to bring them back to full strength, which may either begin at home or within a clinic. Since it's not completely clear which of these approaches is more beneficial for patients, a study was conducted to compare them. Results showed that after completing physical therapy, patients improved in their knee range of motion, walking speed and quality of life, regardless of where they started therapy. When compared to one another, there were no major differences found, but the group that received physical therapy in the clinic first completed their treatment about 20 days sooner than those who had home-based therapy first. This study suggests that after surgery, it may be best to start a physical therapy program in a clinic as soon as possible to speed up the recovery process.

Strengthening exercises that use resistance are
beneficial for patients with knee arthritis

Osteoarthritis is a painful condition in which cartilage that normally protects the joints gradually wears away, which eventually causes pain and disability when bones begin to rub against one another. Osteoarthritis is very common in the knees, and there are several strategies available to treat it. One option is called resistance exercises, which use some form of resistance—such as body weight, elastic bands or machines—to force muscles to contract. Studies have shown that resistance exercises can be effective for knee osteoarthritis, but there have been some flaws in the research. Therefore, a powerful study called a systematic review was conducted to determine the true value of resistance exercises for knee osteoarthritis, and results showed that it did in fact lead to several significant benefits for patients. In particular, these exercises reduced pain, relieved stiffness and improved overall function, especially if they were performed at a high intensity. Patients with this condition are therefore encouraged to seek out the services of a physical therapist, which typically include these types of exercises.

The use of ultrasound as a therapy is found to reduce pain
and improve the function of patients with knee arthritis

Osteoarthritis is a condition in which cartilage that normally protects joints gradually wears away, which causes bones to rub against one another and leads to pain and other symptoms. Osteoarthritis can occur in any joint of the body, but it is most common in the knees and the hips. Physical therapy is commonly recommended to address knee osteoarthritis, and therapeutic ultrasound is one of the many treatments that may be used by a therapist. Therapeutic ultrasound applies sound energy to an injured area through sound waves at different frequencies in order to reduce pain and inflammation. Some studies have shown that ultrasound is effective for treating knee osteoarthritis, but it's not clear to what extent this is true, which led researchers to conduct a in-depth study called a systematic review. To perform the review, researchers identified 10 studies with information on 645 individuals and compared their findings. Results showed that therapeutic ultrasound appears to be beneficial for patients with knee osteoarthritis, as six studies suggested it was more effective than sham ultrasound and no treatment, and three suggested it significantly reduces disability in physical function.

Exercises that strengthen the hip are helpful for patients
with common cause of knee pain

Patellofemoral pain syndrome, commonly referred to as runner's knee, is a broad term used to describe pain that occurs in the front of the knee and around the kneecap. Although many cases of runner's knee improve after patients seek out treatment like physical therapy, about 80% of individuals who develop runner's knee still have pain five years later. One possible reason for this is that people who develop runner's knee have weak muscles around their hips, but this is not a universally held belief. Nonetheless, some treatment programs for runner's knee focus on strengthening the muscles around the hips, and research is needed to evaluate their effectiveness. Therefore, a powerful study called a systematic review was conducted, which collected and reviewed 21 studies on the topic. Most of the studies reviewed showed that the exercises reduced pain and improved hip function for patients with runner's knee. Other analysis found that hip-strengthening exercises reduced the chances of runner's knee developing in the first place as well.

Following a course of exercise leads to
similar results compared to surgery for knee injury

The meniscus is a crescent-shaped piece of cartilage between the thighbone and the shinbone, and its job is to stabilize the knee and absorb shock. Damage to the meniscus (meniscal lesion) can occur from an injury or gradual changes over time due to aging. Although most patients with meniscal lesions are told to follow a "wait and see policy" that usually involves physical therapy, those who are in extreme pain or don’t improve may have surgery to address their condition. After surgery, exercise therapy (a form of physical therapy) is often recommended to help patients improve; however, it’s not clear how effective this approach is. Therefore, a powerful study was conducted to determine the effectiveness of exercise therapy for these patients. The results showed that exercise therapy and surgery led to similar results for patients overall. In addition, exercise therapy was found to help patients improve more rapidly after surgery than if they did not receive any treatment. This study shows that exercise therapy can be considered an alternative to surgery for these meniscus lesions, and when surgery is performed, it can also be effective for helping them rehabilitate afterwards.

Having physical therapy before ACL surgery
leads to better outcomes for patients

Injuries to the knee account for almost 45% of all sports-related injuries, and the anterior cruciate ligament (ACL) is the most commonly damaged structure of the knee. The main treatment for ACL injuries is a surgical procedure called ACL reconstruction, and before surgery, many patients are prescribed a course of physical therapy to prepare the knee. The goal of treatment is to increase muscle strength and function, and reduce damage to the knee in order to shorten the time of recovery. Although this form of physical therapy is commonly used, there is not much research to support it, and for this reason a large-scale study called a systematic review was conducted. The findings of this review showed that even though there was a range of treatments used, they were found to improve outcomes for patients with ACL injuries overall. Patients preparing for ACL reconstruction should therefore ask their doctor or surgeon about physical therapy before surgery if the treatment is not already offered.

An exercise program that targets the
hip muscles is best for painful knee condition

Patellofemoral pain syndrome (PFPS), or runner's knee, is a very common condition in which the kneecap rubs against the upper leg bone. Runner's knee occurs most frequently in physically active individuals and leads to pain that gets worse from running, squatting or climbing stairs. There are many different approaches for treating runner's knee, and one new approach suggests that strengthening a group of muscles around the hip and pelvis may be one option, but more research is needed on the topic. For this reason, a powerful study pairing called a systematic review and meta-analysis were conducted. Results showed that programs that strengthened these muscles led to reduced pain and improved function for patients, and when these exercises were combined with quadriceps-strengthening exercises for the thighs, results were even better. Patients with runner’s knee should therefore consider seeing a physical therapist for an exercise program that involves these types of exercises.

Common type of surgery for knee pain
only leads to small benefits and some harms

Arthroscopic knee surgery is a procedure used to treat people with knee pain that has become very common in recent years, especially for middle-aged or older people with knee osteoarthritis. Despite the fact that research has failed to show an added benefit of arthroscopic surgery when combined with other treatments, many surgeons continue to perform the procedure on patients. Since this type of surgery is expensive and its effectiveness is questioned, a powerful review was conducted in which it was compared to other treatments. Results from this systematic review found that arthroscopic surgery led to small improvements in pain, but they only lasted for six months, and no improvements were found for physical function. This study calls into question whether arthroscopic surgery is in fact worth it for knee pain, and suggests that other treatments like physical therapy and lifestyle modifications may be more effective and less expensive.

Knee bracing proven to be
ineffective in preventing knee injuries for football players

Knee injuries and football players have a direct and unfortunate relationship, accounting for the most common injuries in the sport and plaguing athletes at all levels of competition. Most knee injuries occur in the medial collateral ligament (MCL) since it's the first ligament to be ruptured upon impact, making it a major matter of concern for health-care professionals and those involved in football. Knee bracing is one method that's been used for MCL and other knee injuries, yet the specific benefits of bracing are yet to be proven. Noting this, a study investigated the use of prophylactic knee braces further and did not find sufficient evidence to recommend them for the prevention of MCL injuries.

Treating ACL tears with physical therapy
can eliminate need for surgery

Tears of the anterior cruciate ligament (ACL) occur often in young athletes who are active in sports, and tend to result in extended absences from performance. Reconstructive surgery is considered the preferred method of treatment for tears, despite the fact that surgery is extremely expensive and there is a lack of evidence confirming its effectiveness, while treatment with rehab alone is rarely seen. To compare the two, a study was conducted and found no significant advantages of going into surgery right away, recommending to begin with rehab and only have surgery in cases where it's unsuccessful.

How hip-strengthening exercises
can help reduce knee pain in runners

Patellofemoral pain (PFP) is an extremely common issue encountered by runners in that usually occurs when the kneecap (patella) and thighbone (femur) rub against each other, causing pain in and around the kneecap area. The condition tends to only come about while in the course of running, but can intensify to the point where running becomes nearly impossible. One theory suggests that strengthening the hips will alleviate PFP since stronger hips can mean an improvement in running-form flaws that cause the pain in the first place, and a small trial of collegiate female runners provided outcomes that were favorable in supporting this theory.

Chasing the enigma of female ACL injuries and the
gender differences that cause them

A research retreat was held in Greensboro, NC, to further examine why females suffer from ACL injuries easier than males. The group came up with three important themes that need to be aggressively pursued in order to better understand the mysterious disparity.

How menstrual cycle phase and anatomy may
have an impact on ACL injuries in females

One major consensus emerging in medical literature is the possibility that the menstrual cycle phase of females affects their vulnerability to ACL injuries. According to a number of studies, females are much more likely to experience an ACL injury in the preovulatory phase of their cycle than the postovulatory phase. Female anatomical makeup is also investigated.

An investigation into damaged menisci in
the average middle-aged and elderly

Tears to the meniscus, a pair of fibrocartilaginous discs in the knee that provide support and protection, are one of the most common injuries and surgeries to repair this region are recognized as the most common surgery performed by orthopedic surgeons. In addition, many middle aged and elderly persons suffer from damaged menisci without being aware of it. One study investigated the number of people with the injuries and whether MRI usage was effective in diagnosing them.

ACL injuries and skeletally immature patients

One study set out to examine the exact dynamics of ACL injuries for adolescents who have not yet developed joints, ligaments and bones fully. An immature ACL, the study displayed, is at a much high level of vulnerability than that of an adult, and additionally requires more attention to evaluation and treatment of the injury.

Female athletes and ACL injuries:
A look at factors that may contribute

On a yearly basis, at least 100,000 people nationwide suffer from an ACL injury, more than half of which require surgery. Some studies show female athletes on a collegiate level to be three times more likely to incur an ACL tear than males, while others report that female high school athletes are five times more likely than males to suffer from a knee injury. With ACL injuries rising in prevalence, it has become common knowledge that they result from an assortment of factors...