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Abstract
Background:
Anterior cruciate ligament (ACL) injuries are common. A goal of
rehabilitation is to restore functional capacity. Currently, there
are contrary opinions regarding the effectiveness of using either
closed or open kinetic chain exercises (CKC, OKC) only, or a
combination of both, following ACL injury, to obtain the most
effective outcome. The debate also reflects the approach which
places the least force on the ACL itself. Objective: To
identify the evidence of effectiveness of closed versus open kinetic
chain exercises, or a combination of both, in anterior cruciate
ligament rehabilitation. Methods: A systematic review was
undertaken of experimental studies published since 1990. Included
studies were on humans with ACL injury. The ACL ligament could be
healthy, ruptured, deficient or reconstructed. Studies on animals
and cadavers were excluded. The methodological quality of included
studies was appraised with the PEDro tool. Studies were graded
according to hierarchy level, methodological quality, statistical
significance, effect size, and clinical relevance. Recommendations
were made on the strength of the body of evidence. The outcome
measure of interest was force on the ACL during exercise.
Results: 23 eligible studies were included. The majority of
studies reflected lower level experimental designs with moderate
methodological quality. Three studies showed a significant
difference in ACL force comparing CKC and OKC exercises, 11
demonstrated trends towards significant differences in outcome and
nine showed no significant differences. Conclusion: There is
moderate evidence to recommend CKC exercises or a combination of CKC
and OKC exercises, rather than OKC exercises alone, for ACL
rehabilitation when considering forces on the ACL. |
