FULL KNEE EXTENSION IS KEY TO SUCCESSFUL ACL RECONSTRUCTION

at long-term outcomes after ACL reconstruction based on normal or abnormal extension, with or without meniscus tears and/or chondral injury and the presence and severity of osteoarthritis (OA) on radiographs.

ACHIEVING FULL KNEE EXTENSION in patients with an anterior cruciate ligament (ACL) injury before and after reconstruction is the key to avoiding negative long-term outcomes, according to a study of 1,792 Shelbourne Knee Center patients covering 10+ years of follow up.1 Knee extension equal to the opposite side is important both early on after an ACL reconstruction and in long-term success.

“We have learned that if you don’t have normal extension at two months, you will likely not have it at more than 10 years,” says K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center.

Researchers at the center looked

Study Methods

Researchers followed 1,792 patients treated with ACL reconstruction at Shelbourne Knee Center from 1982 through 2012 for at least 10 years using:

• Subjective, objective and radiographic data for 909 patients (27%)

• Subjective data only for 883 patients (26%).

The study is part of the Shelbourne Knee Center Research Program, which has collected data on outcomes for more than 15,759 patients over 41+ years. The research process includes annual email surveys and objective evaluations (for surgical patients) during free follow-up visits.

Dr. Shelbourne presented study results at the 2023 ACL Study Group meeting. This international group of orthopedic surgeons meets every two years to share and discuss the latest science and clinical work.

Problems Caused by Abnormal Knee Extension

Using subjective, objective and radiographic data, researchers found that patients with abnormal knee extension at two months post-op were 6.4 times more likely to have abnormal knee extension at long-term follow-up (p<.001).1 The objective measurements of knee extension range of motion (ROM) used in the study are critical. “Without objective data, the clinician cannot determine how or why a patient may be doing worse,” says Scot Bauman, PT, DPT, a clinical researcher at Shelbourne Knee Center.

Study results show that decreases in knee extension ROM can lead to:

• Higher rates of OA

• Quadriceps weakness

• Lower subjective scores. The odds of having OA after surgery are:

• 4.8 times higher for patients with abnormal extension

• 2.1 times higher for patients with meniscus tears

• 2.7 times higher for patients with chondral injuries.

Compared to patients with abnormal extension, patients with normal extension had statistically significantly:

• Stronger quadriceps

• Higher subjective scores on the International Knee

Documentation Committee Subjective Knee Evaluation Form.

A loss of extension long term resulted in more negative outcomes than meniscus tears or chondral injuries.

Physical Therapy Restores Knee Extension

Shelbourne Knee Center’s research-backed approach to ACL reconstruction includes:

• Physical therapy to restore ROM before strengthening the knee

• Pre-op physical therapy to prepare for surgery and enable a faster recovery

• Accelerated post-op physical therapy to prevent swelling and facilitate recovery.

“We encourage clinicians to prioritize restoring range of motion after surgery for better short- and long-term outcomes,” says Bauman.

References

1. Shelbourne KD. Objectively measuring knee extension is critical when analyzing long term outcomes after an ACLR. Presented at the 2023 ACL Study Group, February 2023.

ORTHOPEDIC n K. Donald Shelbourne, MD n Rodney Benner, MD

CLINICAL TEAM n Jean Fouts, RN, BSN n Lee Linenberg, CA n Emily Guy, PA

FixKnee.com: A Resource for Clinicians

AT SHELBOURNE KNEE CENTER, we’ve been conducting research for 40+ years. More than 13,000 of our patients have participated in follow-up surveys and exams. The result? A trove of clinical information related to treating knee injuries and disorders. We’ve made much of this material available to clinicians via our website, www.FixKnee.com. Visit to find a complete list of our published research (with links) organized by topic. Our website also features two blogs for clinicians, For Colleagues and For Professionals, which you’ll find under News + Resources. That section also hosts a Knee Treatment News page with links to digital flipbook versions of each issue.

Research-Backed Treatment for Rare Knee Injuries

Shelbourne Knee Center’s two orthopedic surgeons, K. Donald Shelbourne, MD, and Rodney Benner, MD, have had their research published in more than 160 medical journals and over 100 book chapters. To discuss a rare knee injury or other case with one of our surgeons, email skckneecare@ecommunity.com or call 888-FIX-KNEE (317-924-8636).

n Bill Claussen, MPT n Emma Sterrett, LAT, ATC n Darla Baker, PT, DPT, ATC/L n Sarah Eaton, PT, DPT, ATC, LAT n Jennifer Christy, PT n Alana Gillenwater, PT, DPT n Bryanna McKinstry, PT n Noah Runyon, PT

RESEARCH n Scot Bauman, PT, DPT n Diane Davidson, BS, MBA, CCRC n Adam Norris, ACRP-CP n Heather Garrison