1. The Effects of Rehabilitation After Reconstructive Surgery of an Anterior Cruciate Ligament using a Hamstring Graft Bernice Carr, Department of Biology, York College of Pennsylvania Introduction A possible correlation between the effects of rehabilitation on an Anterior Cruciate Ligament (ACL) tear post hamstring-graft surgery vs. no therapy has yet to be examined. Numerous studies have concentrated on the effects of therapy on the different sex, age, and race of society with a reconstructed ACL. The ACL is located in the center of the knee joint, through the intercondylar notch of femur and attaches to the tibial spine. The function of the ACL is to provide stability and minimize stress to the knee and prevent excessive forward and rotational movements of the tibia. An estimated 150,000 Americans a year tear their ACL. The ACL needs to be removed and replaced with a graft. The graft under investigation in this study is the hamstring graft. This graft uses part of the hamstring tendon, semitendinosus, and the gracilis tendon. The graft has normal placement where the ACL originally is located with tunnels made in femur and tibia (Bach 2001). Previous research has indicated that heavy resistance exercises stimulate muscle growth and strength. These exercises consisted of squats, leg press, knee extensions, and hamstring muscle curl. Heavy resistance exercises are shown to contract the muscle to sixty percent of its full potential in comparison with conventional exercises (Andersen et al. 2006). Project Summary Anterior Cruciate Ligament (ACL) tear is the most common injured ligament in the knee which can be removed and replaced with a hamstring graft. Little information is provided on the effects and importance of therapy after a ACL reconstructive surgery. I propose to study the effects of physical therapy, which is a type of rehabilitation, on the ligaments strengths and degrees of passive range of motion for flexion and extension of the newly replaced ACL. This will be measured by a device called a goniometer. Results of patients that followed a regiment program from a physical therapy facility will be compared with patients that did not attend therapy. Ten or more patients from the two categories i.e., therapy vs. no therapy will be compared. The comparison of time and degrees will reflect the effect of therapy. The proposed research would further knowledge on the importance of therapy after an ACL reconstructive surgery. Review of Literature  The ACL provides stability and support for the anterior and posterior regions of the knee. An injury usually occurs in a directional change of movement including pivoting, jumping and cutting (Bach 2001).  A relationship between hip or ankle extensors compensating in an reconstructive ACL have been found. There was a decreased movement in extension with a ACL injury while attempting to perform a one leg jump or a lateral step up motion (Ernst 2000).  The use of controlled heavy resistance exercises as a supplement to traditional physical therapy regimens should be used in a knee injury rehabilitation to induce high levels of neuromuscular activation. This would furthermore stimulate muscle growth and strength (Andersen 2006). Objective  To determine the effects of rehabilitation on a reconstructed ACL by measuring the length of time to regain mobility, strength, and support by a therapy regiment. H A : A patient will regain most strength and range of motion after reconstructive ACL surgery with physical therapy in a shorter time period than no rehabilitation. Prediction  I predict that a person who has a program through a therapy facility will have more strength and mobility in a shorter amount of time than someone who does not attend therapy. Methods Observation of 11 patients (ACL replaced with hamstring graft) Measured mobility and strength of ACL shortly after surgery (initial evaluation) Aided patient with exercises in a facility measuring a patient’s passive range of motion (PROM) periodically until no further progress was being made Literature Cited Andersen, L.L., et al.2006.Neuromuscular Activation in Conventional Therapeutic Exercises and Heavy Resistance Exercises: Implications for Rehabilitation. Journal of Physical Therapy.86:683-697. Bach, Bernard. 2001. Anterior Cruciate Ligament Reconstruction. AORN Journal. 74:152-164. Ernst, G.P., et al.2000.Lower-Extremity Compensations Following Anterior Cruciate Ligament Reconstruction. Physical Therapy[serial online].80:251-260.Available from: Physical Therapy. Acknowledgments Dr. Bruce Smith who helped with guidance and support through the thesis process. Joli Barkanic, who was the physical therapist at Orthopedic Spine and Specialist and my mentor that provided me with the patients and aided in the knowledge of ACL injuries from her experience and educational background. Finally, Orthopedic Spine and Specialists for giving me the opportunity to fulfill this study. Results from patients who followed a rehabilitation program Table 1. Comparison of patient’s passive range of motion before and after therapy Visits 1 Gender Age 2 PROM 3 PROM 3 Flexion/Extension Flexion/Extension 23 Male 20 80/-12 137/0 32 Male 21 80/-15 131/0 29 Female 16 63/-10 140/0 41 Female 16 85/-12 140/0 20 Female 16 85/-15 125/0 12 Female 16 75/-10 140/0 18 Female 17 50/-15 143/0 9 Female 14 90/0 140/0 26 Female 16 80/-20 125/0 29 Female 19 110/-6 130/0 33 Female 16 83/-12 143/0 1 Number of visits 2 In years 3 Degrees by goniometer Removed damaged ACL Taken from: www.adam.com Taken from: www.vanthorre.com