Subacute Clinical Features After Arthroscopy Surgical Reconstruction of Complete Anterior Cruciate Ligament Rupture: A Case-Control Study.

OBJECTIVE: The purpose of this study was to describe the clinical features in the subacute phase after surgical reconstruction of complete anterior cruciate ligament rupture (ACLR) with respect to healthy participants. METHODS: A case-control observational study was performed. A total sample of 80 participants was recruited from an outpatient clinic and divided into case (n = 40 patients after ACLR reconstruction in subacute phase) and control (n = 40 healthy participants) groups. Outcomes, including pain intensity, range of motion (ROM), stability, and functionality were assessed by the visual analogue scale, universal goniometer, the Star Excursion Balance Test, and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. RESULTS: There were no statistically significant differences (P > .05) for sex, side, age, and body mass index between patients with ACLR after reconstruction surgery and healthy participants. Statistically significant differences (P < .001) with a large effect size (Rosenthal r) from -0.86 to -0.93 were shown for ROM (median ± interquartile range [IQR], -70.00° ± 10.00°) and Star Excursion Balance Test (mean ± standard deviation, -38.31 cm ± 4.52 cm) reduction, as well as higher visual analogue scale (median ± IQR, 7.00 ± 1.00) and Western Ontario and McMaster Universities Osteoarthritis Index (median ± IQR, 68.77 ± 6.29) scores in favor of the ACLR reconstructed group, with respect to the healthy control group. CONCLUSIONS: Measurable clinical differences of functionality, stability, and ROM should be considered during the evaluation of patients at a subacute period after complete ACLR reconstruction surgery with respect to healthy matched controls.

Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture.

BACKGROUND: Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. METHODS: This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n = 22) or Rh + TrP-DN (n = 22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24 hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. RESULTS: Comparing statistically significant differences (P ≤ .001; Eta = 0.198-0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P > .05). CONCLUSION: Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.

Anatomical association between wrist extensor musculature and topographical pain sensitivity maps of the elbow area.

OBJECTIVE: High-density topographical sensitivity maps have been developed to visualize nonuniformity deep tissue pain sensitivity in, for example, lateral epicondylitis (LE). The aim of this cadaveric study was to determine the anatomical association between the topographical sensitivity maps over the elbow area and wrist extensor musculature. METHODS: A topographical pressure sensitivity map consisting of 12 points forming a 3 × 4 matrix: 4 points in the superior part, 4 points in the middle, and 4 points in the lower part around the lateral epicondyle was marker on a 50-year embalmed cadaver. Color marker pins were inserted into each point. Pins were removed during the process of dissection, but the small holes created by their removal assured accurate relocation. RESULTS: Progressive dissection revealed that points 1 to 4 (superior line) were placed over the musculotendinous junction and belly of the extensor carpi radialis brevis (ECRB) muscle, points 6 to 8 (middle line) were placed over the musculotendinous junction and belly of the extensor digitorum communis muscle, and points 9 to 12 (inferior line) were located over the musculotendinous junction and belly of the extensor carpi ulnaris muscle. It was also observed that the superficial branch of the radial nerve runs between the belly of the ECRB and extensor digitorum communis muscles. CONCLUSIONS: This study confirmed that anatomical location previously assumed supporting the important wrist extensor muscles, particularly the ECRB, in patients with LE as depicted by pressure pain sensitivity maps. This study also suggests a potential role of the superficial branch of the radial nerve in LE.