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BACKGROUND AND PURPOSE: Treatment techniques involving perturbations of support surfaces may induce compensatory muscle activity that could improve knee stability and increase the likelihood of returning patients to high-level physical activity. The purpose of this study was to determine the efficacy of augmenting standard nonoperative anterior cruciate ligament (ACL) rehabilitation programs with a perturbation training program. SUBJECTS: Twenty-six patients with acute ACL injury or ruptures of ACL grafts participated in the study. Subjects had to have a unilateral ACL injury, be free of concomitant multiple ligament or meniscal damage requiring surgical repair, and pass a screening examination designed to identify patients who had the potential to return to high-level physical activity with nonoperative treatments. Subjects also had to be regular participants in level I activities (eg, soccer, football, basketball) or level II activities (eg, racquet sports, skiing, construction work). METHODS: Subjects were randomly assigned to either a group that received a standard rehabilitation program (standard group) or a group that received the standard program augmented with a perturbation training program (perturbation group). Treatment outcome was determined from scores on the Knee Outcome Survey's Activities of Daily Living Scale (ADLS) and Sports Activity Scale, a global rating of knee function, scores on a series of single-limb hop tests, measurements of maximum isometric quadriceps femoris muscle force output, and the group frequency of unsuccessful rehabilitation. Unsuccessful rehabilitation was defined as the occurrence of an episode of giving way of the knee or failure to maintain the functional status of a rehabilitation candidate on retesting. RESULTS: More subjects had unsuccessful rehabilitation in the standard group compared with the perturbation group. There was a within-group x time interaction for the ADLS, global rating of knee function, and crossover hop test scores. These scores decreased from posttraining to the 6-month follow-up for the standard group. CONCLUSION AND DISCUSSION: Although both the standard program and the perturbation training program may allow subjects to return to high-level physical activity, the perturbation training program appears to reduce the risk of continued episodes of giving way of the knee during athletic participation and allows subjects to maintain their functional status for longer periods. [ABSTRACT FROM AUTHOR]

What has been called 'closed kinetic chain' (CKC) exercise has become popular in the last 5 to 10 years for use after anterior cruciate ligament (ACL) reconstructive surgery. Closed kinetic chain exercises appear to have gained popularity over more traditionally used open kinetic chain (OKC) exercises because many clinicians believe that CKC exercises are safer and more functional. These clinicians also contend that CKC exercise is equally effective as OKC exercise in restoring quadriceps femoris muscle force production following ACL reconstructive surgery. The purpose of this clinical perspective is to examine the evidence concerning OKC and CKC training after ACL reconstructive surgery with regard to these issues and discuss how physical therapists can best apply this knowledge in clinical practice. Based on the review of data, it does not appear that clinicians should completely abandon more traditional OKC exercises and replace them with CKC exercises in postoperative ACL reconstruction rehabilitation programs. Both types of exercise apparently can be modified to minimize (1) the risk of applying excessive strain on the ACL graft and (2) the risk of excessive patellofemoral joint stress. Depending on the functional goals of the patient, both OKC and CKC exercises may be appropriate for simulating functional activities. When improvement in quadriceps femoris muscle function is an essential treatment goal, therapists may need to combine OKC exercises with CKC exercises to provide optimal training stimuli. Suggestions for further research are discussed. [Fitzgerald GK. Open versus closed kinetic chain exercise: issues in rehabilitation after anterior cruciate ligament reconstructive surgery. [ABSTRACT FROM AUTHOR]

Background and Purpose. A series of patellofemoral (PF) alignment tests have been described that are used to determine when and how PF taping techniques should be applied. The reliability of measurements obtained with these tests has not been reported. The purpose of this study was to determine the intertester reliability of measurements obtained with four PF alignment tests: medial/lateral displacement, medial/lateral tilt, medial/lateral rotation, and anterior tilt. Subjects. Twelve physical therapists from four clinics served as testers. A total of 66 patients were evaluated. Methods. Paired testers performed all four PF alignment tests on the same patient. The intertester reliability of judgments of each of the PF alignment tests was determined by a kappa correlation coefficient. Results. Kappa correlation coefficients ranged from .10 to .36 for the four PF alignment tests. Conclusion and Discussion. These findings suggest that the reliability of measurements obtained with the PF alignment tests described in this report ranged from poor to fair. Potential factors affecting the reliability of these measurements are discussed. Alternative methods for deciding when and how to apply PF taping techniques are also discussed. [ABSTRACT FROM AUTHOR]