Shelbourne Knee Center PTs Give 6 Presentations at a Regional Symposium

Six physical therapists shared Shelbourne Knee Center research results at the Fourth Annual Multidisciplinary Scholarly Activity Symposium of Community Health Network and the University of Indianapolis in Indianapolis on May 8th. More than 300 faculty, staff and students attended the symposium, which included 29 oral presentations and 62 poster presentations. Shelbourne Knee Center is part of Community Health Network, an integrated healthcare system in Central Indiana. 
 
The six presentations by Shelbourne Knee Center physical therapists covered: 

• The effect of body mass index (BMI) on functional outcomes following total knee arthroplasty (TKA) 
• The importance of achieving symmetrical range of motion (ROM) on patients’ long-term outcomes for non-operative or operative knees 
• Best practices for rehab after anterior cruciate ligament (ACL) reconstruction 
• A patellar tendon rupture case study. 

Research Facilitates Optimal Outcomes

The Shelbourne Knee Center research program tracks patient outcomes and studies factors related to those outcomes. Data covering 37 years are used in continually improving treatment for knee problems.   

“You don’t know something works until you test it and prove it,” says Rachel Krupski, PT, DPT, one of the physical therapists who presented research at the symposium. “Our research gives us the confidence to know we’re doing the right things.”

BMI and Functional Outcomes After TKA

Subjects and Methods:

299 patients who underwent TKA, divided into four groups based on BMI:

• Normal (18.5-24.9 BMI): 21 patients
• Overweight (25.0-29.9 BMI): 73 patients
• Obese (30.0-39.9 BMI): 147 patients
• Morbidly Obese (>40 BMI): 58 patients

Patients were evaluated at 1-year post-op:

• Isokinetic strength testing for quadriceps muscle strength
• Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, symptoms, activities of daily living, sport and quality of life
• Timed-Up and Go score

Key Findings:¹

• No statistically significant difference in quadriceps strength or KOOS based on BMI.
• The morbidly obese group was slower than the other BMI groups in the TUG test

These findings confirmed Shelbourne Knee Center’s practice of not excluding patients from TKA surgery solely based on BMI. “Our results do not support conclusions that obese patients do worse functionally following a TKA compared to non-obese patients,” says Krupski.

Full Knee ROM and Long-Term Outcomes

Darla Baker, PT, DPT, ATC/L, and Laura Bray-Prescott, PT/LATC, presented their study on the importance of full, symmetrical ROM in knee rehabilitation.

Subjects and Methods:

Review of data from three studies:

• 20-year post-ACL reconstruction study:
  • Objective data of ROM and radiographs
  • Subjective surveys
• Non-operative osteoarthritis (OA) study:
  • ROM measurements
  • KOOS
• TKA study:
  • ROM measurements
  • KOOS

Key Findings:²

• ACL reconstruction study:
  • Significant decrease in subjective scores in patients with
  • ROM deficits at the time of surgery ROM loss significantly increased the odds of developing OA
• Non-operative OA study:
  • ROM improved regardless of the degree of OA present
  • Only 24.4% Of 396 patients went on to have TKA
• TKA study: Most patients had KOOS within the normal range at 1-year post-op:
  • Pain: 93%
  • Symptoms: 84%
  • Activities of daily living: 96%
  • Sport: 91%
  • Quality of life: 90%

“Improving ROM deficits before concentrating on other rehabilitation goals is key to achieving all treatment goals,” concluded Baker and Bray-Prescott.

Return to Competitive Sport After ACL Reconstruction

Bill Claussen, MPT, Sarah Eaton, PT, DPT, ATC, LAT, and Scot Bauman, PT, DPT, repeated presentations they had made at the American Physical Therapy Association Combined Sections Meeting in January. Highlights of these studies, which were covered in another article, follow.

Claussen, Eaton and Bauman presented two studies together on (1) return to competitive sport (2) return of bilateral quadriceps muscle strength after ACL reconstruction using a contralateral patellar tendon graft.

The first study focused on return to competitive sport in 120 school-age Level 9 athletes.

Key Findings:

• 80% of the athletes returned to the same level of sport or higher³
• The Shelbourne Knee Center return to sport rate was nearly double that found by a systematic review and meta-analysis published in the British Journal of Sports Medicine⁴

Read more about this study.

Quadriceps Muscle Strength

The second study presented by Claussen, Eaton and Bauman focused on return of bilateral quadriceps muscle strength in 217 patients.

Key Findings:⁵

• 98% of patients achieved full extension in the ACL knee at 1-month post-op
• 94% of patients achieved normal extension and flexion in the ACL knee compared to the opposite knee at 1-year post-op
• Quadriceps strength in both legs also returned

Read more about this study.

ROM and Quadriceps Strength

Eaton studied the effect of knee ROM on return to full quadriceps strength in 978 patients who underwent primary ACL reconstruction using a contralateral PTG.

Key Findings:⁶

• 891 patients had normal ROM and 87 patients had abnormal ROM at 1-year post-op
• Compared to patients with abnormal ROM, patients with normal ROM had:
  • More symmetrical strength between the knees
  • Stronger quadriceps

Read more about this study.

Patellar Tendon Repair Case Study

Bauman  conducted a retrospective case study of a 35-year-old recreational athlete who underwent a patellar tendon repair using a Dall-Miles cable.

Key Findings:⁷

• After cable removal surgery, the patient attained symmetric extension at day 3 post-op, symmetric flexion and no joint effusion at 4 weeks, and nearly normal quadriceps strength at 8 weeks.
• The patient attained symmetric quadriceps strength at 4 months and maintained this at 8 months.

Read more about this study.

For more information about physical therapy at Shelbourne Knee Center, call 888-FIX-KNEE.

References

1. Krupski R. The effect of body mass index on functional outcomes following total knee arthroplasty. Fourth Annual Multidisciplinary Scholarly Activity Symposium, Indianapolis, May 8, 2019, Indianapolis.
2. Baker D and Bray-Prescott L. The importance of achieving symmetrical range of motion patients’ long-term outcomes for non-operative or operative knees. Fourth Annual Multidisciplinary Scholarly Activity Symposium, May 8, 2019, Indianapolis.
3. Bauman S, Claussen W. Return to competitive sports after ACL reconstruction. Poster session, 2018 Indiana American Physical Therapy Association and Kentucky American Physical Therapy Association Joint Conference, September 2018, Louisville, Ky and American Physical Therapy Association Combined Sections Meeting, January 2019, Washington, DC.
4. Arden CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45(7):596-606.)
5. Claussen W and Bauman S. Return of bilateral quadriceps muscle strength following anterior cruciate ligament reconstruction using a contralateral patellar tendon graft. 2018 Indiana American Physical Therapy Association and Kentucky American Physical Therapy Association Joint Conference, September 2018 and American Physical Therapy Association Combined Sections Meeting, January 2019, Washington, DC.
6. Eaton S. Effect of Knee Range of Motion on Return to Full Quadriceps strength at 1 year Post-op Following Anterior Cruciate Ligament Reconstruction with Contralateral Patellar Tendon Graft. American Physical Therapy Association Combined Sections Meeting, January 2019, Washington.
7. Bauman S. Rehabilitation and outcomes following a patellar tendon repair using a Dall-Miles cable: a retrospective study. Presented at American Physical Therapy Association Combined Sections Meeting, January 2019, Washington.