Can Targeted Exercise Improve Knee Strength Following ACLR (RATE)
Condition: Rupture of Anterior Cruciate Ligament; Muscle Degeneration; Gait, Unsteady
MeSH terms: Gait Disorders, Neurologic; Rupture
Study type: Interventional

Summary: 
      Anterior cruciate ligament reconstruction (ACLR) is high volume surgery, carried out in about
      2800 patients annually in Denmark per year. ACLR patients (using hamstring auto-graft) have
      persistent hamstring strength deficiency when evaluated more than 1-2 years after
      ACL-reconstruction. The investigators have designed this randomized controlled trial (RCT)
      with the main purpose to investigate the effect of a targeted muscle strength exercise
      intervention on the neuromuscular rehabilitation of ACLR-patients compared with 'care-as-
      usual'.

      The study is designed as a prospective, superiority, parallel-group with balanced
      randomization (1:1) RCT (Level of evidence: II) with blinded allocation, and outcome
      assessment according to the CONSORT statement (Consolidated Standards of Reporting Trials).
      50 patients with ACL reconstruction and persistent hamstring muscle deficiency, will be
      recruited at the outpatient clinic 1-year follow-up, and allocated to one of two 12 weeks'
      interventions, either a) the supervised progressive strength and neuromuscular exercise group
      (SNG) with supervised training twice weekly. Or b) the control group (CON) receiving patient
      education based on a home-based exercise regime of low intensity, defined as 'care as usual'.
      Outcome measures include, maximal isometric knee flexor muscle strength (primary outcome),
      knee extensor strength, and the Knee injury and Osteoarthritis Outcome Score (KOOS)
      (secondary outcomes). In addition, the following explorative outcomes will be investigated;
      hamstring to quadriceps strength ratios, the International Knee Documentation Committee
      Subjective Knee Form (IKDC), magnetic resonance imaging (MRI) to evaluate tendon regeneration
      of the hamstrings and finally kinetic/kinematic biomechanical outcomes of knee related
      functional tasks.

      To the investigators knowledge, this is the first RCT to investigate the efficacy of combined
      progressive resistance training and neuromuscular exercise in the late rehabilitation phase
      in patients demonstrating persistent limb-to-limb knee muscle asymmetry following ACLR.
      Reduced hamstring strength represents a potential risk factor for secondary ligament rupture
      and accelerated progression of osteoarthritis (OA). If deemed effective, the intervention
      paradigm introduced in this study may help to improve current treatment strategies.
    

Detailed description: 
      Detailed study description available in the published study protocol:

      "The effect of targeted exercise on kneemuscle function in patients with persistent hamstring
      deficiency following ACL reconstruction - study protocol for a randomized controlled trial".

      Bo Bregenhof1,3* , Uffe Jørgensen1, Per Aagaard2, Nis Nissen3, Mark W. Creaby4, Jonas Bloch
      Thorlund2, Carsten Jensen3, Trine Torfing5 and Anders Holsgaard-Larsen1 Published: Trials.
      2018; 19: 75. Published online 2018 Jan 26. doi: 10.1186/s13063-018-2448-3
    

Intervention name(s): Targeted exercise
Intervention type(s): Other
Intervention description(s): 12 weeks of targeted and supervised exercise intervention vs. "care as usual" (home based exercises)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention