Introduction
Anterior cruciate ligament (ACL) injuries are commonly seen in young athletes, often accompanied by damage to the menisci, particularly the medial meniscus. ACL reconstruction with meniscus repair requires a comprehensive rehabilitation plan to restore joint stability, muscle strength, and functional mobility. Early rehabilitation is crucial for preventing long-term deficits such as fixed flexion deformities, quadriceps weakness, and decreased range of motion (ROM). However, delayed rehabilitation can result in impaired outcomes and slow recovery.
This case report presents the rehabilitation journey of a 23-year-old male who underwent ACL reconstruction with medial meniscus repair and experienced delays in his early rehabilitation, leading to functional deficits. The report emphasizes the importance of early rehabilitation and highlights the recovery process using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Leg Balance Scale (SLBS) as outcome measures.1, 2
Case Presentation
The patient, a 23-year-old male, sustained a sports-related injury leading to ACL rupture and a medial meniscus tear. He underwent ACL reconstruction with medial meniscus repair and was advised to follow a structured rehabilitation protocol. However, due to delayed initiation of rehabilitation, the patient reported back to the clinic 14 days post-operatively with a fixed flexion deformity (FFD) of 10 degrees and a quadriceps lag of 10 degrees. the study was conducted on department of sports medicine.chettinad hosptial and reserach insitute. A detailed physiotherapy program was initiated to address these deficits.
Table 1
Exercise protocol
Table 2
Outcome measures pre test and post test measures of kkoos scale and sslbs testing
|
Time Point |
KOOS Pain |
KOOS Symp- toms |
KOOS ADL |
KOOS Sports / Recreation |
KOOS QoL |
SLBS (Affected Leg) |
SLBS (Unaff- ected Leg) |
|
Post- |
45 |
50 |
30 |
10 |
20 |
5 |
10 |
|
12th |
80 |
75 |
85 |
60 |
70 |
25 |
30 |
The rehabilitation program was designed in phases, targeting the restoration of full knee extension, reduction of pain and swelling, and the strengthening of the quadriceps and surrounding muscles. Progress was tracked using the KOOS scale and SLBS. The patient’s baseline KOOS scores, measured on day 14 post-surgery, indicated significant impairments in pain, symptoms, activities of daily living (ADL), sports and recreation, and quality of life (QoL). The SLBS revealed poor balance, especially on the affected limb.3, 4 (Table 1)
Results
On post-operative day 14, the patient’s KOOS scores were low, reflecting his functional limitations: Pain (45), Symptoms (50), ADL (30), Sports/Recreation (10), and QoL (20). The SLBS also indicated poor proprioception, with a balance time of 5 seconds on the affected leg compared to 10 seconds on the unaffected leg. Following the initiation of a structured rehabilitation program, the patient’s progress was monitored at regular intervals.(Table 2)
By the 12th week of rehabilitation, the patient showed substantial improvement. His KOOS scores had improved significantly: Pain (80), Symptoms (75), ADL (85), Sports/Recreation (60), and QoL (70). The SLBS demonstrated enhanced balance with 25 seconds of single-leg stance on the affected leg, compared to 30 seconds on the unaffected leg. Additionally, the patient regained full knee extension, and his quadriceps strength improved, allowing him to perform straight-leg raises without any lag. The rehabilitation program restored normal ROM, muscle strength, and functional stability in the knee joint. (Table 2)
Discussion
This case underscores the critical importance of early rehabilitation following ACL reconstruction with medial meniscus repair. The initial delay in rehabilitation resulted in a 10-degree fixed flexion deformity and quadriceps weakness, significantly delaying functional recovery. Early mobilization and quadriceps activation are essential to prevent muscle inhibition and joint stiffness. A structured rehabilitation program focusing on progressive loading, functional exercises, and proprioception training resulted in excellent recovery outcomes for this patient. The KOOS and SLBS provided valuable insights into the patient’s progress, demonstrating marked improvements in pain, functional mobility, and balance.5, 6, 7
This case highlights that even after a delayed start, a well-designed physiotherapy program can lead to significant improvements in knee function. The combination of strength training, balance exercises, and sports-specific drills allowed the patient to regain normal function and prepare for a return to sports.8
Conclusion
Delayed rehabilitation after ACL reconstruction with medial meniscus repair can result in significant functional impairments, including limited ROM and muscle weakness. However, with a structured and progressive rehabilitation protocol, substantial improvements in knee function can be achieved. This case report emphasizes the necessity of early and structured rehabilitation in ensuring optimal recovery and preventing long-term deficits. The use of KOOS and SLBS as outcome measures provided objective evidence of the patient’s functional progress, reinforcing the effectiveness of the rehabilitation approach.9, 10, 11
