Title Page
Abstract
Contents
1. Introduction 11
1.1. Background and Necessity 11
1.2. Purpose 15
1.3. Hypothesis 15
2. Theoretical Background 16
2.1. Joint of Knee 16
2.2. Structure 17
2.3. Articular bodies 18
2.4. ARTICULAR CAPSULE 20
2.5. BURSAE 21
2.6. CARTILAGE 22
2.7. MENISCI 23
2.8. LIGAMENTS 25
2.9. Anatomy of anterior cruciate ligament 28
2.10. MUSCLES 31
2.11. Anterior cruciate ligament Injury mechanism 33
3. Method 35
3.1. Subjects 35
3.2. Process of Research 36
3.3. Experimental Apparatus 39
3.3.1. Muscles strength assessment 40
3.3.2. Effusion 42
3.3.3. Pain 44
3.3.4. 10 RM measurement 45
3.4. Intervention 46
3.4.1. Standard rehabilitation programme 46
3.4.2. Eccentric exercise 47
3.4.3. BFR 49
3.4.4. BFR resistance training 51
3.4.5. BCT group 53
3.4.6. BET group 53
3.5. Statistical Analysis 54
4. Results 55
4.1. Comparison between two groups according to training method 55
4.2. Results of BET training methods 56
4.2.1. Involved leg strength 56
4.2.2. Uninvolved leg strength 57
4.2.3. Quadriceps strength deficit 58
4.2.4. Girth 59
4.2.5. Pain 60
4.3. Results of BCT training methods 61
4.3.1. Involved leg strength 61
4.3.2. Uninvolved leg strength 62
4.3.3. Strength Deficit 63
4.3.4. Girth 64
4.3.5. Pain 65
5. Discussion 66
5.1. Pre-operative rehabilitation 66
5.2. Graft healing 69
5.3. Patella tendon graft (BTB) considerations. 70
5.4. Strengthening 71
5.5. Fatigue 71
5.6. Patient specific parameters 72
5.7. Risk factors 73
6. Conclusion 75
7. List of References 76
List of Abbreviation 88
Appendices 92
Appendix 1. ACL Rehabilitation Protocol 92
Appendix 2. Information Provided to Participants 98
Appendix 3. Pre-surgery Medical Health Examination 100
Table 1. Anterior compartment (Extensors) 31
Table 2. Posterior compartment (Flexors) 32
Fig.1. knee anatomy 18
Fig.2. bursae in the knee joint 21
Fig.3. Cartilage in knee joint 22
Fig.4. Meniscus from transverse plane view 23
Fig.5. ACL in the femoral intercondylar notch from the frontal point of view. The length ranging from... 28
Fig.6. The AMB and the PLB are not isometric; the AMB tightens during knee flexion while the PLB... 29
Fig.7. ACL injury through a series of combinations of knee valgus and anterior tibial translation force... 34
Fig.8. Experimental procedure flow chart 37
Fig.9. Anterior cruciate ligament surgery through bone-patellar tendon-bone (BTB) graft 38
Fig.10. Range of motion setting up on Biodex 40
Fig.11. The distance between the lateral malleolus and the ankle strap shows about 2 fingers distance 41
Fig.12. Isokinetic muscle strength test 41
Fig.13. Measuring circumference of the knee joint 42
Fig.14. Cushion under the ankle 42
Fig.15. Space between the edge of the seat and the posterior knee 47
Fig.16. Ankle pad location 47
Fig.17. Leg extension eccentrical exercise 48
Fig.18. Different size of BFR cuffs and sphygmomanometer 49
Fig.19. Determining complete occlusion pressure 50
Fig.20. Leg extension concentric movement 51
Fig.21. Eccentrical exercise with BFR cuff 52