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A Randomized Control Trial of Acute Post Operative Care Following Anterior Cruciate Ligament Reconstruction: A Comparison of Two Protocols Open Access


Other title
ACL Acute Post Operative Care
Anterior Cruciate Ligament
ACL Rehabilitation
Type of item
Degree grantor
University of Alberta
Author or creator
Hallworth, Ian William
Supervisor and department
Magee, David (Physical Therapy)
Examining committee member and department
Otto, David (Medicine)
Beaupre, Lauren (Physical Therapy)
Faculty of Rehabilitation Medicine
Rehabilitation Science - Physical Therapy
Date accepted
Graduation date
Master of Science
Degree level
Very little research has been conducted in this area, and the specific content of any of the protocols during this postoperative period have not been studied. Perhaps because most patients appear to be at similar functional levels by six to 12 weeks following surgery, the assumption has been made that this period of time does not require evaluation. Since the impact on the patient during this phase of recovery sets the tone for the rest of the rehabilitation, optimal short-term outcomes need to be studied because they ultimately may impact the mid and long range outcomes. The sooner patients regain range of motion (ROM) and muscle control the more safely they can return to their functional everyday activity and thus limit the impact of the surgery. Acute postoperative knee care can impact the physical and emotional tone for the patient’s recovery following surgery. Patients who experience an expedited reduction of pain, decrease in swelling, increase in ROM, increase in function, and improved ambulation may result in a faster integration back into the real world of school, work, social lifestyle, and sports. The objective of this study was to design and implement a randomized control trial based upon consolidated standards of reporting trials (CONSORT) criteria in order to assess the results of the two postoperative protocols over the first six weeks following anterior cruciate ligament (ACL) reconstructive surgery. Subjects were randomly allocated into two groups following their surgery with each group following one of the two protocols. The effects of the two protocols were evaluated using four outcome measures: The International Knee Documentation Committee Subjective Knee score (IKDC), the numerical rating scale of pain (NRSP), circumferential measures and ROM. The four outcomes were recorded pre-surgery and at intervals of one week, two weeks and six weeks post surgery. In addition the IKDC and the NRSP scores were also recorded at twenty-four hours post surgery. It was hypothesized that Protocol B which consisted of the existing Protocol A plus the instructional DVD would be statistically superior to the current protocol based upon the four outcome measures. The results of the study rejected the four hypotheses showing no clinical or statistically significant difference between Protocol A and Protocol B. While it may be intuitive that Protocol B would result in better outcomes it did not. Changes in patient education programs, and changes in the patients care pathways in the course of the study, which the researcher had no control over and patient compliance may have affected the outcomes. The optimal protocol can then be adopted to provide the best standard of practice for future patients following their ACL reconstructive surgery. While it was the intent of this study to provide an improved protocol for the care of patients, during acute postoperative care following ACL reconstruction surgery, the study hypotheses were rejected for all four outcomes. This is not to say that improved care and understanding has not occurred. Based on the present study, as described above, the following conclusions can be made: 1. The IKDC subjective evaluation form may not be sensitive enough to measure change when used in the acute post-operative setting. Further research and testing of validity and reliability on the IKDC subjective evaluation form and its wording is required when used in the acute post operative stage following anterior cruciate ligament reconstruction. 2. Both post-surgical protocols provide guidance to the patient. The education of the patient prior to and during the implementation of a protocol, along with the interpretation of the information, may be a key factor in the success of a post-surgical protocol.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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