الفهرس 
I IntroductionOnly 14 pages are availabe for public view
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Abstract
Anterior cruciate ligament reconstruction is common surgical knee
procedure that require intensive postoperative rehabilitation by the
patient. To overcome many complications after ACL reconstruction
(prolonged knee stiffness, limitation of complete extension, delay in
strength recovery and anterior knee pain) several studies demonstrate
accelerated rehabilitation emphasizing on immediate full range of motion,
early full weight bearing, strength training, and an early introduction to
closed chain exercises. (Haddad and Watson, 2005; Swirtun et al.,
2005 and Sekir et al., 2010).
The aim of the current study is to determine effect of exercise
program on knee muscles strength and functional abilities after
arthroscopic ACL reconstruction.
1. Research design:
A quasi experimental research design was utilized in this study.
2. Research Setting:
The study was carried out carried out in orthopaedic department of
Shebin El-Kom Teaching and University hospital at Menofia
Governorate.
3. Subjects:
A convenient sample of 60 patients undergoing arthroscopic
Anterior Cruciate Ligament reconstruction were assigned into two equal
groups, 30 patients for each group:
A. study group (1): exposed to active knee exercise program for the
affected knee after ACL reconstruction with arthroscopy.
B. control group (Π): exposed to routine hospital care.
Tool of the study:
• Tool 1: Structure interview questionnaire (knowledge assessment
sheet)
• Tool 2: Anterior Knee Pain Scale
• Tool 3: Biophysiological measures of Knee ligament injuries
Tool 1: structure interview questionnaire (knowledge assessment
sheet) (Appendix Π)
It was developed and used by the researcher to assess patient’s
knowledge about anterior cruciate ligament injury& reconstruction and
their awareness of postoperative exercise.
Tool (2): Anterior Knee Pain Scale (Appendix ΠΙ)
Anterior Knee Pain Scale: this scale was developed by Kujala
etal, (1993). The scale was specifically designed for patients with
patellofemoral pain to evaluate degree of pain. It consisted of 13 items. It
was categorized from 0 as a minimum to 100 as a maximum point.
Tool 3: Biophysiological measures of Knee ligament injuries
To evaluate muscle strength, knee range of motion and activities of
daily living, it includes 3 parts:
• Part (1): Manual muscle strength testing of the knee muscles
scale (Appendix IV): This scale was developed by Burke et al.,
(2007) and used by the researcher for evaluating the strength of the
intrinsic knee muscles. Muscles were evaluated individually with
comparison to that of the same muscle on the opposite side of the
body. This scale graduated from 0 to 5 grade.
• Part (2): Range of Motion Measurement (Appendix V): This
scale was developed by Luttgen and Hamilton (1997) and used
by the researcher for measuring knee range of motion (flexion and
extension) by using goniometer
• Part (3): The Activities of Daily Living Scale (ADLS) of the Knee
Outcome Survey (Appendix VI): This scale was developed by
Irrgang et al (1998) and used by the researcher to evaluate
patient’s activity of daily living.
Π. Method
1-Written approval:
Official letter from the Faculty of Nursing was delivered to the
responsible authorities of hospitals to conduct this study.
2- Tools development:
Tool 1 was designed and developed by the researcher after
extensive review of the relevant literature. It was written in Arabic. The
other two tools 2 and 3 were developed by other authors.
3- Protection of human rights and consent (patient consent):
Patient’s verbal agreement to participate in this study was obtained
after explanation of the purpose of study.
4- Pilot study:
A pilot study was conducted prior to data collection on 10% of the
study sample (six patients).
5- Data collection: Data collection extended from the first February 2010
to the end of August 2010. patients who agreed to participate in the study
and fulfilling the inclusion criteria were included in the study.
• A convenient sample of 60 patients with a diagnosis of ACL injury
were selected and randomly divided alternatively into two equal
groups; study group (1) and control group (Π). The researcher
was deal with control group (Π) firstly then the study group (Ι) to
avoid contamination of data collection.
• The researcher initiated data collection by using tool 1, in which
the studied sample was interviewed by the researcher on admission
to assess patients’ knowledge about ACL injury and postoperative
arthroscopic ACL exercise as indicated in appendix (Π).
• Health instruction in 3 sessions about ACL injury and practice of
knee exercise program were given to patients in the group (1)
individually by the researcher.
• The exercises that were followed involved 2 phases; the Phase I:
(from 1 to 6 days postoperative) included knee Extension , Knee
flexion to 110 degrees and Leg control. Phase II: (from 1 to 4
weeks postoperative) it included: Towel extensions, Prone hangs,
Wall slides& Heel slides, single leg stance also closed and open
kinetic strengthening exercises ware used. Each exercise was held
for at least 6 seconds and repeated 5 times daily. A colored booklet
was distributed to the study group for reinforcement (appendix VI).
• Every patient in both groups (study and control) was physically
assessed 3 times (immediately on admission, 1st week post
intervention and 4th week post intervention for their knowledge,
exercise practice, pain, muscle strength, ROM, and Activities of
Daily Living by using tool 1, 2, and 3 that indicated in appendix (Π,
ΠI, IV, V and VI ) respectively. It took about 30- 45 minutes.
• Data were collected, analyzed and the comparison was done
between both study and control group to determine effect of
exercise program on knee muscles strength and functional abilities
after arthroscopic ACL reconstruction.
The main results:
Based on the findings of the current study, knee exercise program
after ACL reconstruction provided by researcher achieving research
hypotheses as well as improving patients knowledge about ACL injury
and its postoperative knee exercise. The patient who exposed to knee
exercise program after ACL reconstruction had a reduction in pain and
improvement of their knee muscle strength, ROM and functional abilities.
Based on the findings of the present study the following
recommendations are derived and suggested:
E. Recommendations for patients:
• Providing knee exercise program for patients with ACL
reconstruction to help them to reduce pain and improve knee
muscle strength, ROM and functional abilities.
• A booklet should be available and distributed to all patients
with arthroscopic ACL reconstruction. It should include
knowledge about ACL injury and knee exercise program
after ACL reconstruction.
F. Recommendations for nurses:
• Developing a structured educational program for orthopaedic
nurses about the importance of exercise program for ACL
reconstruction patients in reducing pain and improving knee
muscle strength, ROM and functional abilities.
• A manual should be available to all nurses working in
orthopaedic department about rehabilitation program after
ACL reconstruction.
G. Recommendations for administration:
• A booklet should be available and distributed to all patients
in the orthopaedic ward.
H. Recommendation for further researches:
• Replication of the study with a larger probability sample to
attain more generalizable results.