Comparison of the Effects of Exercise in Water and on Land on the Rehabilitation of Patients With Intra-articular Anterior Cruciate Ligament Reconstructions
Background and Purpose. Exercises in water have been shown to be effective for improving strength and passive range of motion (PROM). Traditional rehabilitation following intra-articular anterior cruciate ligament (ACL) reconstruction has taken place on land. This study was designed to compare the effects of exercises in water on strength and girth of the thigh musculature, knee PROM, joint laxity, effusion, and functional outcome with the effects of similar exercises on land in subjects following intra-articular reconstruction of the ACL. Subjects. Twenty subjects were randomly assigned to either a group that exercised on land or a group that exercised in water. Methods. Thigh girth, joint effusion, and knee PROM measurements were recorded at 2-week intervals for the first 8 weeks postoperatively. Isokinetic and isometric peak torque measurements for the thigh musculature, knee joint laxity assessments, and Lysholm scores were obtained at the end of 8 weeks. Results. Higher outcome scores were recorded in the water group than in the land group, as measured by Lysholm scales. No differences were noted between groups for knee PROM, thigh girth, or quadriceps femoris muscle performance. In the water group, less joint effusion was noted after the 8 weeks. In the land group, greater peak torque for isokinetic knee flexion was recorded. Conclusion and Discussion. Although exercise in water may not be as effective as exercise on land for regaining maximum muscle performance, rehabilitation in water may minimize the amount of joint effusion and lead to greater self-reports of functional improvement in subjects with intra-articular ACL reconstructions.