Summary

Radial Extracorporeal Shock Wave Therapy Enhanced Graft Maturation Up to 2 Years After Anterior Cruciate Ligament Reconstruction

Abstract

Background

Graft maturation is an important prognostic factor for hamstring autograft anterior cruciate ligament reconstruction (ACLR). It remains unclear whether extracorporeal shock wave therapy (ESWT) can promote graft healing after ACLR during the early postoperative phase.

Purpose

To evaluate the therapeutic effect of ESWT in hamstring autograft ACLR.

Methods

Between May 18 and September 2019, 30 patients who met both the inclusion and exclusion criteria were included and randomized into two groups. Patients in the control group followed a 5-week standard rehabilitation protocol (5 times/week, 30 minutes/session) starting at 3 months postoperatively. In the ESWT group, in addition to the 5-week standard rehabilitation training, radial ESWT was added once a week for continuously 5 weeks. Functional scores were assessed at 3 (baseline), 6 and 24 months after the operation, and the KT-1000 measurement was tested at baseline and the 3 (baseline), 6 and 24 months follow-ups. Magnetic resonance imaging (MRI) was performed at the follow-ups. The graft signal/noise quotients (SNQs) of the tibial, intra-articular, and femoral sides were assessed to quantitatively evaluate graft maturation.

Results

In total, 26 patients finished the final follow-up. At baseline, there were no significant differences between the two groups in all assessments. At the 24-month follow-up, the functional scores were significantly improved in both groups (all P values < .05) and the LKSS (P = .002) and Tegner scores (P = .002) were significantly improved in EWST group. No significant differences were found in KT-1000 within groups or between groups (all P value > .05). After ESWT, the SNQ of the tibia intraosseous graft was lower than that of the control group (P = .006) at 6 months, while no difference was found at 24-month follow-up. While the SNQ of the femoral intraosseous graft (P = .002) and intra-articular graft (P = .004) were significantly lower than control group at 24-month follow-up.

Conclusion

Radial ESWT could enhance the maturation of the intraosseous and intra-articular graft as well as improve clinical function in patients receiving hamstring autograft ACLR at 24-month follow-up.