Faculty Bibliography

To determine the necessity of extensive supervised therapy, we reviewed the records of 39 consecutive patients who underwent arthroscopic anterior cruciate ligament reconstruction using mid-1/3 bone-patellar tendon-bone autograft, followed by a minimal therapy program. This study group was subdivided into a noncompliant group averaging 1.7 visits over 6 months (range, 0 to 5), (subgroup I), and a minimally compliant group averaging 12 visits over 6 months (range, 5 to 24), (subgroup II). Thirty patients who underwent similar surgeries and postoperative protocols, but participated in an extensive supervised outpatient therapy program, served as controls. The control group was fully compliant and averaged 60 visits over 6 months. After 6 months, the minimally compliant study subgroup was equivalent to the fully compliant control group in Lysholm score, patient satisfaction, and return to preoperative activity level. Both of these groups fared better in all of these indices than did the noncompliant subgroup. These results suggest that extensive supervised rehabilitation does not afford a measurable advantage over a minimally supervised program of two visits monthly. Complete noncompliance, however, was associated with suboptimal outcome.

Revision instability is a complex clinical problem. A successful outcome is dependent on several factors, including an accurate diagnosis clearly delineating the different pathologic conditions contributing to the failure. Also, from a technical aspect, an attempt should be made to restore the normal anatomic relationships while achieving glenohumeral stability in a functional range of motion. The purpose of this article is to assist the clinician in the evaluation and treatment of failed instability surgery by combining the authors' personal experience with an extensive review of the literature.