Table 8.
Summary of evidence for the effects of OKC vs. CKC exercises after ACLR surgery.
| Outcome measure | Comparisons | Relative effect [95% CI] | CKC/OKC (n studies) | Quality of evidence (GRADE) | Evidence and significance | |
|---|---|---|---|---|---|---|
| Average estimate in the OKC group | Average estimate in the CKC group | |||||
| Lysholm score 2 weeks |
OKC: Mean ± SD was 69.75 ± 13.81 |
CKC: Mean ± SD was 78.2 ± 10.87 |
MD −8.45 [−16.15, −0.75] Statistically significant difference |
20/20 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a significant difference in Lysholm score in favor of CKC compared to OKC at 2 weeks. |
| Lysholm score 3 months |
OKC: Mean ± SD was 78.5 ± 14.5 |
CKC: Mean ± SD was 80.8 ± 19.1 |
MD −2.3 [−10.99, 6.39] Non-statistically significant difference |
28/30 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in Lysholm score between OKC and OKC at 3 months of follow-up. |
| Lysholm score 6 months |
OKC: Mean ± SD was 84.3 ± 9.1 |
CKC: Mean ± SD was 94.1 ± 8.5 |
MD −9.8 [−14.34, −5.26] Statistically significant difference |
28/30 (1) |
⊕◯◯◯ Very low1 |
Very low certainty evidence of a significant difference in Lysholm score in favor of CKC compared to OKC at 6 months. |
| IKDC form 2 weeks |
OKC: Mean ± SD was 78.20 ± 10.87 |
CKC: Mean ± SD was 69.75 ± 13.81 |
MD 8.45 [0.75, 16.15] Statistically significant difference |
20/20 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a significant difference in IKDC form in favor of OKC compared to CKC at 2 weeks of follow-up. |
| Quadriceps isokinetic strength 12 weeks |
OKC: Mean ± SD was 161.1 ± 40.1 |
CKC: Mean ± SD was 133 ± 36.1 |
MD 28.1 [3.17, 53.03] Statistically significant difference |
18/18 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a significant difference in quadriceps isokinetic strength in favor of OKC compared to CKC at 12 weeks. |
| Laxity 14 weeks |
OKC: Mean ± SD was 12 ± 3 |
CKC: Mean ± SD was 12 ± 3 |
MD 0 [−1.72, 1.72] Non-statistically significant difference |
23/24 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in laxity between OKC and CKC at 14 weeks of follow-up. |
| Hughston knee score 14 weeks |
OKC: Mean ± SD was 29 ± 13 |
CKC: Mean ± SD was 12 ± 13 |
MD −3.0 [−10.28, 4.28] Non-statistically significant difference |
24/25 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in Hughston knee score between OKC and CKC at 14 weeks of follow-up. |
| Unilateral horizontal hop 14 weeks |
OKC: Mean ± SD was 0.77 ± 0.17 |
CKC: Mean ± SD was 0.74 ± 0.15 |
MD 0.03 [−0.09, 0.15] Non-statistically significant difference |
14/15 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in unilateral horizontal hop between OKC and CKC at 14 weeks of follow-up. |
| Unilateral vertical hop 14 weeks |
OKC: Mean ± SD was 0.75 ± 0.15 |
CKC: Mean ± SD was 0.78 ± 0.11 |
MD −0.03 [−0.12, 0.06] Non-statistically significant difference |
15/15 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in unilateral vertical hop between OKC and CKC at 14 weeks of follow-up. |
| Triple cross-over hop 14 weeks |
OKC: Mean ± SD was 0.79 ± 0.15 |
CKC: Mean ± SD was 0.81 ± 0.26 |
MD −0.02 [−0.23, 0.19] Non-statistically significant difference |
9/8 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in unilateral triple cross-over hop between OKC and CKC at 14 weeks of follow-up. |
| Pain (VAS) 3 months |
OKC: Mean ± SD was 48.6 ± 11.4 |
CKC: Mean ± SD was 41.1 ± 12.9 |
MD 7.50 [1.24, 13.76] Statistically significant difference |
20/20 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a significant difference in pain in favor of CKC compared to OKC at 3 months. |
| Pain (VAS) 6 months |
OKC: Mean ± SD was 27.2 ± 9.9 |
CKC: Mean ± SD was 22.1 ± 10.5 |
MD 5.10 [−0.15, 10.35] Non-statistically significant difference |
28/30 (1) |
⊕◯◯◯ Very lowa |
Very low certainty evidence of a non-significant difference in pain between OKC and CKC at 14 weeks of follow-up. |
GRADE, Grading of Recommendations Assessment, Development and Evaluation; CKC, close kinetic chain; OKC, open kinetic chain; MD, mean difference; SD, standard deviation.
a
Downgraded due to risk of bias.
b
Downgraded due to inconsistency.
c
Downgraded due to indirectness.
d
Downgraded due to imprecision.