Table II.
Summary of the 18 randomized controlled trials included.
| Study/country | First day of intervention | Period | Follow-up | Groups n = (women%) | Withdraw | Description of exercise/therapy | Outcomes |
|---|---|---|---|---|---|---|---|
| Bade et al. 2017 USA (26) | Day 4 | 11 w | 12 M | EXP1 (HI) = 84 n = 45, p = 54% EXP2 (LI) = 87 n = 52, p = 66% |
EXP1 = 0 EXP2 = 0 | Both groups: Patients were seen 3/w for the first 6/w and 2/w over the next 5 w. (26 sessions). (45 min each session) Both had education on healing. Hi group: high-intensity, progression-based, rehabilitation programme-based. PRE targeting. Weight-bearing, functional, balance, agility, and activity exercise (2 sets- 8 rep). 30 min walking 5/w. swimming, cycling, elliptical machine, stair climber. LI group: time-based rehabilitation programme. 1) iso and ROM ex for the first 4/w. 2) slower transition to w-b ex. 3) less progression in difficulty of w-b ex 4) no resistance beyond body weight or elastic bands 5) restricted activity outside of ADLs for the first 4/w gradually building to 30 min by the end of therapy (restricted to walking and low-resistance cycling) |
Stair-climbing test, TUG, 6MWT, ROM, MCS, SF-12, muscle strength, WOMAC |
| Beaupre et al. 2001 Canada (14) | Day 3 | 7 d | 6 M | EXP=40 n = 20, p = 50% CON = 40 n = 13, p = 30% | EXP = 9 CON = 11 | EXP1: standard rehabilitation (ROM ex + strength ex + functional ex) + CPM CON: Standard rehabilitation + SB |
Walking, A/ROM Ex, isometric knee extension, stair-climbing. |
| Bruun-Olsen et al. 2009 Norway (18) | Day 1 after Op | 6 d | 3 M | EXP= 30 n = 22, p = 73% CON = 33 n = 22, p = 67% |
EXP = 5 CON = 2 | EXP: CPM + active Ex: flexion/ extension exercises, active isometric contraction of the quadriceps, walking, climbing stairs (crutches), passive movement. CON: same programme without CPM |
ROM, pain, function, balance, walking |
| Demircioglu et al. 2015 Turkey (27) |
Day 1 | 6 w | 3 M | EXP=30 n = 28, p = 93% CON = 30 n = 29, p = 96% | EXP = 0 CON = 0 | Both groups started 30 min (ROM)-(CPM)/w, ankle ROM ex, isometric quadriceps ex, stand up with a walker and fully extend their knees and active and assisted ROM ex, Active ROM and isometric quadriceps exercise, mobilization, active hip abduction and adduction ex. A home ex programme was recommended. Closed kinetic chain ex, 15 min cryotherapy. EXP: 1st/D after surgery 30-min NMES on VM 5/D week, for 4-6 weeks* | Knee extension, flexion, pain, stiffness, function, TUG, SF-36. |
| Denis et al. 2006 Canada (15) | Day 2 after Op | 7-8 d | 2 years | EXP=28 n = 14, p = 51.9% CON = 27 n = 13, p= 46.4% |
EXP = 1 CON = 0 | EXP: CPM group 1 (35 min) + conventional CON: Group 2 (2h): respiratory and circulatory Ex, strength extension EX and extension knee alignment, A/P knee flexion, abduction and add of the hip in the horizontal plane, and knee extensor muscle Ex, functional Ex |
ROM (flexion-extension), TUG, WOMAC, length of stay |
| Ebert et al. 2013 Australia (24) | Day 2 after Op | 6 w | 6 w | EXP= 24 n = 7, p= 29% CON = 26 n = 7, p= 27% |
EXP = 0 CON = 0 | EXP: Lymphatic drainage+ conventional therapy CON: conventional therapy active- assisted knee flexion + (active knee flexion + hip and knee flexion + functional Ex + CPM + Cryotherapy | Active knee flexion and extension range of motion, lower limb girths (ankle, mid-patella, thigh, and calf), and pain |
| Hardt et al. 2018 Germany (23) | Day 1 | 7 d | 7±1 d | EXP =22 n = 3, p = 12.5% CON = 25 n = 4, p = 15.6% | EXP = 11 CON = 2 | EXP: Genusport knee trainer extra. CON: active and passive knee mobilization, gait training, assisted walking with crutches, strength exercises, stair-climbing, manual lymphatic drainage, and cryotherapy 3 times daily with ice packs. | Active and passive range of motion (ROM), pain, knee extension strength, TUG, 10-m Walk Test, 30-s Chair Stand Test, (KOOS), (KSS), |
| Jakobsen et al. 2014 Denmark (28) | 1 w after Op | 6 w | 26 w | EXP =35 n = 21, p=60% CON = 37 n = 16, p=57% |
EXP = 5 CON = 2 | EXP: warming up + knee ROM Ex + knee extensor stretches and 1-legged balance Ex + strength training + functional training + balance training (the programme was applied earlier) CON: Same programme |
Walking, ROM (flexion, extension), pain, 6MWt, KOOS, Qof, activity of daily living, Oxford knee score. |
| Labraca et al. 2011 Spain (19) | Within the first 24 | 4 d | 4 d | EXP = 153 n = 101, p = 73.1% CON =153 n=110, p = 81.4% |
EXP =15 CON = 18 | EXP: P/A ROM + Strength Exflexion/extension + breathing + Functional EX (the programme was applied earlier) CON: same programme |
ROM, muscle strength, pain, autonomy, gait, and balance |
| Lastayo et al. 2009 USA (29) | 1 - 4 years after Op | 12 w | 3 M | EXP = 9 n= 7, p = 77.7% CON =8 n = 6 p = 75% | EXP =0 CON = 0 | EXP: Strength Ex + ROM+ NMES+ Walk+ setups + wall squat (Eccentric (ECC) resistance Exmachine/additional) CON: same programme without ECC training |
Quadriceps volume, extension strength, TUG, 6MWT, stairs (ascending, descending) |
| Lenssen et al. 2006 Netherlands (20) | Day 1 | 4 d | 3 M | EXP = 21 n = 15, p = 71.4% CON = 22 n = 17, p = 77.2% |
EXP =0 CON = 0 | EXP: A/P mobilization of the knee joint + active strengthening (quadriceps) + ADL functions treatment session (30 min), mean total of treatment sessions EXP- CPM more than the CON group CON: same programme | Passive flexion ROM, active ROM and passive extension ROM, functional status, length of stay, pain, satisfaction with treatment |
| Lenssen et al. 2008 Netherlands (21) | Day 1 after Op | 17 d | 3 M | EXP= 30 n = 18, p = 60% CON = 30 n = 21, p = 70% |
EXP = 0 CON = 0 | EXP: active and passive mobilization of the knee + strengthening of the quadriceps muscle + functional exercises + transfers from a supine position to sitting and from sitting to standing + walking and stair climbing CON: same programme |
Functional status, ROM, perceived effect, postoperative medication, satisfaction with treatment, quantity, duration, and nature of PT intervention |
| Liao et al. 2013 Taiwan (30) | At least 2 months after Op | 8 w | 8 w | EXP= 58 n = 46, p = 79.3% CON = 55 n = 37, p = 67.2% |
EXP = CON = | EXP: Exercises for strength + walking + endurance + 30 min function + 60 min balance CON: same programme without balance EX | Walking, balance, functional walking, pain, stiffness, function |
| Mau-Moeller et al. 2014 Germany (22) | Day 1 after Op | 3 w | 3 M | EXP1 (Sling) = 19 n = 7, p = 36.8% EXP2 CPM = 19 n=9, p = 47.3% |
EXP1 = 7 EXP2 = 10 | EXP1: Standard care + sling training (ST) EXP2: Standard care = A/P ROM Ex + Strength (quadriceps) + ADL Ex + walking + climbing stairs. Ex for pain and tolerance |
ROM, pain, physical activity, static posture control, function, QoL |
| Piva et al. 2017 USA (31) | After discharge | 3 d | 6 M | EXP=22 n = 18, p= 82% CON = 22 n = 13, p= 59% |
EXP = 0 CON = 0 | EXP: Warm up-5 min. Endurance- 20 min treadmill walking 50-75% intensity. Resistance ex (knee extensor, flex, hip extension, abduction) 60-80%. ((2 steps - 8 rep). Skilled ex 15 min. Education sessions. CON: Warm up - 15 min (bike). Endurance - 20 min (treadmill walking). Resistance ex - 40-50%. Both had home Ex |
Pain, function, stair- climbing, chair-standing, single-leg stance, 6MWT, gait speed, daily activity |
| Rahmann et al. 2009 Australia (16) | Day 4 | 14 d | 12 M | EXP= 18 n = 8 p= 44.4% CON = 17 n = 12, p= 70.5% |
EXP = 10 CON = 3 | EXP: Water programme: Hip adduction/abduction, squats, heel raises walk, lunges, stability Ex, hip extension, knee: walking, lunges, ROM CON: same programme without aquatic Ex |
Hip abductor strength, walking speed, self-reported disability (WOMAC), ROM, quadriceps + hamstring strength, function |
| Schache et al. 2019 Australia (32) | 2 w after Op | 6 w | 26 w | EXP =54 n = 39, p = 72% CON = 51 n = 30, p = 58% | EXP = 6 CON = 3 | EXP: Extra exercises targeting the strengthening of the hip abductor muscles CON: All participants received exercises to improve quadriceps, hamstring, and calf strength, increasing knee range of movement and improving walking and stair- climbing ability. These exercises have been described in detail previously.17 Manual therapy, including joint mobilization and massage, |
Pain, knee extension- flexion, hip strength, quadriceps strength, chair- stand test, stair-climbing test, 40 m fast-paced walk, TUG, step taps, 6MWT. |
| Steven-Lapsley et al. 2012 USA (25) |
Day 2 after Op | 6 w | 52 w | EXP =35 n = 20, p=57.1% CON = 31 n = 16, p=51.6% |
EXP = 5 CON = 6 | EXP: Exercises + NMES+ P/A ROM Ex + Functional Ex + ROM Ex + strengthening W/B non-W/B + walking CON: Passive (ROM) + cycling + flexibility + walking + functional training + strength |
Iso-quadriceps and hamstring torque and activation testing, NMES dose assessment, function, pain, ROM, health status questionnaires. |
D-day, W-week, M-month, EXP-experimental, CON-control, ROM-range of motion, A/P ROM-active/passive range of motion, TUG-time up and go test, 6MWT-6 minutes walking test, MCS-Mental Component Score, SF-12-Short Form Survey, ADL-activity of daily living, CPM-Continuous Passive Motion, SB-Slide Board, EX-exercise, NMES-Neuromuscular Electrical Stimulation, VM-Vastus medialis, KOOS-Knee Injury and Osteoarthritis Outcome Score, KSS-Knee Society Score, Qof-Quality of life, ECC-Eccentric, PT-Physiotherapy, OP-Operation, ST-Sling training, non-W/B non-weight bearing.