Exercício resistido unilateral versus bilateral na fisioterapia pós-operatória do LCA contralateral: ensaio clínico randomizado

• Ano de defesa: 2019
• Autor(a) principal: Oliveira, Marcio de Paula e [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Anterior Cruciate Ligament; Resistance Training; Injuries to Athletes; Knee Injuries.; Ligamento Cruzado Anterior; Treinamento de Resistência; Traumatismos em Atletas; Traumatismos do Joelho.
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=8185649; https://repositorio.unifesp.br/handle/11600/59068

Objective: This study aimed to verify if the use of unilateral isotonic resistance exercise is more effective than the bilateral form to obtain the highest level of muscular performance symmetry between the donor limb (DL) and ACL reconstructed limb (ACL-L) in the postoperative phase of the contralateral ACL rehabilitation. Methods: A randomized blinded trial was conducted with 88 patients divided into Control Group (N = 44) and Intervention Group (N = 44). It was included male and female practitioners of recreational sports whom were at the end of the third month of post-operative treatment. The intervention was done by submitting the groups to an eight week program of resistance training. The Control Group (CG) was maintained according to the conventional methodology, performing bilateral exercises. For the Intervention Group (IG), an alternative approach was adopted, with unilateral exercises for the DL - representing the segment with the greatest disability. Previously and at the end of the intervention period all participants were evaluated for the presence for the presence of inflammatory signs, range of motion (ROM), objective joint stability (KT-1000TM), muscle performance (peak torque and H/Q ratio at 60°/s on the isokinetic dynamometer), objective (Single Leg Hop Test - SLHT and Y Balance Test - Y Test) and subjective (Lysholm Questionnaire - LQ and Activities of Daily Living Scale - ADLS) functionality. Results: The results showed that both research groups evolved significantly with the intervention, except for Visual and Analog Pain Scale, ROM of hyperextension and flexion, joint line perimeter at the ACL-L, KT-1000TM, and H/Q ratio in ACL-L. Among the categorical variables, the CG maintained the largest number of patients with hypotrophy in the DL (87.8%), and in the IG there was a significant reduction in the number of cases, from 61.4% in the pre-intervention period to 13.6% in the post-intervention period (p <0.001). Regarding symmetry between the limbs, the only criteria that did not present significant differences between the groups was the perimeter at the joint line level. Regarding the differences found, it was possible to observe that there was an increase in IG symmetry in relation to the CG for all variables and, except for the H/Q ratio, the effect size was large (> 0.80). The final analysis of the sample showed that the IG was in release conditions for all variables, while in the CG were found changes in the perimeter parameters at 10, 20 and 30cm above the joint line, H/Q ratio and peak torque, demonstrating the presence of significant asymmetry between the DL donor and ACL-L. Conclusion: The use of unilateral isotonic resistance exercise is more effective than the bilateral form to obtain the highest level of symmetry of muscle performance between the donor and ACL reconstructed limb in the postoperative phase of the contralateral ACL rehabilitation.