Latihan Penguatan untuk Meningkatkan Kemampuan Fungsional Lutut pada Pasien Anterior Cruciate Ligament Reconstruction Pascaoperasi: Studi Kasus

Novi Anggraini; Taufik Eko Susilo; Sigit Saputro

doi:10.17977/um062v7i32025p130-141

Authors

Novi Anggraini Universitas Muhammadiyah Surakarta
Taufik Eko Susilo Universitas Muhammadiyah Surakarta
Sigit Saputro Klinik Ibest Solo

DOI:

https://doi.org/10.17977/um062v7i32025p130-141

Keywords:

anterior cruciate ligament reconstruction, strengthening exercises, functional ability, latihan penguatan, kemampuan fungsional

Abstract

Abstract: This study aims to evaluate the effectiveness of strengthening exercises in improving the functional capacity of patients following Anterior Cruciate Ligament Reconstruction (ACLR) surgery. The research method used is a case study, where patients are assessed for pain, joint range of motion, and functional ability, and then provided with a physiotherapy program focusing on strengthening. The results show significant improvement after six physiotherapy sessions, with pain reduction (score 4 to 2), increased knee range of motion (110 degrees to 138 degrees), and an improvement in LEFS scores (40 to 53), indicating a shift from moderate to mild functional limitation. The improvement in LEFS scores is evident in activities such as work, wearing shoes, squatting, lifting objects, and stair climbing. However, limitations remain in activities such as running, jumping, and sharp movements. In conclusion, strengthening exercises are effective in reducing pain, improving range of motion, and enhancing functional ability in patients following ACLR surgery. However, further rehabilitation is necessary for full recovery. The use of evidence-based guidelines such as the Melbourne ACL Rehabilitation Guide 2.0 is recommended for structured and effective rehabilitation.

Abstrak: Penelitian ini bertujuan untuk mengevaluasi efektivitas latihan penguatan dalam meningkatkan kemampuan fungsional pasien pascaoperasi Anterior Cruciate Ligament Reconstruction (ACLR). Metode penelitian menggunakan studi kasus, di mana pasien diperiksa untuk nyeri, lingkup gerak sendi, dan kemampuan fungsional, kemudian diberikan program latihan fisioterapi yang fokus pada penguatan. Hasil penelitian menunjukkan perbaikan signifikan setelah enam sesi fisioterapi, dengan penurunan nyeri (skor 4 menjadi 2), peningkatan rentang gerak lutut (110° menjadi 138°), dan peningkatan skor LEFS (40 menjadi 53), yang menunjukkan peningkatan dari keterbatasan fungsional sedang menjadi ringan. Peningkatan skor LEFS terlihat pada aktivitas seperti pekerjaan, memakai sepatu, jongkok, mengangkat benda, dan naik turun tangga. Namun, masih ada keterbatasan pada aktivitas berlari, melompat, dan gerakan tajam. Kesimpulannya, latihan penguatan efektif dalam mengurangi nyeri, meningkatkan rentang gerak, dan kemampuan fungsional pasien pascaoperasi ACLR, namun rehabilitasi lanjutan diperlukan untuk pemulihan penuh. Penggunaan pedoman berbasis bukti seperti Melbourne ACL Rehabilitation Guide 2.0 direkomendasikan untuk rehabilitasi yang terstruktur dan efektif.

References

Amin, A. A., Amanati, S., & Novalanda, W. (2018). Pengaruh Terapi Latihan, Transcutaneous Electrical Nerve Stimulation Dan Kinesiology Taping Pada Post Rekonstruksi Anterior Cruciatum Ligamen. Jurnal Fisioterapi Dan Rehabilitasi, 2(2), 115–124. https://doi.org/10.33660/jfrwhs.v2i2.39

Bieler, T., Aue Sobol, N., Andersen, L. L., Kiel, P., Løfholm, P., Aagaard, P., Magnusson, S. P., Krogsgaard, M. R., & Beyer, N. (2014). The effects of high-intensity versus low-intensity resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. BioMed Research International, 2014. https://doi.org/10.1155/2014/278512

Buckthorpe, M., Danelon, F., La Rosa, G., Nanni, G., Stride, M., & Della Villa, F. (2021). Recommendations for Hamstring Function Recovery After ACL Reconstruction. Sports Medicine, 51(4), 607–624. https://doi.org/10.1007/s40279-020-01400-x

Buckthorpe, M., Gokeler, A., Herrington, L., Hughes, M., Grassi, A., Wadey, R., Patterson, S., Compagnin, A., La Rosa, G., & Della Villa, F. (2024). Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Medicine, 54(1), 49–72. https://doi.org/10.1007/s40279-023-01934-w

Carter, H. M., Webster, K. E., & Smith, B. E. (2021). Current preoperative physiotherapy management strategies for patients awaiting Anterior Cruciate Ligament Reconstruction (ACLR): A worldwide survey of physiotherapy practice. Knee, 28, 300–310. https://doi.org/10.1016/j.knee.2020.12.018

Cooper, R. (2018). ACL Rehabilitation Guide. Thermoskin, 28. https://www.fitasaphysio.com/uploads/4/3/3/4/43345381/randall_cooper_acl_rehabilitation_guide.pdf

Dhuhairi, M. S., Israwan, W., Zakaria, A., & Hargiani, F. X. (2021). Pengaruh Pemberian Cryotherapy terhadap Penurunan Nyeri pada Pasien Post-op ACL di Rumah Sakit Al-Irsyad Surabaya Mukhammad. TRIK: Tunas-Tunas Riset Kesehatan, 11(November), 219–222. https://doi.org/DOI: http://dx.doi.org/10.33846/2trik11406

Djawas, F. A. (2022). Efektivitas Terapi Latihan terhadap Kemampuan Fungsional Post Rekonstruksi ACL Grade 2. Jurnal Fisioterapi Terapan Indonesia, 1(1). https://doi.org/10.7454/jfti.v1i1.1027

Fonseca, R. M., Roschel, H., Tricoli, V., De Souza, E. O., Wilson, J. M., Laurentino, G. C., Aihara, A. Y., De Souzaleão, A. R., & Ugrinowitsch, C. (2014). Changes in exercises are more effective than in loading schemes to improve muscle strength. Journal of Strength and Conditioning Research, 28(11), 3085–3092. https://doi.org/10.1519/JSC.0000000000000539

Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., & Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: An overview of Cochrane reviews. Cochrane Database of Systematic Reviews, 2014(8). https://doi.org/10.1002/14651858.CD011279

Gusma, K. C. (2022). Survei Penyebab Terjadinya Cedera Anterior Cruciate Ligament (Acl) Pada Komunitas Acl Indonesia Cabang Jateng Diy. Unnes Journal of Sport Sciences, 6(2), 104–117. https://doi.org/10.15294/ujoss.v6i2.54852

Hayati, N., Rahayu, U. B., & Mardianto, H. (2024). Exercise For Rehabilitation After ACL Recontruction To Improve Neuromuscular & Strenght And Return To Sport. 2(1).

Ichsan, A. N. (2024). Manajemen Fisioterapi Pada Pasien Yang Terkena Cedera ACL Pasca Operasi : Literatur Review. 1(6), 374–383.

Irianto, I., Wahab, B., Ainun, N., Sirenden, A. F., & Nuskin, G. S. (2023). Physiotherapy Management in Postoperative Anterior Cruciate Ligament. Jurnal Ilmiah Kesehatan Sandi Husada, 12(1), 247–254. https://doi.org/10.35816/jiskh.v12i1.1035

Kaya, D., Guney-Deniz, H., Sayaca, C., Calik, M., & Doral, M. N. (2019). Effects on Lower Extremity Neuromuscular Control Exercises on Knee Proprioception, Muscle Strength, and Functional Level in Patients with ACL Reconstruction. BioMed Research International, 2019. https://doi.org/10.1155/2019/1694695

Kyritsis P, W. E. (2014). Return to Sport after Anterior Cruciate Ligament Reconstruction: A Literature Review. Journal of Novel Physiotherapies, 04(01), 1–6. https://doi.org/10.4172/2165-7025.1000193

Maralisa, A. D., & Lesmana, S. I. (2020). Penatalaksanaan Fisioterapi Rekonstruksi ACL Knee Dextra Hamstring. Indonesian Journal of Physiotherapy Research and Education, 1(1), 4–17.

Mehta, S. P., Fulton, A., Quach, C., Thistle, M., Toledo, C., & Evans, N. A. (2016). Measurement Properties of the Lower Extremity Functional Scale: A Systematic Review. Journal of Orthopaedic and Sports Physical Therapy, 46(3), 200–216. https://doi.org/10.2519/jospt.2016.6165

Mohd Yunus, M. A., Musa, R., & Nazri, M. Y. (2017). Construct and criterion validity of the Malaysia version of Lower Extremity Functional Scale (LEFS). Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 10, 8–11. https://doi.org/10.1016/j.asmart.2017.09.002

Mustari, Y., Kaharuddin, G. A., Febrianty, R. E., Chaerunnisa, C., & Nuraeni, N. (2024). Physiotherapy management of functional activity disorders of knee dekstra et cause post-op anterior cruciate ligament reconstruction. Jurnal Ilmiah Kesehatan Sandi Husada, 13(1), 76–83. https://doi.org/10.35816/jiskh.v13i1.1176

Narici, M., Vito, G. De, Franchi, M., Paoli, A., Moro, T., Marcolin, G., Grassi, B., Baldassarre, G., Zuccarelli, L., Biolo, G., di Girolamo, F. G., Fiotti, N., Dela, F., Greenhaff, P., & Maganaris, C. (2021). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science, 21(4), 614–635. https://doi.org/10.1080/17461391.2020.1761076

Nuccio, S., Del Vecchio, A., Casolo, A., Labanca, L., Rocchi, J. E., Felici, F., Macaluso, A., Mariani, P. P., Falla, D., Farina, D., & Sbriccoli, P. (2021). Deficit in knee extension strength following anterior cruciate ligament reconstruction is explained by a reduced neural drive to the vasti muscles. Journal of Physiology, 599(22), 5103–5120. https://doi.org/10.1113/JP282014

Rahayu, K. (2020). Profil pasien ruptur ligamentum krusiatum anterior yang dilakukan tindakan operasi di rsup sanglah tahun 2018 – 2019 1. 9(5).

Reza, R. P. K., & Tiara, T. F. (2022). Pengaruh Cryotherapy, Ultrasound dan Strengthening Exercise pada Post Rekonstruksi Anterior Cruciate Ligament Fase I: A Case Report. COMSERVA Indonesian Jurnal of Community Services and Development, 2(3), 217–225. https://doi.org/10.59141/comserva.v2i3.243

Seehafer, L., Morrison, S., Severin, R., & Ness, B. M. (2022). A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Cardiopulmonary System. International Journal of Sports Physical Therapy, 17(1), 60–73. https://doi.org/10.26603/001c.29451

Thomas, A. C., Wojtys, E. M., Brandon, C., & Palmieri-Smith, R. M. (2016). Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction. Journal of Science and Medicine in Sport, 19(1), 7–11. https://doi.org/10.1016/j.jsams.2014.12.009

Yuliana, E., & Kushartanti, D. W. (2020). Fungsional lutut dan kesiapan psikologis pasca cedera ACL penanganan operatif dan non-operatif Knee functional and psychological readiness of post ACL injury in operative and non-operative treatment. Jurnal Penelitian Pembelajaran, 6(3), 561–574. https://doi.org/10.29407/js_unpgri.v6i3.14626