Review Article

Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Table 1

Characteristics of included studies.

Author(s)ParticipantsCountryInterventionWeeksFrequency (session/week)IntensitySession time (min)Surgical approachOutcomes

Bynum et al. 1995 [8]97 patients randomized to OKC () and CKC ().USPatients in the CKC group performed a mixture of resistance exercises including knee bends, seated leg press, stationary biking, and running. The OKC group performed a variety of exercises including leg raises, isotonic quadriceps with low weights, and treadmill jogging forwards and backwards.52Not providedNot providedNot providedArthroscopically assisted patellar tendon autograft and fixed with 9-mm interference screws.Adverse events, graft failure, Lysholm knee function scoring scale, modified Tegner activity rating scale, overall patient assessment rating, patellofemoral pain, extension deficit, and flexion deficit using a KT-1000 (20 lb and max)

Hooper et al. 2001 [18]37 patients randomized to OKC () and CKC ().UKPatients in the CKC group performed unilateral resistance training of the hip and knee extensors on a leg press machine; patients in the OKC group performed exercises using knee and hip extension machines or ankle weights.433 sets of 20 RM were done in each session for each training group. The training ROM for both hip and knee extensors in both groups was 90 to 0 degrees. Target speed settings were 1.5 s for the concentric phase and 3.0 s for the eccentric phase of training repetition, with a 1.0 s interval between phases.Either arthroscopically assisted patellar tendon autograft or the technique described by Kennedy et al. (1980) using a fixed patellar tendon allograph.Graft failure, Hughston clinic visual analog scale, knee flexion at heel-strike, peak extensor moment, extensor impulse, peak concentric power, and concentric energy.

Kang et al. 2012 [12]36 patients were randomized to OKC () and CKC ().KoreaStationary cycling for 5 minutes for warm-up and cool-down. OKC exercises were composed of straight leg raise, leg extension, and leg curl; CKC exercised were composed of squat, leg press, and lunge.12370% intensity of 1 repetition maximum (RM).30 minutesNot provided.Extensor isokinetic strength, flexor isokinetic strength, extensor isokinetic endurance, flexor isokinetic endurance, and squat.

Morrissey et al. 2000 [11]36 patients were randomized to OKC () and CKC ()UKPatients in the CKC group performed unilateral resistance training of the hip and knee extensors on a leg press machine; patients in the OKC group performed exercises using knee and hip extension machines or ankle weights.433 sets of 20 RM were done in each session for each training group. The training ROM for both hip and knee extensors in both groups was 90 to 0 degrees. Target speed settings were 1.5 s for the concentric phase and 3.0 s for the eccentric phase of training repetition, with a 1.0 s interval between phases.Not providedEither arthroscopically assisted patellar tendon autograft or the technique described by Kennedy et al. (1980) using a fixed patellar tendon allograph.ADT

Morrissey et al. 2002 [15]43 patients were randomized to OKC () and CKC ().UKPatients in the CKC group performed unilateral resistance training of the hip and knee extensors on a leg press machine; patients in the OKC group performed exercises using knee and hip extension machines or ankle weights.433 sets of 20 RM (rep max) were done in each session for each training group. The training ROM for both hip and knee extensors in both groups was 90 to 0 degrees. Target speed settings were 1.5 s for the concentric phase and 3.0 s for the eccentric phase of training repetition, with a 1.0 s interval between phases.Not providedEither arthroscopically assisted patellar tendon autograft or the technique described by Kennedy et al. (1980) using a fixed patellar tendon allograph.Total cycling time, number of treatment sessions where patient was treated for pain/swelling, hypomobility, or poor balance/position sense, frequency for pain site location, Hughston clinic questionnaire (items 1, 2, and 25), knee extensor isometric peak torque, and knee pain during knee extensor isometric maximum peak torque.

Perry et al. 2005 [13]49 patients randomized to CKC () and OKC ().UKPatients in the CKC group performed unilateral resistance training of the hip and knee extensors on a leg press machine; patients in the OKC group performed exercises using knee and hip extension machines or ankle weights.6320 RMNot providedEither arthroscopically assisted patellar tendon autograft or the technique described by Kennedy et al. (1980) using a fixed patellar tendon allograph.Hughston clinic questionnaire, training parameters, ATD, horizontal jump, vertical jump, and crossover jump.

Ucar et al. 2014 [10]66 patients were randomized to CKC () and OKC ().TurkeyPatients in the CKC group performed squatting lunges, standing weight shift, wall sits, one-legged quad dips, and lateral step-ups; patients in the OKC group performed isometric quadriceps, flexor-extensor bench, isotonic quadriceps, long leg press on-off, and knee flexion-extension stretching exercises.Not providedNot providedNot providedNot providedArthroscopically assisted hamstring autograft.Subjective pain visual analog scale, thigh circumference, knee flexion, and Lysholm score.