The patient was a 47-year-old woman who had been referred to a physical therapist following an anterior cruciate ligament reconstruction of the left knee, using a bone-patellar tendon-bone autograft. While temporary within-session knee extension range-of-motion gains were recorded following physical therapist interventions, there was a lack of sustained improvement. Magnetic resonance imaging revealed an intact anterior cruciate ligament graft and a moderate joint effusion, as well as an area of intra-articular arthrofibrosis anterior to the anterior cruciate ligament graft. The patient underwent arthroscopic surgery and, after debridement of the joint arthrofibrosis, was referred to the physical therapist. Following 2 months of treatment, the patient demonstrated full symmetrical knee range of motion, reported no pain, and had initiated a running program without difficulty.

J Orthop Sports Phys Ther 2011;41(1):32. doi:10.2519/jospt.2011.0401

KEY WORDS: ACL, magnetic resonance imaging

STUDY DESIGN: Case series. CASE DESCRIPTION: Five consecutive collegiate Division I wrestlers, with a mean age of 20.2 years (range, 18-22 years), were treated postsurgical stabilization to address posterior glenohumeral joint instability. All received physical therapy postoperatively, consisting of range-ofmotion, strengthening, and plyometrics exercises, neuromuscular re-education, and sport-specific training. Functional outcome scores using the Penn Shoulder Score questionnaire were recorded at postsurgical initial evaluation and discharge. Isometric shoulder strength, measured with a handheld dynamometer at discharge, was compared with measurements made during preseason screening. OUTCOMES: Postsurgery, upon initial physical therapy evaluation, scores on the Penn Shoulder Score questionnaire ranged from 37 to 74 out of 100. All 5 wrestlers improved with rehabilitation such that their scores at discharge ranged from 81 to 91 out of 100. Mean external rotation-internal rotation strength ratio for the involved shoulder was 73.5% (range, 55.9%-88.7%) preseason and 80.9% (range, 70.2%-104.1%) postrehabilitation. Four patients were able to return to wrestling over a period of 1 season, with no episodes of reinjury to their surgically repaired shoulder. DISCUSSION: Current research on posterior glenohumeral instability is limited, due to the relatively rare diagnosis and infrequent need for surgical intervention. Providing a structured physical therapy program following this surgical procedure appeared to have assisted in a return to full functional activities and sports. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2009;39(7):550-559, Epub 24 February 2009. doi:10.2519/jospt.2009.2952

KEY WORDS: dislocation, dynamic stability, glenohumeral, joint instability, strength