CLINICAL OUTCOMES  (CASE STUDY)



ARP Results:

Outcomes for ARP treatment have been based, thus far, on retrospective clinical observations. Randomized, double blinded, prospective studies have been initiated for the treatment of ankle sprains, hamstring injuries, and distal radius fractures. The hypotheses for these prospective studies is that ARP treatment will yield recovery rates 60% to 80% faster than for traditional conservative treatment.

The basis for these hypotheses is the large retrospective clinical data on ARP treatment over the past 5 years. In general, recovery rates for acute soft tissue injury have been 60% to 80% shorter than the predicted clinical outcome. Specific examples include grade II lateral ankle sprains, and grade II acute hamstring injury.

Athletes sustaining grade II lateral ankle sprains (partial ligament tear with moderate swelling and ecchymosis and limited weight bearing ability) treated with 6 to 10 ARP sessions, and no other conservative treatment except supportive bracing, had an average recovery rate and return to play at 3 to 5 days post injury. Athletes sustaining grade II hamstring injuries (1-2cm soft tissue defect with associated ecchymosis and inability to walk without limp) treated also with 6 to 10 ARP sessions, without other modalities, had an average recovery rate and return to play at 8 to 12 days post injury.

These accelerated recovery rates also extrapolated to the more severe grade III injuries, as well as chronic soft tissue tendinopathies. In many cases of chronic tendinopathy, all other conservative measures were exhausted, without relief of symptoms, before ARP treatment was initiated.

The ARP experience has produced a sense of astonishment among both the practitioner and the patient. Undoubtedly, prospective data will be required to corroborate these retrospective findings, but it is certainly clear that the rate of acceleration in healing has been dramatic.

 

CASE STUDY #1

 SUMMARY: ARP Protocols provide full recovery from complete ACL rupture and Grade 2 MCL sprain... in 6 weeks

 An 18-year old running back injured his right knee while making a cut to his left and struck on the lateral joint line with a valgus type stress.

Physical exam revealed a 3+ Lachman and 3+ pivot shift with 2+ valgus laxity in 30 degrees of flexion. His diagnosis was consistent with a complete ACL rupture and a grade 2 MCL sprain confirmed by MRI scan.

 

 He was placed in a knee immobilizer splint for two weeks. During that time he performed 100 quadriceps ISO pulses daily and was treated with ARP set at 500 pps and 20/20 duty cycle with electrodes placed over the quadriceps once every two days. The power was set to the highest tolerable level.


At two weeks post injury, the athlete performed extreme ISO holds in front lunge position with ARP quad placement at level 10 for 5 minutes on each leg. If the athlete was not able to complete the required time, he stopped and rested for one minute and resumed until the total work time equalled five minutes. He performed this two days on and one day off for three weeks.


He then performed sprinting exercises for the following week and was cleared to return to play six weeks post injury. His Lachman, pivot shift, and valgus stress test were all negative at that time. The athlete competed in the following five games without any giving way episodes or pain in the affected knee. In his first game back after injury, he rushed for 75 yards and two touchdowns and was awarded the team's game ball.


A repeat MRI scan was taken three months after the injury to document the status of the ACL.

  

 The ACL appeared reconstituted with complete loss of the posterior bow and intrasubstance gapping which had been present at the initial MRI.

The patient's clinical exam was also remarkable for a stable knee with continued negative Lachman, pivot shift, and valgus stress test. Because of the player's clinical result, surgery has not been required. 

 

CASE STUDY #2

 SUMMARY: Ortopedic breakthrough spurs clinical study on ACL rupture repair without surgery.

 A 40 year old active skier sustained complete ACL tear after skiing injury on 3/1/06. Physical exam revealed 3+ lachman test, and 3+ pivot shift. MRI revealed complete rupture of ACL. The patient was apprised of her diagnosis and because of her high activity level, wanted to proceed with ACL reconstruction. This was scheduled for 4/18/06. The patient wanted to do high intensity strengthening pre-op and thus she was placed on ARP strengthening for 10 sessions.

 

 The patient was seen for her pre-op appointment on 4/13/06 and on exam was noted to have full ROM from 0 to 155 degrees as well as negative lachman and pivot shift testing. Due to these unexpected findings, a repeat MRI was obtained which showed an intact ACL. Surgery has been cancelled and the patient continues to do ultra fit type strengthening exercises.

  

  

While we're waiting for this study to be organized, we are offering ARP treatments to patients with acute ACL tears while they are waiting for surgery. My partner just had a patient yesterday that he enrolled for 10 pre-op ARP treatments. We'll see how this goes.

 Again, my partners couldn't believe their eyes and really couldn't refute what they saw on these two separate cases. Because the evidence was so convincing they're very willing to recommend ARP pre-op to their ACL patients to see what happens. This will just be anecdotal evidence and we'll have to do a formal prospective study but at least we'll be collecting some data while we're waiting for all the approvals.