CLINICAL OUTCOMES (CASE STUDY)
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
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
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
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
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
CASE STUDY #2
Ortopedic breakthrough spurs clinical study on ACL rupture repair
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.