When Orthopedic Surgeon K. Donald Shelbourne, MD, began his practice in 1982, the mother of a 15-year-old girl whose ACL he had reconstructed asked him a question he couldn’t answer. “She wanted to know what was going to happen to her daughter’s knee in 20 years. I had no idea,” says Dr. Shelbourne.
To find out what would happen down the road, Dr. Shelbourne began to collect data on his patients. For 38 years now, he’s been using that data to continually improve outcomes for patients at Shelbourne Knee Center.
Learning What Works Best
The research program tracks patient outcomes and studies factors related to those outcomes to determine how to improve treatment for knee problems. It covers more than 13,000 patients. The main focus of the research program is:
- ACL reconstruction.
- Knee arthroscopy.
- Nonoperative treatment of knee osteoarthritis.
Shelbourne hired a research manager/medical writer back in 1984. Later, he hired two research coordinators to collect patient data. “By tracking our results, we ensure the best outcome with the fewest complications,” he says.
The first and most extensive line of research focuses on surgical ACL patients, who are followed for up to 30 years. Research follow-up starts two years post-op. Patients complete annual surveys and are asked to return to the clinic for objective evaluations (radiographs, physical examination and testing) at five, 10, 15, 20, 25, and 30 years. Knee arthroscopy patients are surveyed annually.
Nonoperative treatment of knee osteoarthritis is the most recent line of research, conducted by Dr. Shelbourne and Orthopedic Surgeon Rodney Benner, MD. Data currently cover range of motion evaluation and patient surveys from the initial evaluation through one year, with additional survey data at two years. Occasionally, the physicians conduct small studies with other patient populations.
“I want our outcomes to get better every year,” says Dr. Shelbourne.
Key Research-Based Improvements
Key improvements to knee treatment based on research conducted at Shelbourne Knee Center include:
- Pre-operative rehabilitation (pre-op rehab) and personal patient navigators.
- Prevention of post-op swelling and an accelerated ACL rehab protocol.
Pre-op rehab became part of the center’s system for optimizing surgical outcomes after Dr. Shelbourne’s research on ACL reconstruction patients revealed the importance of full range of motion (ROM) and returning the knee to a normal state (except for the ACL tear) before surgery in a good outcome (1). The pre-op protocol uses a step-wise process:
- ROM: Restore knee extension equal to the normal knee.
- ROM: Restore knee flexion equal to the normal knee.
- Strengthening for good leg control and everyday function.
Each patient works with the same physical therapist or athletic trainer from pre-op through post-op rehab.
Accelerated ACL Rehab Protocol
Post-op rehab changes after ACL surgery focus on eliminating problems with swelling by having patients lay down with the knee above the heart for the first five days instead of walking frequently (1,2).
Today, the accelerated post-op ACL rehab protocol includes:
- Full extension exercises beginning the day of surgery.
- Hospital stay for 23 hours.
- Weight-bearing allowed as tolerated for bathroom privileges.
- Emphasizing ROM exercises for flexion while maintaining full knee extension.
- Strengthening exercises beginning when full extension and flexion is achieved.
Most patients benefitted from this protocol:
- Consistent maintenance of objective stability.
- Less pain.
- Less struggle to increase and maintain ROM.
- Decreased rate of scar resections.
Sharing Research Results
Dr. Shelbourne and Dr. Benner share research results through international, national and regional presentations and articles in medical journals. Together, they’ve published more than 160 articles and more than 100 book chapters.
Learn more about Shelbourne Knee Center’s research results.
- North Am J Sports Phys Ther. 2009;4:2-12.
- Shelbourne KD, Gray T. Principles of Anterior Cruciate Ligament Rehabilitation. In Prodromos CC (ed), Anterior Cruciate Ligament: Reconstruction and Basic Science, 2nd edition, Elsevier, Philadelphia, PA, 2017, p444-450.