knee rehabilitation
after
anterior cruciate
ligament reconstruction using the patellar tendon secured with two
interference screws (Kenneth Jones)
(without meniscal repair)
(On the website we give indications of a general nature: in any
case it is necessary to follow " to the letter" the indications
of your orthopedic surgeon.)
(click here for a general knee rehabilitation chronological
protocol ...)
Mobility
(anterior cruciate ligament rehabilitation)
The knee should be mobilized immediately after intervention:
during the first 15 days, flexion should reach 110° to 120°,
achievable with gentle daily
exercises.
Complete flexion (the heel touches the buttock) generally
requires 90 days to be obtained. Extension is recovered
immediately post-operative, without any risk to the graft.
(biblio art.1). Hyper extension (physiological in a knee
recurvatum) should not be sought even if a recurvatum exists in
the controlateral side. Often the surgeon recommends a fixed
flexion protection (of 5°) during the first 45 days to avoid all
recurvatum.
Muscular reprise and musculation
(anterior cruciate ligament rehabilitation)
Return to a good muscular contraction (in particular of the
vastus medialis), is the first objective of post-operative care.
To
obtain this, we suggest:
·
electrostimulation: it facilitates the muscular
"awakening" "I mean : the muscle that is able again to contract
itself again after surgery"
·
the exercises are practised in a closed kinetic chain, and not
in an open kinetic chain. This means that it is better to carry
out the exercises by reinforcing the muscle with the
foot supported on the ground. Isometric contraction (contraction
without articular movement) is a useful complement. Work in an
open chain (contraction with articular movement) is appropriate
at the end of the rehabilitation program, when the patient is
almost ready to go back to sport. Isokinetics are not advised
during the first 4 months. Isokinetic exercises, however, are
very important in the muscular evaluation just before the return
to sport. (biblio art. 3 and 4).
Proprioceptive rehabilitation
Proprioception plays an important role after anterior cruciate
ligament graft. This
type of rehabilitation does not present risks to the graft. It
is essential for the prevention of iterative accidents. A study
carried out by the team of Prof. Cerulli (biblio art. 5) on 600
football players, of which 300 integrated proprioceptive work
during their training over a three year period, showed 10
anterior cruciate injuries in the "proprioception" group
compared with 70 in the players having had a traditional
training without proprioception.
Stretching
(anterior cruciate ligament rehabilitation)
Very important: stretching must be combined with muscle building
exercises.
Knee braces.
The authors advise the use of a post-operative rest splint fixed
at approximately 20° . It protects the transplant during the
first hours in particular after the intervention by avoiding any
accidental hyperextension. It will be discarded 10 -15 days
after intervention.
A brace, on the other hand, is not necessary: no study has shown
their total stabilizing effectiveness. Their only real advantage
is the comfort which they give to the patient. Certain patients
feel better with a flexible brace when returning to sports, but
it does not have any mechanical role. Certain authors recommend
that it facilitates a proprioceptive answer.(biblio
art. 6)
Crutches
The authors advise walking without crutches 20-30 days after
surgery. During the first few days, partial support is allowed.
