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rehabilitation after hamstring principle (reconstructive surgery of the anterior cruciate ligament by the technical TLS)

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rehabilitation after hamstring principle (reconstructive surgery of the anterior cruciate ligament by the technical TLS)

Dr Thierry DE POLIGNAC


* Rehabilitation is recommended preoperatively in order to recover a little knee or non-painful range of motion and with a satisfactory muscle control.

* Surgical treatment of partial or total rupture (new or old) Anterior Cruciate Ligament is based on the realization of a single or dual beam ligament arthroscopically using the technique using the (s) tendon (s) of domestic law and / or the semitendinosus (hamstring or DT4)
* Compliance with this protocol (rehabilitation and recovery instructions to schedule physical activities and sports) is fundamental in order not to defeat the operation performed. Failure to comply may damage the ligamentisation (ligamentisation = progressive and physiological transformation tendon transplanted to a ligament structure).

* This protocol will be customized and modified according to the surgical technique, possible associated injuries (ligaments, meniscus, cartilage) (see report operative) and changes after surgery.

* For your physical therapist this protocol is indicative and through its expertise in rehabilitation knee ligament he will fit your knee for optimal rehabilitation.

POST-OPERATIVE REHABILITATION IMMEDIATE from D0 to D3



Relieve pain, limit the inflammatory reaction, fight against trophic disorders (edema, hematoma)

- Drugs: analgesics, anti-inflammatory, anti-coagulants
- Prevention of thromboembolic disorders (phlebitis)
- Scar care
- ice cream
- Stockings 2 to 3 weeks
- Sloping postures
- Analgesic electrotherapy


Avoid installing adhesions

- Joint running by active-assisted gentle mobilization
- Mobilization of the patella


Sunrise stunning the quadriceps

- Electrotherapy in order to promote muscle toning, muscle vasculature and its relaxation
- Static contraction working the quadriceps contraction and flash


weight bearing, splint and autonomy

- Splint or not depending on the surgical techniques (see report operative)
- Walking with full support by pain
- If necessary under cover of two crutches pending active locking of the knee
- Movements in torsion or rotation are against-indicated
- The up and down stairs should be made step by step



REHABILITATION J4 to J21



On leaving the clinic two possibilities:



Rehabilitation in Rehabilitation Specialist

-Stay 2 to 4 weeks
-2 Physiotherapy sessions a day
significant technical -plateau whose spa ... (Available all day)
-follow by a physiatrist for the detection and treatment of complications



or




Cabinet rehabilitation in Physiotherapy
(3 to 5 sessions per week /- home early)

This phase is crucial. Proper care of patients in the early postoperative intervention allows to consider following the rehabilitation auspiciously for optimal recovery (joint mobility, muscle quality, proprioceptive control) with the ultimate aim of a resumption of physical and sports activities safely.

This physical therapy protocol should not be standardized but customized through the rehabilitation expertise of ligament knee physiotherapist.

Fight against trophic disorders

- Manual lymphatic drainage
- pressure therapy
- Stockings 2 to 3 weeks
- ice cream


Recovery of range of motion (0 ┬░ -100 ┬░)

- Mobilization of the patella transversely and longitudinally
- Massage dead ends (sub-quadriceps and side-to-condylar)
- Manual passive mobilization by short shots
- Active-assisted mobilization


Wake and muscle toning

quadriceps
- electrotherapy
- Flash contraction
- Up to knee extended leg (NOT WEIGHT)
- The dynamic work of the quadriceps against resistance is forbidden =
MOTION NO KNEE BENDING OF THE EXTENSION WITH WEIGHT

No work the hamstrings

Relearn walking

- Phasing out of the splint and crutches to recover physiological march J21
- The up and down stairs should be made step by step


Propriocpetif work (balance)

- Very progressive within a specific protocol
- By starting in closed kinetic chain in the sagittal plane in bipodal support


Whirlpools
The spa is not mandatory but can be a useful adjuvant


REHABILITATION of J21 to J100



Caution: during this phase "your new ligament is fragile" and may be distended in case of technologically unsuitable work.


Recovery of range of motion
- Achieve full extension (0 ┬░) or without flexum recurvatum
- Until J45: 0-120 ┬░
- Until then J100: 0-130 ┬░


muscle recovery and proprioceptive
- Suitable for transplant used for ligament reconstruction
- Metered and progressive with a suitable equipment and guided by the physiotherapist


authorized physical activities
- Driving from J21
- Up and down the stairs step by step from D0 then free after locking active quadriceps

- Walking on flat and stable ground (avoid slopes)
- Bike (reeling in) apartment and / or on road or track without elevation
- Swimming: crawl and back-crawl and without fins (not stirred)

The only authorized exercises are those that you were taught by your physiotherapist.

Do not use: trampoline, unstable platform (Freeman)





On athl├ętisation STAGE J100 to J115


For sports professionals and top athletes and a competitor athl├ętisation line with intensification of rehabilitation over 2 weeks may be proposed in a Rehabilitation Specialist with muscle work, proprioception and cardiopulmonary adapted to their level of recovery .



REHABILITATION of J100 D 6MOIS


Recovery of range of motion
- Recovery of the last degrees of flexion
- No search hyper-extension (hyperextension)

Recovery of muscle building
- Strength, endurance and velocity of all muscle groups (thigh, calf)
by exercises increasingly dynamic and different planes of space
- Also perform stretching

Intensification of proprioception

Training cardiorespiratory functions

gradually allowed sports
- Normal down stairs
- Swimming (all strokes)
- Skipping on both feet
- Walking on uneven ground stabilized with light
- Running on flat ground and stabilized
- Bicycle with slight elevation

From D 5 months
- Previous activities with biggest drop, over rough terrain and pace of change
- Basic footwork preferential sport under strict supervision of the physiotherapist




REHABILITATION after the 6th MONTH


Re-education
At 6 months postoperatively, a balance can be achieved by Specialized Rehabilitation Center to evaluate the full capabilities of the knee and possibly propose a rehabilitation program to correct past deficits


Calendar of sporting occasions
- From the 6th month, complete and progressive sport resumption of sports "pivot" (skiing, tennis ...) and sports "hub-contact" (football, basketball, handball, rugby, martial arts ...)
- 6 to 8 weeks of training seem necessary before considering the resumption of the competition

Doctor Nicolas LEFEVRE. - 25 avril 2012.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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