ambulatory rehabilitation after anterior crossed ligament
, Despina Beer2
of Craiova, Faculty of Phisical Education and Sport,
Knee is one of most important
joint of our
body, that presents frequently many traumas. The anterior cruciate
ligament (ACL) is the major stabilizing ligament of the knee. This is
one of the structures most often injuried by sportsmen. This injury
causes internal rotational instability of tibia to the femur when the
knee is in flexion. The ACL reconstruction with anatomically
bone-tendon-bone graft harvested from the patellae ligament, is
accepted today as the “golden standard”. The aim of
this study is
to evaluate the rehabilitation of knee after ACL reconstruction. We
compared two groups of subjects, one with ambulatory rehabilitation
by kinetic programme and one with rehabilitation in a rehabilitation
words.: knee, ACL, ambulatory rehabilitation
The achievements in
rehabilitation treatment have helped post-surgical line in patients
with surgical reconstruction of anterior cruciate ligament (ACL).
arthroscopy, are less invasive and injuring on articular and
periarticular structures offering better stability and faster
mobilization and support.
The improvement of
rehabilitation techniques, such as closed kinetic chain, has permitted
a faster rehabilitation, decreasing the solicitation on the knee. These
progresses allowed ambulatory rehabilitation to win in the competition
with rehabilitation in a rehabilitation hospital service with complete
The aim of this
study is to evaluate
the efficiency of a program of ambulatory functional rehabilitation of
the knee after surgical reconstruction of ACL injury.
We compared the
results of two
groups of patients: one with ambulatory rehabilitation, one with
rehabilitation during three weeks of hospitalization in a
rehabilitation hospital service.
We studied a number
of 24 patients
with ACL injuries and bone-tendon-bone graft surgical reconstruction
and rehabilitation started first day post-surgery.
reconstruction we mead 2
lots: group A with ambulatory rehabilitation and group B with
reeducation in a rehabilitation and physical medicine center.
rehabilitation activities -
walking, climbing, descending - in a period of 4-6 weeks mean walking
without support, complete extension of the knee and an active flexion
in 120 degrees.
Group A –
rehabilitation with a
kineto-therapist during 6 weeks, three times in a week- home exercises.
Group B –
two hours/day, two days/week, three weeks, then ambulatory
rehabilitation like in group A.
- 6 weeks to 4
months - during this phase kinetotherapy was suspended; home physical
exercises; the result: swimming, bike-riding.
reeducation - 4 to 6 months
post-surgery; result: maximal rehabilitation in movement, force and
stability of the knee.
rehabilitation - 6 to 12
months post-surgery - progressive sport activities, training and then
The study was made
between june 2003
– july 2005, on 24 patiens, 16 males and 8 females, average
age - 24 years old, 70% performance sportsmen, 23%
freetime-sportsmen, and 7% are not sportsmen (graph 1).
patients present: ACL injury with or without menisci injury, surgical
reconstruction with bone-tendon-bone technique and accepted
did not select patients with other kind of surgery of the knee
(excepting exploratory artroscopy), with degenerative joint pathology
or important injuries of periarticular structures.
evaluation-3, 6 weeks, 4, 6 months and 1 year post-surgery.
general: age, sex,
period between the
(goniometry) of the
flexion and extension of the knee
test Lachmann -
Trillat for the
ligaments of the knee
functional score of
(evaluation of the instability, pain, swallowing, articular blocking of
24 patients, 12 group A, 12 group B were 24 +/- 7 years old, high 172
+/-8 cm, weight 69 +/-11 kg.
Lachmann test was positive in all patients meaning high risk of
instability or real instability.In
75% of patients surgery was performed 1 year after the injury, half
of these after 6 months, 1/3 after 3 months.
frequency of menisci injury was more important in group A (43%) then
in group B (19%)
was no difference in mobility, in flexion and extension of the knee
between the two groups (exception: flexion after 3 weeks
significant differences in swelling evolution between the two groups.
differences in Lachmann and Lysholm tests (table 2, 3).
reeducation after surgery for ACL injury can be proceeded in
ambulatory from the beginning and it is based on a well-established
protocol of easy home kinetic-therapy techniques.Weekly
medical supervising during first period of reeducation may improve
the results by adjusting kinetic program on each patient and early
registration of the complications.
relationship patient-physician –kinetic-therapist determined
comparable results in ambulatory rehabilitation and hospital
rehabilitation in surgical reconstruction of ACL.