1 / 62

REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. H SELCUK KUCUKOGLU ULUDAG UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PM&R AND SPORTS MEDICINE. EPİDEMİOLOGY. Yearly incidence of ACL injuries has been reported to be 3/10,000 inhabitants in Denmark (Nielsen, 1991),

elvina
Download Presentation

REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION H SELCUK KUCUKOGLU ULUDAG UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PM&R AND SPORTS MEDICINE

  2. EPİDEMİOLOGY • Yearly incidence of ACL injuries has been reported to be 3/10,000 inhabitants in Denmark (Nielsen, 1991), • In Sweden, ACL injuries comprise 43% of all soccer related injuries (Roos,1995),…

  3. GOAL • The goal of ACL reconstruction is to improve the patients level of function, with in the hope of allowing them to return to an active life style, with minimal disability, while protecting them from further injury to the knee.

  4. why treat • After an ACL lesion, knee instability is common and may produce progressive functional changes and damage to other joint structures (meniscal damage,articular cartilage damage,and degenerative arthritis) which may also affect daily life activities.

  5. why TREAT • The ACL has poor potential for spontaneous healing after complete rupture,and therefore conservative treatment aims to develop joint motion patterns that help control abnormal knee motions which can arise in the absence of functional ACL.

  6. why TREAT • In the years following an ACL injury additional meniscus ruptures frequently occur. 80% of ACL deficient patients were found to have a torn meniscus within 2 years of ACL injury. • Gillquist-Messner (Sports Med. March 1999)

  7. why REHABILITATION • Optimal healing of an ACL graft and the knee is dependent on rehabilitation, • The strains applied to an ACL graft by body weight, muscle activity, and joint motion affect its healing response,

  8. ACCELERATED REHABILITATION • Investigations of ACL grafts that have been done in animals indicate that they lose their ultimate failure strength and undergo a decrease of stiffness and the knees have an increase in anterior laxity develop during healing.

  9. Accelerated rehabilitation • The exact cause of above mentioned changes and the application of this data to humans are unclear.Rougraff-Shelbourne reported that large proportion of the tendon survives and ACL graft healing in humans may not undergo the same complete necrotic stage that has been reported in animals. • Knee Surg Sports Traumatol Arthrosc 1999

  10. ACLRehabilitation • Preoperative Phase: • Goals • Diminish inflammation,swelling, and pain • Restore normal range of motion (extension) • Restore voluntary muscle activation • Provide patient education to prepare for surgery • Brace-elastic wrap or knee sleeve to reduce swelling • Weight bearing-as tolerated with or without crutches

  11. ACL Rehabilitation2 • Preoperative phase • Exercises • Ankle pumps • Passive knee extension to zero • Passive knee flexion to tolerance • Straight leg raises (3-way, flexion, abduction, adduction • Quadriceps setting • Closed kinetic chain exercises: mini squats, lunges, step-ups

  12. ACL Rehabiltation3 • Preoperative Phase • Muscle stimulation-electrical muscle stimulation to quadriceps during voluntary quadriceps exercises (4-6 hours/day) • Cryotherapy/elevation-apply ice 20 minutes of every hour, elevate leg with knee in full extension • Patient education- review postoperative rehabilitation program

  13. BIOMECHANICS • Isometric exercises that strain the ACL involve contraction of the dominant quadriceps muscle group with the knee between extension and 60° flexion, or involve isotonic contraction of the quadriceps between extension and 50° flexion,

  14. Biomechanics2 • The largest ACL strain magnitudes that have been measured and produced by isometric and isotonic contraction of the quadriceps muscles with the knee near extension.

  15. Biomechanics3 • Squatting, stationary bicycling,and closed kinetic chain exercises that involves body weight loading and substantial cocontraction of the muscles does not create an appreciable change in ACL strain values.

  16. ACL Rehabilitation • Immediate postoperative Phase (1-7 days) • Goals • Restore full passive knee extension • Diminish joint swelling and pain • Restore patellar mobility • Gradually improve knee flexion • Reestablish quadriceps control • Restore independent ambulation

  17. ACL Rehabilitation • Early Rehabilitation Phase (2-4 weeks) • Criteria to progress to phase 2 • Quad control (ability to perform good quad set and straight leg raises • Full passive knee extension • Passive ROM 0° -90° • Good patellar mobility • Minimal joint inflammation • Independent ambulation

  18. ACL Rehabilitation • Early Rehabilitation Phase • Goals • Maintain full passive knee extension • Gradually increase knee flexion • Diminish swelling and pain • Muscle training • Restore proprioception • Patellar mobility

  19. ACL Rehabilitation • Controlled ambulation Phase (weeks 4-10) • Criteria to enter phase 3 • Active ROM 0° to 115° • Quadriceps strength 60%>contralateral side (isometric test at 60° knee flexion) • Minimal to no joint inflammation • No joint line or patellofemoral pain

  20. ACL Rehabilitation • Controlled Ambulation Phase(2) • Goals • Restore full knee ROM (0° -125°) • Improve lower extremity strength • Enhance proprioception,balance and neuromuscular control • Improve muscular endurance • Restore limb confidence and function • No brace or immobilizer, may use knee sleeve

  21. ACL Rehabilitation • Advanced Activity Phase (10-16 weeks) • Criteria to enter Phase 4 • Active ROM 0°-125° • Quad strength 80% of contralateral side • Knee flexor:extensor ratio 70%-75% • No pain or effusion • *Satisfactory clinical exam • *Satisfactory isokinetic test (values at 60°/sec, 180°/sec and 300°/sec) • *Hop Test (80% of contralateral leg) (4test) • *Subjective knee scoring 80 points or better (Noyes)

  22. ACL Rehabilitation • Advanced activity phase (2) • Goals • Normalize lower extremity strength • Enhance muscular power and endurance • Improve neuromuscular control • Perform selected sport-specific drills

  23. ACL Rehabilitation • Return to activity phase • Criteria to enter phase 5 • Full ROM • Isokinetic test that fulfills criteria • Quad bil comparison (80% or greater) • Hams Bil comparison (110% or greater) • Proprioceptive test (100% of contralateral leg) • Hamstring/quadriceps ratio (70% or greater) • Functional test(85%or greater of contralateral side) • Satisfactory clinical exam • Subjective knee scoring (Noyes) 90 points or better

  24. ACL Rehabilitation • Return to activity phase (2) • Goals • Gradual return to full unrestricted sports • Achieve maximal strength and endurance • Normalize neuromuscular control • Progress skill training

  25. Complications • Hemarthrosis; Operative trauma and repeated operations • Pretension of the substitute ligament • Septic arthritis • Postoperative arthrofibrosis • Patellafemoral pain • All may lead to gonarthrosis in the long run

  26. ROLE of PMR • Check for the goals and the criterias to upgrade the patient • Evaluate the results of isometric and isokinetic tests • Evaluate the results of four HOP tests • Examine the patient when appropriate for the stability • Examine the patient for the complications and progress

  27. PROPRIOCEPTION AND BALANCE AFTER ACL RECONSTRUCTION Ufuk Şekir , Bedrettin Akova , Hakan Gür Medical School of Uludag University, Department of Sports Medicine , BURSA

  28. THE AIM OF THE STUDY To observe the changes in the proprioception and balance after ACL reconstruction.

  29. PATIENTS AND METHODS • 31 patients, mean age 24±7 (17-44) • Patellar tendon autograft • Time period between injury and the operation: 12 months ( 1-96) • Follow-up :At 1th, 2nd, 3rd, 4th, 6th, and 12thmonths after operation • Accelerated rehabilitation program, includes proprioceptive exercises (which began in the first month): • Single-leg stance on hard surface (eyes open-closed) • Single-leg stance on soft surface (eyes open-closed) • Balance board exercises (eyes open-closed)

  30. Cybex 6000 JPS active JPS passive Joint Position Sense (JPS) Eyes closed Index angles: 200,450 and 700 Angular velocity: 10/s Before matching an index angle, the examiner extends the knee passively to the index angle for 3 s. Three repetitions for each index angle was made. The mean of absolute error score (AES) for each index angle was calculated Mean AES= Sum of means of index angles /3

  31. Single-limb Balance • On a soft surface. • Eyes open-closed. • First on the uninjured and then on the injured side. • Arms crossed, contralateral leg flexed. • The subjects were required to stand 60s. • Two repetition were made. • Mean number of touchdowns and mean time to first touchdown were recorded.

  32. STATISTICS To compare injured-uninjured leg results; Wilcoxon test

  33. The results at the follow-up of the Single-limb Balance Test (Mean number of touchdowns) ** p<0,01, *p<0,05

  34. The results at the follow-up of the Single-limb Balance Test (Mean time to first touchdown) ** p<0,01, *p<0,05

  35. Joint Position Sense at 200 of Flexion *p<0,05

  36. Joint Position Sense at 450 of Flexion ** p<0,01, *p<0,05

  37. Joint Position Sense at 700 of Flexion

  38. Joint Position Sense (Mean)

  39. CONCLUSION The results of this study indicates that the proprioceptive capabilities of the ACL reconstructed knee can improved to the same level of the uninjured knee at 2 months after operation, with a rehabilitation program including proprioceptive exercises in early phase.

  40. FUNCTIONAL CAPACITY AFTER ACL RECONSTRUCTION: RELATIONSHIPS WITH KNEE EXTENSOR AND FLEXOR MUSCLE STRENGTH 1Bedrettin Akova ,1 Hakan Gür, 1 Ufuk Şekir, 2 Sefa Müezzinoğlu 1Medical School of Uludag University,Department of Sports Medicine , BURSA 2 Medical School of Kocaeli University, Department of Orthopaedic Surgery, KOCAELİ

  41. THE AIM OF THIS STUDY; To determine 1) the functional capacity and 2) the relationships between the functional capacity and knee extensor, and flexor peak torque after ACL reconstruction.

  42. PATIENTS AND METHODS Between January, 2000 and June, 2002 21 male patients, mean age 24±7 (17-44) Patellar tendon autograft Time period between injury and the surgery: 7 months ( 1-48) The follow-up was performed at 2nd, 3rd, 4th, 6th, and 12th months after operation

  43. Triple Hop For Distance Cross-over Hop For Distance Timed Hop Single Hop For Distance 6 meters Total distance Total distance Total distance FUNCTIONAL TESTS

  44. ISOKINETIC TEST • Cybex 6000 • Concentric test for knee flexors and extensors at the angular velocity of 600 and 1800/seconds • Peak torques (Pt) • Both legs

  45. STATISTICS To compare injured-uninjured leg results; Wilcoxon test Relationships between functional capacity and isokinetic test results; Pearson correlation coefficient test

More Related