Knee ligament reconstruction is based on replacing one of the torn ligaments in the knee. Generally, this operation involves the anterior cruciate ligament (ACL) rather than the posterior cruciate ligament (PCL). knee rehabilitation The procedure induced by this type of operation allows the patient to relearn how to perform the different movements of the knee, in order to gradually regain all of their motor skills.
Post-ligamentoplasty rehabilitation: what is it?
Post-operative rehabilitation for a cruciate ligament rupture is based on five essential phases, which we will detail later in this article. Through exercises performed with a healthcare professional and based on various methods, the patient can progressively regain their motor skills until they reach the level they were at before the rupture of the anterior cruciate ligament or the posterior cruciate ligament.
When should it be implemented?
Ligament reconstruction remains a surgical procedure. This means that, although the ligament is repaired, it cannot immediately stabilize the knee. Furthermore, it is important to know that cruciate ligament surgery can also cause inflammatory reactions in the knee and worsen any loss of mobility.
Post-operative rehabilitation of the cruciate ligament is therefore essential for several reasons. The first is to relieve pain related to the surgery and restore a certain level of flexibility to the knee. It also allows the patient to regain muscle strength by working the muscles surrounding the knee. Finally, rehabilitation also offers the opportunity to restore the knee's function as a joint, thus ensuring the stability of the entire body (proprioceptive training).
The 5 phases of cruciate ligament rehabilitation
As we mentioned earlier in this article, post-operative rehabilitation of the cruciate ligament is divided into 5 distinct phases:
- healing;
- the resumption of free walking;
- consolidation;
- re-athleticization;
- the resumption of sport.
The healing phase
This phase extends from the end of the surgical procedure to the removal of the stitches. It allows the knee to become more flexible (achieving active locking in flexion and extension from 60° to 90°) and minimizes pain.
To achieve this, the healthcare professional will, for example, be able to perform massages and offer the patient physiotherapy, electrostimulation (to prevent muscle atrophy), and proprioceptive exercises. Depending on the patient's progress, ambulation with a gradual return to weight-bearing using crutches may be considered.
The phase of resuming free walking
Resumption of unrestricted walking begins immediately after the initial phase and is based on full weight-bearing mobility, as well as the recovery of knee range of motion. The patient's brace can be slowly removed, and the use of crutches can be discontinued.
At the end of this phase, the inflammation and pain should have disappeared. The knee should no longer require protection, and the joint's range of motion should reach 120° in flexion and 0° in extension. Mobility should also be complete, and muscle control should have regained a good level of reflexes. To achieve this, the healthcare professional may suggest gait retraining, moderate and progressive muscle activities, muscle strengthening through electrostimulation, etc.
The consolidation phase
The post-ligamentoplasty consolidation phase is then essential for the patient to regain confidence in their knee. Proprioceptive activities then come into play, alongside movement rehabilitation (walking, cycling, step aerobics, swimming, etc.). At this stage, the physiotherapist can suggest that the patient work on the hamstrings, quadriceps, neuromuscular control, and proprioception.
The rehabilitation phase
Once the tendon has regained its strength, the patient can begin to engage in activities requiring more power and endurance (jogging, swimming, cycling, etc.). This return-to-sport phase is entirely based on muscle rehabilitation and endurance training, combined with dynamic proprioceptive activities.
The return of sport
The return of sport This is the last significant phase of post-operative cruciate ligament rehabilitation. It is based on comparative isokinetic tests to determine the patient's muscle capacity, then (if the situation allows), intense muscle work and learning sports movements.
The Allyane neuromotor reprogramming method in the context of cruciate ligament rehabilitation
The Allyane method is based on proprioception, listening to low-frequency sounds emitted by patented medical devices, and mental imagery. It accelerates the return to mobility for patients suffering from various conditions, including... knee flexion contracture, which can occur following ligamentoplasty.
In this scenario, the certified Allyane practitioner can guide the patient to relax their hamstring muscles using a protocol inspired by the Schultz and Jacobson methods. Once the muscles are relaxed, it is then possible to treat the reactivation of the muscle responsible for knee stability (the vastus medialis) by identifying the natural neuro-sensory-motor information from the healthy knee and transferring it to the affected limb in a mirror image.
A clinical study* presented at the ECOSEP sports medicine congress in November 2021 shows that an Allyane session allows:
- to increase the average muscle activity (measured by surface EMG**) by 41% statistically significant (p<0,001)
- a statistically significant average reduction in flexion contracture of 9,01 degrees (p<0,001)
* Case series, evidence level 4
** Average of three isometric contractions of the Vastus Medialis Oblique
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We hope that this information about post-operative rehabilitation of the cruciate ligament will help you better understand its challenges and benefits.