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The different steps of the post-surgery
rehabilitation of the anterior cruciate ligament
each meet fixed recovery goals based on the
post surgery period, on the type of transplant
used, associated actions. It should be noted that
for the last 5 years, ACL reconstructions with
hamstring (DIDT) superseded ACL transplants
on the patellar tendon, previously considered
as the “gold standard”.
Schematically there are 3 following steps:
• D1-D45:
Rehabilitation mainly based on
analytics exercises,
• D45-D90:
Rehabilitation mainly based on
functional exercises,
• D90-D150:
Begin controlled physical
activity,
Beyond D150 begin normal physical and sports
activities.
It is important to note that:
• Recovering extension takes priority over
recovering flexion;
• Working on dynamic weight bearing must
always be prepared first with working on
static weight bearing;
• Effectively removing the crutches implies a
perfect quadriceps control of 0° of extension
in full weight bearing, without flexum, pain
or limping;
• CCF work (closed kinetic chain exercises)
must remain the basis to strengthen the
quadriceps muscle until 16 weeks after
surgery. After that period, it can be associated
with a more analytical CCO work (open
kinetic chain exercises) allowing a better and
more optimal recovery of the quadriceps
(Mikkelsen, Shaw, Fitzgerald);
• Recovering hamstrings must be paid special
attention for two reasons: as protectors of the
reconstruction graft and because of their
deficiency when the transplant is taken at
their expense.
The first rehabilitation period (D1-D45) is the
most important as it determines the functional
future of the operated knee. During this period,
4 goals must be reached:
- Wakening the quadriceps,
- Recovering the complete passive extension,
- Restoring a normal walking pattern,
- Wakening the hamstrings, then strengthening
them even in the last degrees of flexion.
KEY POINTS OF REHABILITATION
OF THE ANTERIOR CRUCIATE
LIGAMENT
O. RACHET, B. QUELARD