ARTHROSCOPIC RECONSTRUCTION OF THE CRUCIATE LIGAMENT

Introduction

Rupture of the anterior cruciate ligament is an injury requiring surgical treatment and a long convalescence combined with arduous rehabilitation. The transplant is usually made of gracilis and semitendinosus muscles which are implanted. A very important, if not the most relevant factor in returning to full fitness, is quick and proper rehabilitation. It should begin in the first week after the procedure and be carried out regularly under the supervision of a qualified physiotherapist.

How to prepare for the procedure?

Before the reconstruction, it is good to discuss the process of rehabilitation with a physiotherapist and prepare the limb for the procedure. Depending on the condition of the knee, the therapy performed before the procedure should be focused on achieving maximum knee flexion and extension as well as rebuild the full muscle mass of the limb. This will facilitate and speed up the process of rehabilitation. Another important element is to acquire basic therapy equipment, such as: a ball, elastic band and a stationary bike in order to continue exercises at home. In addition to practicing in the physiotherapist’s office, the rehabilitation must be continued individually, which is why the auxiliary equipment is very important. You should also have elbow crutches because they are necessary in the first weeks after the procedure. The last element is to reduce swelling of the knee with gel compresses.

How long does rehabilitation take?

Post-reconstruction rehabilitation can be divided into 3 main phases:

  • phase 1 – from the surgery to approximately 6 weeks. During this period, the patient moves in an orthosis and with elbow crutches, gradually putting off orthopaedic equipment. We pay great attention to working out full extension of the knee and reaching flexion of around 120 degrees. Another element is to rebuild the muscle mass of the operated limb.
  • phase 2 – from approximately 6 to 12 weeks. During this period, the patient usually moves without orthopaedic aids. We focus a lot on strengthening the muscles of the operated limb, knee stabilization and balance exercises. Despite good patient’s condition, at this stage, the ligament is the weakest, therefore great attention ought to be paid to the technique and method of practicing.
  • phase 3 – from 3 months to a year after the procedure. During this phase, we focus on dexterity exercises with the elements of sport, we introduce jumps and running. The patient regains full knee mobility and strength.

Rehabilitation ends about a year after the surgery. The patient is subjected to a series of examinations, a positive test result means that the patient is fully rehabilitated.

The main goals of rehabilitation:

  1. reduction of swelling and pain;
  2. obtaining full extension of the knee and the appropriate knee flexion;
  3. developing strength of the muscles of the operated limb and knee stability so that the patient can move independently without orthopaedic aids;
  4. dexterity training with the elements allowing the patient to return to favourite sports activities.

In the Szpital Zakonu Bonifratrów, physiotherapy is performed by a team of specialists:

Rafał Trąbka, PhD

Łukasz Gregulski, MSc

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