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ACL Rehabilitation.
By: Joan J. Womack, Tue Jan 19th, 2010
Arthroscopic surgery techniques, applied in principle to the knee and then extended to any other joint interventions have been the subject of controversy, bitter basis for discussions in professional forums and conferences between proponents of conventional open surgical techniques and "modern" acl recovery (anterior cruciate knee ligament) seems however that all these processes are undergoing similar discussion of acceptance first, building later and finally setting some indications that everyone accepts and that are standardized internationally. This has happened with plasty of the knee, and more specifically aimed at correcting the anterior cruciate ligament rupture. It is not disputed that must be operated by arthroscopy but on the way we have been correcting the direction to correct some errors. For example, now no longer used artificial plasty, however, are increasingly resorting to allografts. The criteria for surgical decision on the anterior cruciate ligament rupture were extensively discussed in our article on choosing ACL plasty.
We will now continue with the establishment of rehabilitation protocols.
The performance criteria are very similar regardless of the type of plasty used to repair anterior cruciate ligament, but mentioned the difference of opinions among the experts who care enough to publish findings from the study of outcomes among their patients. We refer to any difference between obtained from tendons plasties anserine and plasties such as "bone-tendon-bone" obtained from the patellar tendon. Some of the negative aspects of the choice of either can be mined with the placement of an allograft, as the body of a lyophilized pellet patellar bone with patella and tibia. As tendons are not used from the patient, eliminating the effects of postsurgical bleeding and swelling and is not necessary to compensate for their lack of empowerment with a hamstring. It also prevents pain in the lower pole of patella or a complication that is much more important, the patella reflex sympathetic dystrophy, without the usual complications that can sour the postoperative outcome and reduced opportunities to return to competition in professional sport. The patterns of anterior cruciate ligament rehabilitation will be the same but without fear of late complications arising from the lack of a tendon taken from the patient.
Key Aspects
The objective of an accelerated recovery of the intervention of an ACL plasty provides:
* Early onset of walking to support body weight, this movement favors cartilage compression and facilitates the reorganization of collagen and bone tissue provides and other soft tissues of the knee's ability to respond to normal physiologic loads.
* Recover fast range of motion of the knee in a relevant way the last degrees of extension.
* Conduct an aggressive strength program based on passive and active exercises electrostimulation closed kinetic chain that will protect the graft.
Considerations
Scarring of the plasty
All plasty implanted following process of maturation: avascular necrosis, revascularization, proliferation and remodeling. These stages may not have a phased development and attend several at once. Revascularization appears that peaks at about 6 months of implantation. ruptured anterior cruciate ligament plasty arthroscopy This suggests that much to require plasty between 4-6th month may involve a risk of stretching and rupture of the plasty. These aspects, extrapolated from animal studies, may have a different evolution in humans. A very interesting Rougraff (1993) suggests revascularization from the 3rd week, the refurbished between 2 and 10 months (range !!!!!), will talk about a better predisposition plasty bone-tendon-bone for the rehabilitation accelerated, and about 3 years for the plasty is histologically as a ligament. More recent work suggests the possibility that at 6 months, plasties behave both as vascularization of collagen tissue as is the normal ligament. The latter seems to be favored by rapid participation in physical activity that would stimulate an increase in metabolism that increase collagen synthesis and increasing strength and size of the plasty.
Plasty type
There is widespread recognition HTH reference to the resistance in all stages of healing but more recently, MacDonald (1995) has shown that the semitendinosus-gracilis plasty is as effective in the accelerated rehabilitation of HTH.
Stability plasty
Biomechanical and histological studies suggest that the plasty ligamentización starts about 24 weeks and take about 3 years to complete. Objective evaluations of anterior tibial laxity compared with normal accelerated rehabilitation, show no significant differences. Shelburne and Gray (1997) observed no statistical differences in comparison plasty failures of both programs (2.6% in accelerated rehabilitation and 4.4% in normal).
In conclusion
A recent review of Graham and Parker (2002) found no differences in postoperative evolution between the 2 options above plasty. These authors suggest that knee stability and good clinical outcome during recovery, not dependent on the type of plasty used. Aspects such as anatomically correct positioning of the graft, a good fixing this, the existence of associated meniscal and ligament injuries and a structured rehabilitation program, would be really responsible for the clinical and stability of the knee.
