Rehabilitation after rupture of the anterior cruciate ligament of the knee joint

Causes and types of anterior cruciate ligament rupture

The causes of the pathology are directly related to the anatomical location of the ligament and its functional characteristics - it stabilizes the knee joint and keeps the tibia from moving in and out. With a sharp turn of the torso, in which the thigh is involved (with the lower leg and foot in a static position), a rupture (complete or partial) of the anterior cruciate ligament occurs.

There are internal factors that determine the predisposition to traumatic injury with a relatively small force impact:

hormonal levels (in women, the frequency of ruptures of the anterior knee cruciate ligament is higher);
anatomical features of the structure of the knee joint;
condition of the muscle tissue of the lower limb.

According to the degree of pathological disorders, they are distinguished:

micro-fractures, stretching;
incomplete ligament rupture;
complete anatomical violation of integrity.

Symptoms

Pain that occurs at the time of injury and intensifies with subsequent movements in the knee joint.
Hemarthrosis with the appearance of swelling in the knee.
Hyperemia in the affected area, cyanosis of the skin.
Crepitus in the knee joint.

The posterior cruciate ligament consists of two powerful bundles; if one of the bundles ruptures, the ligament can heal on its own; the patient is prescribed conservative treatment, including wearing a special knee brace for two months from the moment of injury.

With a complete rupture of the PCL, severe disturbances in the biomechanics of the knee occur.

Any flexion of the knee joint causes a posterior displacement of the tibia. Instead of rotating the knee joint when bending, the lower leg slips and moves backward. As a result, when walking, only the front part of the tibia and the back part of the femoral condyles are loaded, the rest does not participate in the load. In this case, the load on the cartilage increases thousands of times, and the knee joint is completely destroyed within 5 years. In addition, when the shin moves backward, the load in the patellofemoral joint increases, the cartilage under the kneecap also wears out quickly, causing crunching and pain in the knee joint.

Diagnosis of damage to the posterior cruciate ligament begins with an external examination; the lower leg is often retracted backwards; a number of patients can spontaneously dislocate the lower leg. The examination reveals the posterior drawer and false anterior drawer tests. X-rays in lateral projections determine the degree of backward displacement of the tibia. In some cases, a stress radiograph is performed. MRI is the most accurate method for diagnosing a posterior cruciate ligament rupture.

Treatment of a ruptured posterior cruciate ligament is usually performed arthroscopically.

A posterior cruciate ligament reconstruction is performed using a semitendinosus and gracilis tendon graft. This is the most gentle technology using our own fabrics. This technique is used only by experienced surgeons with extensive experience in arthroscopy; such operations are the pinnacle of arthroscopic surgery.

With a small incision of 2-3 cm on the lower leg, the tendon is harvested, it is folded 4 times and a posterior cruciate ligament graft is formed from it, comparable in strength to a normal posterior cruciate ligament. Under arthroscopic control, tunnels are formed in the condyles of the femur and tibia, into which the graft is inserted and fixed using absorbable fixatives consisting of lactic acid and hydroxyapatite, which, as the screw dissolves, helps the new ligament to grow to the bone.

Rehabilitation is the key to treating posterior cruciate ligament tears.

For a month, the lower limb is fixed in a special brace that relieves the load on the PCL.
You cannot bend your leg completely for 6 weeks.
The leg can be flexed passively with the support of the other leg, and it can be extended actively by tensing the quadriceps muscle.
A special articulated knee brace must be used for up to 4 months.
Swimming after 3 months
Running after 4 months
Sports without restrictions 6-8 months after surgery.

Successful treatment of a PCL rupture is a collective and synchronous work of the patient, the surgeon and the rehabilitator.

Treatment methods and rehabilitation after anterior cruciate ligament rupture

It is better to entrust complex treatment and rehabilitation after a rupture of the anterior knee cruciate ligament to professionals. However, you need to know a set of measures that you can perform independently immediately after an injury:

limit the load on the knee joint;
apply cold;
ensure joint immobility.

A conservative therapeutic method is immobilization of the affected area - the duration of wearing the bandage depends on the degree of damage. If the rupture is complete, surgery will likely be required. The operation consists of suturing the fibers of the damaged ligamentous apparatus to prevent the development of joint instability and arthrosis.

KNEE LIGAMENTS. TREATMENT AND RECOVERY AFTER INJURY AND OPERATION

What is the most common knee injury? According to statistics from our center, these are ligament injuries - sprains, tears and ruptures. For many, such diagnoses sound like a death sentence, since they actually mean that a complex operation and long-term rehabilitation are ahead with an unclear prospect of recovery. Why isn't it clear?

Because not everyone, even large medical centers in Russia, can offer truly high-quality rehabilitation, and victims often turn to Western clinics for help. However, medical tourism is not a cheap pleasure, it involves significant material and time expenses, and requires a break from family and work.

Rehabilitation at the Kazan Kinesitherapy Center

Even a successfully performed operation is not capable of putting a person back on his feet. The success of treatment and how the knee or other damaged joint will function in the future largely depend on subsequent rehabilitation.

Rehabilitation accounts for at least 80-90% of the success of any surgical treatment.

Our center has been specializing in professional rehabilitation after complex injuries, surgeries on joints and spine for 10 years. We offer a complex of modern drug-free recovery techniques. In our Center, people undergo restorative rehabilitation, including professional athletes and team players, for whom it is especially important to return to duty as quickly as possible.

We have everything for successful treatment: highly qualified specialists with extensive experience in the field of rehabilitation medicine, modern rehabilitation equipment, European hardware technologies. And the main thing is an individual approach to each person, the interest of the instructor and the doctor in the patient’s recovery, since professional rehabilitation is always a joint work, where the instructor and the attending physician are themselves active participants in the process.

In addition to postoperative recovery, the Kazan Kinesitherapy Center also deals with conservative treatment of all types of injuries, including damage to the knee ligaments.

Damage to the anterior cruciate ligament. Is it possible to do without surgery?

The anterior cruciate ligament (ACL) is the main stabilizer of the knee joint, which keeps the knee (tibia) from moving forward and from rotating. When an ACL ruptures, other structures of the knee are often damaged: cartilage, menisci (medial meniscus tear), other knee ligaments, such as the medial collateral ligament, medial collateral ligament, and patellar ligaments. At the same time, diagnoses such as chondromalacia of the knee joint, hemarthrosis, synovitis of the joint (inflammation and effusions in the joint) can be made.

On a note.
A sprain or rupture of the ACL is considered a “signature” injury of athletes, mainly dynamic sports in which you have to run a lot
,
sharply changing the pace, direction of movement and stopping (classic examples are football, volleyball, basketball, tennis).
Fans of active recreation such as running, sports games, and cross-country skiing are also at risk. In such cases, the anterior cruciate ligament bears a fairly serious load and is damaged approximately 15 times more often than the posterior one. However, the ACL can also be damaged in the gym, working out with a barbell, or due to an unsuccessful fall or blow. Therefore, for the prevention of injuries, special gymnastics is useful to strengthen the ligamentous apparatus of the joints .

Ligament rupture. Symptoms and correct diagnosis

The main complaint after a knee injury , ACL, is instability (instability) of the knee joint - the patient feels a “breaking” or “shaking” of the leg when walking, especially on an uneven surface or descent. The knee increases in volume, becomes hot to the touch, and fills with blood (hemarthrosis of the knee joint). Over time, a weakened joint may develop deforming arthrosis (gonarthrosis) with pain, crunching, and limited joint mobility.

Important!

With a knee injury, it is especially important to make the correct diagnosis to determine further treatment tactics.
An accurate diagnosis can be established by tomography - MRI, CT, and mandatory examination by a doctor. But mistakes happen here too. Not always a knee injury is so serious that it requires surgery, cleaning and removal (resection) of the meniscus
. In some cases, with a tear or sprain of the knee ligaments, conservative treatment is possible, without surgery.

Contact professionals in time for advice!

We have a promotion! Doctor’s consultation + diagnosis of the spine and joints – 1000 rubles.

Conservative treatment of knee injuries at the Kazan Kinesitherapy Center

Conservative treatment of the knee joint includes a set of techniques that have been successfully used in many leading clinics around the world for the last ten years. These are autoplasma therapy, kinesitherapy (active rehabilitation on special equipment with a gradual increase in the volume and intensity of physical exercise), exercise therapy (exercises to strengthen the stabilizing muscles of the knee joint), therapeutic massage, and electrical stimulation.

Our methods of restorative treatment can significantly improve the situation and even eliminate surgery, or prepare for it in order to further facilitate and speed up the recovery process.

Rehabilitation after ACL plastic surgery. If the operation has already been done

Our Center provides rehabilitation after damage to the ligaments of the knee, patella, arthroscopic autoplasty of the cruciate ligament ( rehabilitation after ACL

), resection of the meniscus.

The recovery stage is very important, since ACL plastic surgery gives good results only if the patient undergoes high-quality postoperative rehabilitation.

On a note . Doctors do not hide: not a single operation, even the most successful one, gives the desired result without competent rehabilitation. There are situations when, after suffering an injury, a person needs, in fact, to learn to move his legs and walk again. And here a lot depends on the patient himself, his courage and desire to work on his body.

People come to us to return to a full life, work, or favorite hobby. Our instructors help patients develop the operated joints and return to normal life and sports training as quickly as possible. The rehabilitation program is compiled individually in accordance with each specific case after consultation with a specialist from the center. The doctor’s task is the correct organization of the patient’s work, the development of a comprehensive individual recovery system by periods - from the early to the final stage. This ensures the most optimal result in the shortest possible time.

The rehabilitation period ends after complete functional restoration of the joint and limb.

Objectives of postoperative rehabilitation

The center provides high-quality recovery after surgery, as well as after any injuries to the musculoskeletal system.

Postoperative rehabilitation solves the following problems:

relieve pain, swelling and inflammation in the joint;
restore tissue trophism, blood supply and nutrition to the joint, accelerate the regeneration of damaged tissues and the survival of the autograft after ACL;
prevention of joint contracture and atrophy of muscles weakened after injury;
strengthening the thigh muscles and knee ligaments;
restoring the mobility of the injured knee, strengthening the second one so that there is no imbalance, as well as increasing the tone of the entire muscle corset;
return to daily activities and sports;
preventing future complications such as the development of joint arthrosis.

Specialist consultation is required.

Doctor’s consultation + diagnostics using applied kinesiology – 1000 rubles.

Call, write! Tel.: (843) 570-55-25 , WhatsApp: 79655968085 or VKontakte group .

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Rehabilitation methods after anterior cruciate ligament rupture

For complete tissue restoration, rehabilitation after anterior cruciate ligament rupture is necessary. Physiotherapy, exercise therapy and massage can speed up recovery, but they are not able to properly strengthen the muscular-ligamentous system and completely relieve pain in the development of tissues atrophied after immobilization.

At the Innovative Medical Center, recovery from anterior cruciate ligament rupture is carried out using kinesitherapy.

Rehabilitation after ACL plastic surgery

The leading area of rehabilitation activity in St. Petersburg is rehabilitation after ACL of the knee joint. The use of the author's program aimed at restoring the supporting, motor and shock-absorbing functions of the knee allows us to achieve a significant improvement in the final results. In addition to the above methods of restorative correction, the RC uses innovative techniques designed to optimize the rehabilitation process:

CPM-mechanotherapy

CMP (Continues Passive Motion) stands for continuous passive motion. Involves the use of equipment designed to develop the knee joint in the early postoperative stage. The flexion and extension of the knee is performed not by the patient, but by the machine. The main goal of this procedure is to gradually increase the range of motion and prevent contractures.

Lymphatic drainage massage

The hardware procedure, based on sequential rhythmic compression and muscle stimulation, is performed in a special pneumatic suit. The main goal of lymphatic drainage massage after ACL plastic surgery is to normalize lymph circulation and relieve postoperative swelling.

Kinesiotherapy (PNF)

PNF (proprioceptive neuromuscular stimulation) is a kinesiotherapeutic technique aimed at restoring functional connections between muscles and the central nervous system. This type of movement therapy involves stimulating manual stimulation of specific muscle groups. By pressing, twisting and stretching healthy muscles, the motor activity of weakened ones is improved. PNF eliminates compensatory-adaptive changes caused by anterior cruciate ligament injury, includes lost patterns and helps restore proper biomechanics of movements.

Medical fitness

Yoga therapy and Pilates are designed to adapt the body after injury and subsequent surgery. Proper use of asanas and techniques that involve the knees helps to activate the front, back and inner thighs, and strengthen the calf muscles.

IASTM therapy (instrumental soft tissue mobilization)

Motor correction using gentle techniques for instrumental mobilization of soft tissues includes methods of mechanical impact on muscles, fascia and trigger points with special instruments (blades). Using various techniques, soft tissues are separated. This helps to increase the outflow of lymph, decompress the compressed nerve, eliminate swelling and improve the range of motion in the knee joint.

Manual therapy (Mulligan and Kaltenborn-Event concept)

Joint mobilizations with movement are used to reduce the intensity of postoperative pain and increase the range of motion. The key feature of these techniques is the therapeutic effect parallel to the plane of the joint. The chiropractor mobilizes (supports), and the patient himself performs the necessary movements, and almost painlessly. Pain relief is achieved immediately, from the first session.

NEURAC Method

NEURAC therapy is a method of neuromuscular activation that is effectively used during the recovery period after ACL surgery. It is a set of static exercises using a suspension system. Trainings that minimize the influence of gravity are aimed at targeted training of weakened groups of deep muscles that are not involved in traditional modes. An individualized approach, in which controlled vibration and range of motion are selected based on the patient's condition, can significantly speed up the healing process.

Advantages of the method

Multifunctional decompression simulators eliminate the load on the affected joint - a strong, supporting muscle frame is formed around it.
Stimulation of muscle tone implies activation of tissue trophism at the site of rupture of the anterior knee cruciate ligament, as a result of which stagnant processes are eliminated, so rehabilitation is effective and painless.
Dosed strength exercises are developed individually for each patient.
A significant improvement in condition after the first classes allows you to eliminate the use of medications during rehabilitation - discomfort and pain after a rupture of the anterior cruciate ligament are relieved using the body’s own recovery resources.

Plastic surgery of the knee joint ligaments

The knee joint is made up of four ligaments that connect the thigh bones to the lower leg bones: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL), and internal collateral ligament (ICL). The anterior cruciate ligament runs down the middle of the outside of the knee and connects the femur to the tibia. The ACL also serves as a stabilizing force during sudden changes in position, such as the sudden jerks found in some sports.

Since the ACL performs the very important job of stabilizing the knee joint, it is quite susceptible to injury. A torn UCL is a common sports injury, especially in basketball, soccer, and skiing. A rupture of the UCL may not appear immediately. You may feel a “pop” during exercise, followed by symptoms such as: pain that gets worse when walking, swelling, instability of the knee joint

In order to assess the extent of ACL damage, it is necessary to examine the knee joint using magnetic resonance imaging (MRI).

About ACL reconstruction

Some ligaments can heal on their own, but not the anterior cruciate ligament. Previously, surgeons used the method of suturing the damaged ligament, but this approach showed unsatisfactory results. At the moment, surgical reconstruction (plasty) of the ACL is the only effective method for completely restoring the stability of the knee joint.

Surgeons at the MIRT Clinic perform arthroscopic reconstruction of the ACL. The operation is performed under general anesthesia. During the operation, the doctor operates through several punctures. To restore the ligament, the surgeon uses various synthetic materials or forms a ligament from the patient’s own fascial tissue.

Plastic surgery of the knee joint ligaments - treatment methods

For this purpose, autografts, that is, parts of the patient’s body, are used. This method of plastic surgery is extremely effective, since the recovery rate of patients is very high. Several types of tendons are used for plastic surgery. This may be a tendon that is attached to the femur and tibia. Sometimes it is called a VTV graft, which is due to the fact that the abbreviation comes from the English words bone-tendon-bone, which translated means bone-tendon-bone. It is cut out from its natural place and attached as if diagonally, exactly to the place where the ligament was attached. The effectiveness of this method is due to the fact that parts of the bone tissue quickly take root. The graft is fixed using titanium or absorbable screws. This type of treatment promotes rapid results, and after 2-3 weeks the implanted tissue fuses with the cartilaginous tissue of the bones. There are other autografts, including hamstrings. This is the tendon of the semitendinosus femoris muscle. In order to increase the efficiency of the tendon, after harvesting it is folded in half and stitched. And just as in the method described above, they are inserted into the drilled channels of the femur and tibia in place of the damaged ligament. But for fixation with this method of plastic surgery, there is a greater variety of methods, these can be staples, buttons, etc.

Each of the two methods of plastic surgery has its own advantages and disadvantages. Reconstruction using the patellar ligament is more complex and takes longer to recover. But it is considered more reliable. After such an operation, a five-centimeter scar will remain. But plastic surgery of the knee joint with the help of the semitendinosus muscle occurs with fewer incisions.

Another type can be called plastic surgery using allografts. This is a transplant of donor tissue such as the patellar ligament, hamstrings or Achilles tendon. After the death of a person, such tissues are sent for storage to a special bank. The advantage of this method is that the patient does not undergo additional surgery to remove the body’s own tissues. But there is also a drawback, because there is no 100% certainty that the donor tissue will take root.

If adjacent structures (cartilage or meniscus) are also damaged, the doctor also removes the affected tissue. Cold plasma is widely used for this purpose. After carefully fixing the new ligament, the surgeon removes all instruments and sutures the incisions.

Recovery after knee surgery

According to the American Academy of Orthopedic Surgeons, in 82-95% of cases, ACL reconstruction surgery is successful and allows you to return to a full lifestyle, including playing sports.

Modern methods of surgical ACL reconstruction provide a number of important advantages:

Less scars
Less pain after surgery
Less bleeding
Reducing the risk of infection

After surgery to restore the ACL, to strengthen the muscles around the ligament, restore flexibility and functionality of the joint, a course of physiotherapy and physical therapy is required using proprietary methods developed at the MIRT clinic.

Rehabilitation after anterior cruciate ligament rupture