Contact us

Make an appointment

our specialists

 

  01 40 79 40 36

 

secretariat

@chirurgiedusport.com

 

SOS KNEE

 

Sports Clinic

36 bd St Marcel

75005 PARIS

Sports clinic Paris

Metro: Saint Marcel

Parking 6 rue test


sur

'Pages chirurgiedusport :

HONCode

Ce site respecte les principes de la charte HONcode de HON Ce site respecte les principes de la charte HONcode.
Site certifié en partenariat avec la Haute Autorité de Sant├ę (HAS).
Check here

QRCode

Youtube video

13:54
Docteur GEROMETTA Antoine - Retour au sp ...
195 views


14:12
Monsieur Olivier HOMAGE - Chaussage et s ...
174 views


09:05
Docteur Nicolas LEFEVRE - LCA de lÔÇÖenf ...
93 views


10:55
Docteur BOHU Yoann - 1├Ęre luxation dÔÇÖ ...
97 views


41:09
Surgical management 's knee osteoar ...
2143 views


10:06
Ligamentoplastie du ligament crois├ę an ...
16648 views


09:53
TKA MyKnee PTG Dr. Nicolas Lefevre
664996 views


00:41
Cracked meniscus bucket handle dislocate ...
26403 views


09:33
Arthroscopic knee surgery for fracture o ...
83301 views


07:39
Total knee replacement (TKR), descriptio ...
52507 views


11:04
DIDT TLS: surgery of the anterior crucia ...
362750 views


10:21
Surgery sport, hamstring: surgery of the ...
428778 views


05:12
Zapping meniscus
17155 views


03:37
Combing the patellar tendon under arthro ...
27119 views


05:10
Surgery sport, PIP Prevention of knee in ...
12020 views


00:08
bucket handle meniscal 3D movie
17278 views


05:44
Suture of the lateral meniscus injury ra ...
15662 views


05:18
partial tear of the anterior cruciate li ...
10139 views


02:01
Levy for the hamstring ACL reconstructio ...
30028 views


06:25
partial ACL tear, technical anatomical r ...
11258 views


10:02
Complete rupture hamstring tendon repair ...
17796 views


04:09
Surgery sport, endoscopic treatment of c ...
5077 views


06:18
compartment syndrome 's efforts
38389 views


09:01
Rupture du tendon d'achille chirurgie du ...
3127 views


03:23
greffe de me?nisque Dr Alain myer Dr Yoa ...
789 views


09:05
Docteur Nicolas LEFEVRE - LCA de lÔÇÖenf ...
93 views


14:12
Monsieur Olivier HOMAGE - Chaussage et s ...
174 views


13:54
Docteur GEROMETTA Antoine - Retour au sp ...
195 views


Knee rehabilitation after ligament according to TLS technique.

Print Article

Knee rehabilitation after anterior crossed ligament using tendons of the bridle according to TLS technique

Dr. ROBERT H.
CH North Mayenne


The need for autograft type of ligament reconstruction has become the views of poor results in the medium term simple sutures, peripheral plasty or ligament prostheses. Among the intra-articular plasty, the choice is usually between a door with the patellar tendon graft or a graft with the hamstring tendons. Techniques 2 give results very close to medium term, but the grafts with hamstrings exposed to less postoperative pain and a faster recovery.

Whatever the type of sample, the principles of reconstruction remain the same:

- A tendon transplant tendon half alone, prepared in 4 strands,
- An anatomical anchor to the femur and to the tibia,
- Pre optimal tensioning,
- Mounting in tunnels by a screw pressing on a strip.
The tendon graft ligament will then undergo a transformation process for 1 to 2 years. This should be free of excessive stress during the early months.

The intervention will be carried out at least a few weeks after the accident to let the inflammatory phase.


1) SURGICAL TECHNIQUE

The operating time of the ligament are:

1- sampling tendon (semitendinosus) by an oblique way anteromedial (3 cm) to make a neo-ligament 4 strands, calibrated to 8 or 9 mm

... / ...



2- arthroscopy to practice:

Locating anatomical points of presence,
Drilling blind tunnels, tibial and femoral
The rise and transplant blockage in each tunnel with a screw,
A possible meniscal gesture.


2) SPECIFIC PROBLEMS OF THIS TYPE OF TRANSPLANT


1- The tendon removal leaves a muscular body "orphan" who will likely adhere to its sheath. During this phase, the muscular body is fragile and overburdened, it may be responsible for painful phenomena type "breakdown."

2 fastening systems must be highly resistant to mechanical afford to wait a biological anchorage tendon - bone tunnel entrances, which takes several weeks or months. We must therefore spare the anterior translation forces, including those induced by quadriceps and outlaw any intermittent static work or work in open chain quadriceps for at least 3 months.


3) REHABILITATION


It started before the procedure if there is atrophy of the thigh

It will be customized and we give the main principles

- The operative day:
The leg remains slightly flexed to ensure maximum comfort during this painful phase; the knee will be frozen. A morphine infusion will be in place for 24-48 hours. Active mobilization of the ankle and the knee is encouraged that evening because we avoid most often the use of anticoagulants, source of hematoma. The bed is kept slightly sloping to promote venous return in the lower limbs.







- 2nd and 3rd postoperative day:
The physiotherapist will pick you up 1-2 times a day, you will be removed the day after surgery. Rehabilitation includes several steps:

- Walk the full support, even if meniscal suturing. - Purely active mobilization, closed chain, from 0 ┬░ to 60 ┬░ without going recurvatum.
- Wearing a brace is not necessary.
- It must involve regular mobilization of the ankle and hip.
- Hamstrings can be processed into pure static without resistance,

- 3rd to 30th postoperative day: rehabilitation continued in city using the same protocol.
- Mobilization of 0 ┬░ to 60 ┬░ active closed chain, for 15 days and beyond up to 90 ┬░
- Working in a closed chain,
- Work in co-contraction quadriceps and hamstrings.
- Work walking,
- Canes can be discontinued after 8 to 15 days depending on the patient.
- Strengthening the quadriceps, with the end of weights or walk on the anterior tuberosity of the tibia, isometric and dynamic is prohibited.
- 2nd and 3rd postoperative month:
- Walking is free with only an elastic compression stocking. It must then fight against the possible flexion pure active and if necessary by axial traction 2 kg for 20 minutes if he resists,
- Bending is recovered gradually to 130 ┬░ -135 ┬░ in 4 to 6 weeks, without forcing,
- A work in dynamic closed string Stepper or Squatt can be started,
- The proprioceptive work is started, first bi-podal, then monopodal using Freeman trays or manual stimulation of the physiotherapist,
- The scar will be massaged,
- It is possible to combine electrical stimulation co-contraction of the quadriceps and hamstrings.
- Of cycling is possible.

Professional work is usually taken between 2 and 6 weeks after surgery depending on the activity.



- After 3 months:
- Work continued in closed chain, eg cycling, swimming (crawl), the pre-jogging.

- Work in open chain quadriceps with proximal load (2-4 kg) is possible from the beginning of the 4th month
Complete recovery of the extension is imperative at this time,


Jogging, cycling, swimming are highly recommended, work on trampoline becomes possible in dual and single stance.


- More than 8 months
The patient can resume specific training of sports played:
- In case of footballer slalom runs with a ball in the foot,
- In case of volleyball, working impulse, receptions, jumps,
- In case of tennis, work acceleration, pivots, turns.


The resumption of sports can pivot from 9 to 10 months, if the surgical opinion is favorable, in principle if indolence, good passive and dynamic stability and good mobility. Isokinetic study is desirable to evaluate a residual deficit of hamstrings or quadriceps and correct, but it is mostly the patient's confidence in his knee that will be decisive. You will be regularly monitored in consultation for 2 years. Whatever type of plastic surgery, there is a risk of relaxation and re-break of about 10%.


Rehabilitation of ACL plasty with the tendons of the crow's feet is much more cautious, gradual than that of Kenneth Jones type plasty, for within the same time a satisfactory result but with much less pain on removal of the extensor, tendinopathy, patellar pain and better mobility final.

Doctor Nicolas LEFEVRE. - 26 janvier 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

News

Injury prevention program and performance improvement: PEP program

By Dr. Yoann BOHU , Dr. Nicolas LEFEVRE , Dr. Serge HERMAN .

An injury prevention exercise program and improve the perforamnce for sports, PEP PROGRAM: Prevention injury and Enhance Performance

Read also ...

The most read articles

Technical cruciate ligament

By Dr. Nicolas Lefevre

More videos

Last publications

Feature: knee prosthesis

total knee replacement

Feature: knee ligaments

Dossier: Ambulatory Surgery ACL

Dossier: meniscus

MENISCUS 3D CRACK MENISCUS TEAR SURGERY SPORTS

Feature: Shoulder sportsman

Folder: hip prosthesis

Dossier: break hamstring

Dr. Lefevre proximal anatomie_ischio_jambier_rupture chirurgiedusport

Dossier: prosthetic and sports

hip replacement and knee and sports

Dossier: PRP

Chirurgiedusport - Who are we - Contact us - Legal Notice - Web design Digitaline - EMC2 Studio development - Clinique du Sport