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Return to sport after ACL reconstruction of the anterior knee ligament

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These three criteria will overlap in time.
 
 
1 criterion ANATOMY:
 
GRAFT LIGAMENT REPLACE BROKEN AND CONTROL THE knee laxity.
 
It takes at least 6 months for the graft to be considered effective and robust. And for at least 36 months after surgery, the graft is still evolving, gaining strength. Plasty when integrated in the knee became capable of undergoing new phenomena traction, stretching, and bring knees feeling of comfort, safety, strength in sports exercises. This step can be evaluated with clinical examination of the surgeon, the extent of laxity (TELOS, GNRB) and MRI.
 
2nd criterion FUNCTIONAL:
 
KNEE RECOVERED ITS MOBILITY AND STABILITY. THIGH A RECOVERED ITS STRENGTH, ENDURANCE AND ITS MUSCLE PUISSANE.
 
Another major factor is the recovery of proprioception, ie the knee's ability to properly respond to external constraints by adapting the neuro muscular response. It shows the example of the pulse quality on jumps or lateral movements on flat unstable form.
THE PROPRIOCEPTION is tested by a jump performed on each leg, called "SHT = Single Hop Test." A jump must have recovered 90% of the length compared to the healthy side.
We can evaluate the recovery of muscle strength with an analysis of a ISOKINETIC TEST. We must have recovered 90% of the strength of the quadriceps and hamstrings hamstrings from the side. Is measured at 60 ° / s, 240 ° quadriceps and 30 ° / s hamstrings hamstrings. These values ??are used to assess and correct the joint protection of the knee muscles and the risk of secondary muscle damage.
We must also take into account the range of motion of the hip joint that will protect the operated knee.
 
We also perform a psychological evaluation of the patient's recovery, the disappearance of apprehensions of return of confidence in him and in his knee. These psychological elements are predominant over all other muscular elements, ligament, rehabilitative, anatomic for the period and the level of return to sport.
 
Our team uses an Australian score, ACL-RSI score, developed by PR K Webster at La Trobe University in Melbourne. We have validated its use in French before offering it to our patients. This score indicates the psychological recovery level. Below 56%, patients have not resumed their sport. Beyond 80% they resumed their sport. That is not a recovery criterion is an independent objective evidence of other factors tracking for tracking athletic recovery.
Indeed, the physical resilience is not correlated with psychological capacities. With identical anatomical lesions, patients will be occasions sports activities in time and to totally different levels. The most striking example is that of professional athletes patients we operate and who take their sport more quickly than other patients.
 
 
3rd criterion: CRITERIA SPORTS:
 
IS THE TECHNICAL MANAGEMENT (physical trainer, coach) WHO MAKES THE DECISION.
 
Neither the doctor nor the therapist will determine the ability to practice a sport. The medical staff ensures no against indication. The knee and the patient are not prepared according to the aforementioned criteria the risk of breaking the graft. However, the ability to be involved in a sport is the responsibility of the technical sports frames. The recovery in competition is determined by the coaches and conditioning coach, is the technical supervision which determines whether or not the player's ability is applied once the first two steps perfectly validated.

 

Doctor Yoann BOHU, Doctor Nicolas LEFEVRE, Doctor Serge HERMAN. - 3 janvier 2015.

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

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