Cruciate - rehab
Submitted by admin on March 13, 2008 - 8:36pm.
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Rehabilitation is of major importance in the success of cruciate ligament surgery. What one needs to remember in planning rehabilitation after cruciate ligament surgery is that every single graft used today, whether natural or synthetic, from your own body or someone else's, lacks a blood supply when it is inserted during surgery. The first period of rehabilitation concentrates on preventing the formation of adhesions (internal scars) inside the knee - using the CPM (continuous passive motion) machine post op (passive mobilisation), icing to reduce inflammation - and just watching out for any immediate complications like infection. The knee will be uncomfortable because of the graft harvest as much as the actual graft insertion, and initially only gentle active work will be allowed - eg hydrotherapy - to slowly mobilise the joint actively. As with everything to do with knee work, initial muscle attention focuses on keeping strength in the quads muscle as it is so very sensitive to early inhibition - so straight leg raising, quads sets etc in bed. One of the problems of cruciate rehab is that 'proprioception' is altered, i.e. the feeling of where your joint is and what it is doing. So there is quite a lot of emphasis on re-educating the leg with balance exercises - wobble-boards and the like. |
Rehab issues of different types of graft
In an autograft your own patellar tendon or hamstrings tendon is disconnected from its blood supply when the graft is harvested. The blood vessels have to regrow into the harvested tendon from the ends, and find their way towards the middle. During this 'revascularisation' the graft is unable to alter to strengthen itself and is vulnerable to breaking.
An allograft is taken from a dead person, and the tissue is treated and stored, so the blood vessels again have to grow in and vascularise the graft.
Synthetic ligaments were used before patellar tendon and hamstrings came into vogue. There is not much of an issue of revascularisation here as the materials used are very strong (eg polyethylene and carbon fibre), although certain synthetic ligaments did act as a scaffold to encourage growth of new ligament material. This phase of surgical development encouraged the attitude that early rehabilitation to contact sports was possible, and this attitude has carried over into the modern surgical techniques. Thus there are surgeons who encourage 'aggressive rehabilitation' and others who advocate a more cautious approach. That is why it is dangerous to put a rehab protocol onto the internet - each surgeon uses different techniques and fixation devices and has different rehab protocols - and it is important to listen to your own surgeon as he will know what works in his group of patients.
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