mercoledì 8 maggio 2013

Rehabilitative protocol after an intervention of reconstruction of the Anterior Cruciate Ligament (ACL): application of CPM devices

Reconstruction of the Anterior Cruciate Ligament (ACL)
Use of Continuous passive motion (CPM) devices in the first weeks after the intervention.
Injuries of the Anterior Cruciate Ligament (ACL - picture 1) are very frequent in sport field, and often they happen together with meniscu's fractures and others ligamental structures (Posterior Cruciate Ligament or Exterior Cruciate Ligament), with reference to different faces of the trauma.
Picture 1
ACL injury can not be easily referred to precise cinetics outlines, due to the wide variety of traumatic events. Generally, it's possible to affirm that injury mechanisms result as a combination of different stresses at knee level: some examples are in valgus-flexion external rotation, in varus-flexion internal rotation, in varus or valgus with extended knee and so on. 
In the acute injury of ACL (picture 2), patient often complain an intense pain which go with a "crak" sensation, and clinically, it's possible to observe a behaviour in smooth flexion of the knee, functional impotence, tumefaction and articular instability, which can be underlined with some test (of the "anterior drawer", Jerk test, Lanchman test).
Picture 2
The election's treatment in ACL fractures, it's the surgical intervention of reconstruction which forecast a transplant of the new structure, with osteosynthesis screws, using part of the kneecap's tendon (more frequent) or those of the semi-tendon.
After this intervention, it's necessary to follow a specific rehabilitative program so as the patient recover the physical level present before the injury.
In order to facilitate the post-operative recover, it's suggested to have a good activity at the gym for almost one month before the intervention, as described here below:
- At least one month before the intervention, exercises and activities at the gym for muscle strengthening, with growing loads;
- If it's possible, have an isocinetics muscle valutation test;
- Accurate education of the patient about the intervention's methodology and about the time of recovery in the post-operative period;
The targets during this period are especially related to the reduction of hematoma and of the infiammation and a first recovery of the articular travel.
The most important steps are:
a) mobilization of the kneecap;
b) Passive mobilization  (with CPM) of the knee, at least up to 90°: in this case, is compulsory to be prudent and not exceed from the maximum load recommended.
Fisiotek CPM devices have an internal sensor which notices if the patient apply an opposite resistance (load) to the movement, reversing it to the lower limit set.
c) Isometric contractions for quadriceps and flexors;
d) beginning of the deambulation (partial and progressive), with canadians crutches from the first post-operative day;
PREMATURE PERIOD (5th - 30th day)
In this phase, the objectives are the recovery of the complete articular range, the prevention of the muscular atrophy and the recovery of deambulation without aids.
a) application of a growing load; within the 15th day, reaching of the full load;
b) Passive mobilization (with CPM) of the knee, over 90°: it's always recommended to be prudent, in order to not force the articulation.
All Fisiotek CPM devices have an handheld remote control with Start&Stop button, used to control the movement.
c) Isometric exercises at 30° - 60° - 90°, elevation with the knee locked and growing weights at the ankle;
d) stretching;
e) cyclette;
f) proprioceptive recover only with the kinetics chain closed;
g) exercises for muscle strengthening only with the kinetics chain closed;
h) possible exercises in water (avoid the frog-style);
After this period, it lefts a middle (31st - 60th day), an advanced (61st - 90th day) and a final step (91st - 150th day) where the patient have to recover the muscular tone, the agility and the sport's movement.
Even if passive rehabilitation represents a small part of all the rehabilitative program, it's very important for a correct recovery of the joint mobility: it's important to remember that passive mobilization is more accurate if done by a CPM device, and not manually, because the device has a software and features already programmed for that precise movement.
Our range of CPM devices are studied in order to cover all the needs in case of injury or fracture, from hip to ankle, and from shoulder to wrist.
What do you think about Fisiotek CPM mobilizers? Have you ever had experience with one of them?
Discuss your experience and leave a comment!

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