By professor Rosario Bellia
Stabilization protocol in the after-effects of partial or post-operative injury of the anterior cruciate ligament
Knee sprains are among the most frequent injuries found in the practice of sports medicine, especially in some sports such as skiing, soccer, basketball, volleyball and rugby. The diagnosis of these lesions must be made with precision and rapidity, in order not to pass to an irreversible lesion that will inexorably lead the sportsman to a chronic instability of the knee, often responsible in the long term for secondary arthrosis.
Traumatic mechanism and etipatogenesis
a) trauma in internal varus-rotation, may be associated with ACL injury also rupture of the external tibial plateau, anterolateral ligament and external meniscus;
b) trauma in external valgus-rotation, often associated with ACL injury and also to that of the internal collateral ligament and oblique posterior ligament;
c) Hyperextension causes an isolated ACL lesion;
d) An abrupt contraction of the quadriceps which, leading to an anterior subluxation of the tibial plates, leads to the lesion (in the ski).
Here's how the moment of the Tessa trauma, national triathlete, recalls during a phase of obstacle course training, he says:
"in the phase of supporting the foot of the first leg after crossing the obstacle, in the transfer of the load I felt a sensation that the knee went backwards, as if it came out of place with a violent crack and a strong pain-heat to miss the after I collapsed and when I tried to get back up, my knee didn't support me anymore, after a few minutes the pain faded, gave way to a general soreness and a lack of strength. "Next day the knee was swollen, painful and with a sense of instability. First an objective diagnosis of suspected lesion and after MRI confirmed the diagnosis of complete isolated ACL."
The diagnosis
The diagnosis is based on an accurate medical history followed by an objective examination, which unfortunately due to pain and analgesic muscle contracture is often poor, but always sufficient to indicate the type of conservative or surgical treatment. The history of an acute "severe" ligamentous lesion, with impaired ACL, is based on some fundamental points:
a) the type of traumatic mechanism
b) the crack perceived by the patient is often associated with the feeling that the knee has gone out of place and is back in place
c) the failure that frequently occurs when the patient rises from the ground, after the first trauma, warns trying to load again on the traumatized knee
d) the appearance of an immediate payment or a few hours after the trauma.
It is based on the positivity of some tests of which the most important and significant is the Lachman, in addition to the Jerk test (or pivot shift), which is a dynamic test.
With great interest I have revised from the technical-methodological point of view an intuition of a young colleague-student, but very brilliant, Dr. Andrea Conti di Terni, who suggested some parts of this bandage for the anterior knee instability.
From a physiotherapeutic point of view, in addition to the specific muscle strengthening protocol and a proprioceptive re-education program for global reprogramming, the proposed bandage can be used.
Furthermore, this bandage mode can be used synergistically for a stabilization of the anterior drawer, consisting of: two I at 50% tension in the central part with anchorage to the femoral condyles, and in the femoral flexors a Y in functional correction, passing through the cable popliteal.
This technique becomes even more effective if it is realized with the Linear tape of the company
Kinesiology® taping trajectories to counteract the unstable anterior knee drawer. The Application is shown on a Kick boxing professional in Bolzano and a national triathlete.
The elastic tapes used for the studio applications are Kinsiotape and Linear of the company: Visiocare Srl. Vedano al Lambro (MI)
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