The Guide to Rehabilitation after Anterior Cruciate Ligament Reconstruction

First month after the surgery 30 minutes Cryotherapy knee brace, every two hours a day.
From 2 to 4 months, Cryotherapy knee brace 30 minutes three times a day.
Each cryotherapy session lasts 30 minutes only in a resting position.

Cryotherapy knee brace KNEEFREEZ® , Watch Instruction for Use:

REHABILITATION WITH PHYSIOTHERAPIST

>Standing D1 to D7

Standing D1 to D7: no orthesis, walk with 2 crutches until efficient quadriceps contractions then progressively withdrawal in 4 to 5 days. Thromboprophylaxis as local haset. Compression bands “Biflex” worn after the surgery. 3 first days on both legs. From the fourth day only on the operated leg from morning till evening. Resting at home without physiotherapy during one week. Walking for couple of minutes often.
Do it shortly is recommended during the first week (with crutches because of Quadriceps proficiently, thrombosis precautions).

Objective:

1. Analgesic
2. Anti-inflammatory
3. Quadriceps self-contractions

Rehabilitation program:
4000 isometric contractions per day.
No target on flexion recovery.

Possible issues:

• Knee hydarthrosis: cold therapy applied and resting
• Venous problem: consult the GP
• Scar problem: contact the surgeon

Self-Rehabilitation at HOME:
• Rest is essential
• Cryotherapy
• Quadriceps Contraction: fast & sustained (Picture 1)

Picture 1: the vastus medialis must contract efficiently like a ball.
The patella must rise & the patellar tendon tightens.

TO KNOW
• If despite the therapies, the pain is difficult to control, please we advise to contact your GP or surgeon’s assistants.
• Avoid standing and sitting extended stations.

>Step II : D7 to D21

D7 to D21: Physiotherapy from D7 to D21. 2 crutches could be used (if inefficient Quadriceps contractions) until the third week then progressively withdrawal in 4 to 5 days. Compression bands “Biflex” worn during 21 days after the surgery. From D7 to D21 only on the operated leg from morning till evening. It can be extended according to the surgeon’s recommendations.

Objective:

1. Walk without limping .
2. Recovery of joints mobility.
3. Healing of the collection site.
4. No orthesis.

Rehabilitation program:

• Cryotherapy after each sessions of Physiotherapy
• Patella motion, scar massages and around patella
• Articular amplitudes recovery
• End of the complete flexion recovery
• Intensify isometric by contracting quadriceps and hamstrings
• Improving walk exercises.
• Soft Articular lapping & painless (Picture 2)

Picture 2: sitting on the edge of the chair, foot of the operated side flat on the skate-board. Rolling the skate moving forward, by pressing the heel, then step back, by pressing the tiptoe

Possible issues:
Warm knee and hydarthrosis, important pains, recovery difficulties of articular amplitudes in all cases,
contact the surgeon.
TO KNOW
• Crutches including gradual withdrawal (2 crutches until the third week)
• Automobile driving at 21 days.
• Taking over the apartment bike at 45 days.
• Bike recovery on flat ground at 75 days.
• Resumption of swimming at 90 days by gradually including the legs.
• Recovery of bending: 100° at 21 days – 120° at 45 days.

>Step III : D21 to D90

Strength training & Reathleticism: muscles strengthening training and proprioception

Objective:

1. Starting running on flat ground with running shoes
2. Normal mobility compare to healthy side
3. Full trust on his knee
4. Good muscle control and self-defense reflex daily life.

Rehabilitation program:
Develop all isometric muscle types of work, eccentric, bearing closed chain. Isokinetic rehabilitation
Bearing proprioceptive work (on movable platen and trampoline) increasing difficulties to adapt to the pain
and reactive leakage
Swimming, cycling and running personal practice and reshaping

TO KNOW
• Running again at 4 months
• Isokinetic assessments at 6 months & return-to-sport 1
st evaluation.
• RTS at 8-9 months

>Step IV : at 8-9 months

Objective:

• Return to competition at 8-9 months

Athletes competitors program:
• Improvement of the weaknesses observed during Isokinetic test and proprioceptive tests,
intensify proprioception thanks to exercises more and more dynamics on various planes of the
space.
• Beginning of technical movement of the sport practice under strict control of the physiotherapist.
• Start competition program by practicing the gesture of the sport
• C.T. stat. of the operated knee to decide if return to sport training without physical contact at 6
month

Isokinetic checkup:
• Assessment of Quadriceps strength & hamstring, which allow to optimize
rehabilitation and return to the most traumatic sports.
• Comparative muscular assessment of both thighs; the objective forecasted is:
• 20% for quadriceps
• 10% for Hamstring

Single Leg hop Test:
• Unipodal length jump test
• Assessment on both sides, the objective forecasted is Deficit below 10%

Return-to-Sport:
• Sports training if criteria are met
• Sport competition at 8 months

FLYING

There is no universal agreement as to when it is safe to travel by plane after an ACL reconstruction. It seems that most Orthopaedic Surgeons advise their patients not to fly for 4 to 6 weeks following the ACL reconstruction.
Short flights do not seem to be a problem. However, long intercontinental flights are a potential problem as there is an increased incidence of spontaneous DVT (deep venous thrombosis), even in the young and healthy passengers.

Surgeon Profile

Johannes BARTH is an orthopaedic surgeon working in a private hospital in the Grenoble area. His main clinical interests are knee and shoulder arthroscopy with an emphasis on sports injuries. He did his residency in Grenoble, and his clinical fellowship with Dr. Pierre Chambat in Lyon, France (in 2001) where he also met Dr. Gilles Walch. He subsequently spent six months with Pr. Stephen Burkhart in San Antonio, Texas, USA (in 2003), as research fellow. He participated in the 2016 travelling-fellowship in Asia (APKASS) for ESSKA. He became a member of the Lyon School of Knee Surgery and the Burkhart Research Association of Shoulder Surgeon both involved in education, research, and meeting organization. He managed a project to build an institution exclusively dedicated to muscular and skeletal diseases from 2010 to 2013 and the Centre Ostéo-Articulaire des Cèdres (a 1,500 m2 facility) opened in October 2013. He is the president of the French Society of Arthroscopic and a member of the SOFCOT, ESSKA and ISAKOS. He has published several articles in peer-reviewed journals and is a reviewer of the AJSM, OJSM, JSES, OTSR, and IJSS. He is operating approximately five hundred cases per year (including forty shoulder arthroplasties, two hundred rotator cuff repair, eighty shoulder instabilities, one hundred fifty ACLs and PCLs). He started a clinical and research fellowship program in 2012 involving Resident or surgeon from E.U. and over-seas. He manages a yearly fellowship (one fellow for a one-year period, minimum six months) to allow the transmission of technical skills and where the fellow is expected to assist in all aspects of the profession (e.g. surgery, scientific research, etc.).

Affiliations

• President of the French society of Arthroscopy (SFA) (2021);
• Member of the French society of Orthopaedic and Traumatology surgeries (SOFCOT);
• Member of the European society of the Shoulder and the Elbow (ESSSE-SECEC);
• Member of the European Society of Sport Traumatology Knee Surgery andArthroscopy (ESSKA);
• Member of the International Society of Arthroscopy, Knee surgery and Orthopaedic Sports Medicine (ISAKOS);
• Reviewer of peer-reviewed journals (AJSM, OJSM, JSES…)

Specialty

Sport traumatology & surgery, Knee surgery (arthroscopy, meniscal repair, ACL Reconstruction) Shoulder surgery (Rotator Cuff Repair, Shoulder prothesis).

Languages spoken

• French
• English
• German

CENTER DETAILS

Established in 2013, Clinique Ostéo-Articulaire des Cèdres has developed an excellent reputation as a well renowned Centre of Excellence (CoE) for sports medicine based in Echirolles, Grenoble.
The clinic isfully equippedwitha comprehensive imaging suite andboasts aselect groupofspecialists inthe fieldofsports medicine, orthopaedic, physiotherapists, nurses, orthotist, and radiology. Within the field of sports medicine, Clinique du Sport not only specialises in sports related surgery but also incorporates facilities that provide medical monitoring for high-level athletes, including rehabilitation monitoring, psychological and cardiological assessments as well as injury prevention pathways.

Publications

► The „Jardé” Law: The shambles threatening to kill off clinical research in France. How to reconcile clinical research with data protection, informed consent and scientific rigor? Barth J., Bauer T, Sonnery-Cottet B.Orthop Traumatol Surg Res. 2020 Dec;106(8S):S181-S182.
► Prospective study of tendon healing and functional gain after arthroscopic repair of isolated supraspinatus tear, Bagheri N, Bonnevialle N, Gallinet D, Barth J, Labattut L, Metais P, Godeneche A, Garret J, Clavert P, Fatras-Meyer I, Collin P; Francophone Arthroscopy Society. ,Orthop Traumatol Surg Res.
2020 Dec;106(8S):S201-S206.
► Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study Gallinet D, Barth J, Labattut L, Collin P, Metais P, Bonnevialle N, Godeneche A, Garret J, Clavert P; Francophone Arthroscopy Society (SFA). Orthop Traumatol Surg
Res. 2020 Dec;106(8S):S207-S211.
► Increased T2 signal intensity in the distal clavicle does not justify acromioclavicular resection arthroplasty during rotator cuff repair. Métais P, Gallinet D, Labattut L, Godenèche A, Barth J, Collin P, Bonnevialle N, Garret J, Clavert P; Francophone Arthroscopy Society (SFA) Orthop Traumatol Surg Res. 2020 Dec;106(8S):S217-S222.
► Arthroscopic Trillat Procedure: A Guided Technique. Swan J, Boileau P, Barth J. Arthrosc Tech. 2020 Apr 23;9(4):e513-e519.
► Superior Capsular Reconstruction With the Long Head of the Biceps Autograft Prevents Infraspinatus Retear in Massive Posterosuperior Retracted Rotator Cuff Tears. Barth J, Olmos MI, Swan J, Barthelemy R, Delsol P, Boutsiadis A. Am J Sports Med. 2020 Apr 8:363546520912220.
► How to Succeed in Arthroscopic Anterior Cruciate Ligament Primary Repair? Step-by-Step Technique. Olmos MI, Sonnery-Cottet B, Barth J. Arthrosc Tech. 2018 Dec 17;8(1):e37-e46.
► Influence of uncemented humeral stem proximal geometry on stress distributions and torsional stability following total shoulder arthroplasty. Barth J, Garret J, Geais L, Bothorel H, Saffarini M; Shoulder Friends Institute, Godenèche A.; J Exp Orthop. 2019 Feb 25;6(1):8

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