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La stabilité du genou, indispensable à son bon fonctionnement est assurée par :",{"type":126,"children":146},[147],{"text":148,"type":130},"– les ligaments latéraux situés de part et d’autre du genou",{"type":126,"children":150},[151],{"text":152,"type":130},"– les ligaments croisés, antérieur et postérieur, situés au milieu du genou et constituant ce qu’on appelle le pivot central",{"type":126,"children":154},[155],{"text":140,"type":130},{"type":126,"children":157},[158],{"text":159,"type":130},"Le rôle principal du Ligament Croisé Antérieur est de lutter contre le tiroir antérieur, c’est à dire la translation antérieure du tibia sous le fémur",{"type":126,"children":161},[162],{"text":163,"type":130},"La rupture du LCA : Conséquences",{"type":126,"children":165},[166],{"text":140,"type":130},{"type":126,"children":168},[169],{"text":170,"type":130},"L’entorse grave du genou avec rupture du Ligament Croisé Antérieur a lieu le plus souvent lors d’un traumatisme sportif. C’est « en se tordant le genou », c’est à dire par un traumatisme indirect du genou, que l’on se rompt le Ligament.",{"type":126,"children":172},[173],{"text":140,"type":130},{"type":126,"children":175},[176],{"text":177,"type":130},"Le plus souvent les patients ressentent un dérobement du genou, une douleur vive, et ont un gros genou.",{"type":126,"children":179},[180],{"text":140,"type":130},{"type":126,"children":182},[183],{"text":140,"type":130},{"type":126,"children":185},[186],{"text":187,"type":130},"L’examen clinique suffit le plus souvent pour faire le diagnostic. L’IRM est un complément indispensable pour confirmer le diagnostic, et surtout pour faire un bilan complet du genou à la recherche notamment de lésions méniscales associées.",{"type":126,"children":189},[190],{"text":140,"type":130},{"type":126,"children":192},[193],{"text":194,"type":130},"L’absence de ligament croisé antérieur expose le patient à plusieurs risques :",{"type":126,"children":196},[197],{"text":198,"type":130},"– la survenue d’accidents d’instabilité, c’est à dire de dérobements du genou suivis de douleurs et d’épanchements. La survenue de ces accidents empêche la pratique du sport, notamment des sports de pivot comme le football.",{"type":126,"children":200},[201],{"text":202,"type":130},"– à long terme, le genou va s’altérer, et il est actuellement prouvé scientifiquement que la rupture du LCA engendre l’arthrose.",{"type":132,"level":133,"children":204},[205],{"text":206,"type":130},"La chirurgie ligamentaire",{"type":208,"image":209,"children":238},"image",{"ext":210,"url":211,"hash":212,"mime":213,"name":214,"size":215,"width":216,"height":217,"caption":218,"formats":219,"provider":236,"createdAt":237,"updatedAt":237,"previewUrl":218,"alternativeText":214,"provider_metadata":218},".jpg","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL1_7531f1b263.jpg","L1_7531f1b263","image\u002Fjpeg","L1.jpg",10.44,269,519,null,{"small":220,"thumbnail":228},{"ext":210,"url":221,"hash":222,"mime":213,"name":223,"path":218,"size":224,"width":225,"height":226,"sizeInBytes":227},"\u002Fuploads\u002Fsmall_L1_7531f1b263.jpg","small_L1_7531f1b263","small_L1.jpg",10.17,259,500,10171,{"ext":210,"url":229,"hash":230,"mime":213,"name":231,"path":218,"size":232,"width":233,"height":234,"sizeInBytes":235},"\u002Fuploads\u002Fthumbnail_L1_7531f1b263.jpg","thumbnail_L1_7531f1b263","thumbnail_L1.jpg",2.23,81,156,2230,"local","2024-08-08T17:32:17.913Z",[239],{"text":140,"type":130},{"type":208,"image":241,"children":257},{"ext":210,"url":242,"hash":243,"mime":213,"name":244,"size":245,"width":246,"height":247,"caption":218,"formats":248,"provider":236,"createdAt":256,"updatedAt":256,"previewUrl":218,"alternativeText":244,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL2_3a75b87bb0.jpg","L2_3a75b87bb0","L2.jpg",8.77,308,330,{"thumbnail":249},{"ext":210,"url":250,"hash":251,"mime":213,"name":252,"path":218,"size":253,"width":254,"height":234,"sizeInBytes":255},"\u002Fuploads\u002Fthumbnail_L2_3a75b87bb0.jpg","thumbnail_L2_3a75b87bb0","thumbnail_L2.jpg",3.29,146,3285,"2024-08-08T17:32:17.792Z",[258],{"text":140,"type":130},{"type":126,"children":260},[261],{"text":140,"type":130},{"type":126,"children":263},[264],{"text":265,"type":130},"La décision d’une intervention se fait au cas par cas, en fonction de nombreux critères : l’âge, les activités sportives et professionnelles, les lésions associées, etc.",{"type":126,"children":267},[268],{"text":140,"type":130},{"type":126,"children":270},[271],{"text":272,"type":130},"La suture d’un ligament croisé est inefficace, car, une fois rompu, le ligament ne peut pas cicatriser. Il faut donc remplacer le LCA rompu : c’est ce qu’on appelle une ligamentoplastie.",{"type":126,"children":274},[275],{"text":140,"type":130},{"type":126,"children":277},[278],{"text":279,"type":130},"Les ligaments artificiels ont toujours donné des échecs jusqu’à présent, et ne sont donc plus utilisés.",{"type":126,"children":281},[282],{"text":140,"type":130},{"type":126,"children":284},[285],{"text":286,"type":130},"On utilise une autogreffe tendineuse, c’est à dire que l’on prélève un tendon qui va remplacer le ligament rompu. Grossièrement il existe deux techniques différentes :",{"type":126,"children":288},[289],{"text":140,"type":130},{"type":126,"children":291},[292],{"text":140,"type":130},{"type":132,"level":107,"children":294},[295,297],{"text":296,"type":130},"–",{"bold":298,"text":299,"type":130},true," la technique du tendon rotulien (Kenneth Jones)",{"type":126,"children":301},[302],{"text":303,"type":130},"C’est une partie du tendon rotulien qui sera prélevé (environ 1\u002F3) et qui permettra de remplacer le LCA. Par une courte incision qui part de la pointe de la rotule jusqu’au sommet de la tubérosité tibiale on prélève le tiers du tendon rotulien avec ses attaches osseuses. La suite de l’intervention se déroule sous arthroscopie : on introduit une caméra dans l’articulation qui va permettre de faire un bilan complet (ménisques et cartilages). Les reliquats du LCA lésé sont enlevés, puis le transplant tendineux et mis en place exactement au même endroit que l’ancien ligament. Il est fixé par des systèmes bio résorbables, c’est à dire non métalliques.",{"type":132,"level":107,"children":305},[306],{"text":140,"type":130},{"type":208,"image":308,"children":331},{"ext":210,"url":309,"hash":310,"mime":213,"name":311,"size":312,"width":313,"height":314,"caption":218,"formats":315,"provider":236,"createdAt":330,"updatedAt":330,"previewUrl":218,"alternativeText":311,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL3_4c6abe386c.jpg","L3_4c6abe386c","L3.jpg",18.6,381,523,{"small":316,"thumbnail":323},{"ext":210,"url":317,"hash":318,"mime":213,"name":319,"path":218,"size":320,"width":321,"height":226,"sizeInBytes":322},"\u002Fuploads\u002Fsmall_L3_4c6abe386c.jpg","small_L3_4c6abe386c","small_L3.jpg",17.29,364,17292,{"ext":210,"url":324,"hash":325,"mime":213,"name":326,"path":218,"size":327,"width":328,"height":234,"sizeInBytes":329},"\u002Fuploads\u002Fthumbnail_L3_4c6abe386c.jpg","thumbnail_L3_4c6abe386c","thumbnail_L3.jpg",3.04,114,3044,"2024-08-08T17:32:17.868Z",[332],{"text":140,"type":130},{"type":208,"image":334,"children":350},{"ext":210,"url":335,"hash":336,"mime":213,"name":337,"size":338,"width":339,"height":340,"caption":218,"formats":341,"provider":236,"createdAt":349,"updatedAt":349,"previewUrl":218,"alternativeText":337,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL4_42ea05fce4.jpg","L4_42ea05fce4","L4.jpg",10.7,287,410,{"thumbnail":342},{"ext":210,"url":343,"hash":344,"mime":213,"name":345,"path":218,"size":346,"width":347,"height":234,"sizeInBytes":348},"\u002Fuploads\u002Fthumbnail_L4_42ea05fce4.jpg","thumbnail_L4_42ea05fce4","thumbnail_L4.jpg",2.9,109,2897,"2024-08-08T17:32:17.818Z",[351],{"text":140,"type":130},{"type":126,"children":353},[354],{"text":140,"type":130},{"type":126,"children":356},[357,358,360],{"text":296,"type":130},{"bold":298,"text":359,"type":130}," la technique des tendons des muscles ischio-jambiers (DIDT)",{"text":361,"type":130}," Les tendons prélevés sont les tendons des muscles droit interne et demi tendineux. Pour ce faire, on pratique une courte incision à la partie interne du tibia. Le reste de l’intervention est identique à celle précédemment décrite.",{"type":126,"children":363},[364],{"text":140,"type":130},{"type":208,"image":366,"children":389},{"ext":210,"url":367,"hash":368,"mime":213,"name":369,"size":370,"width":371,"height":372,"caption":218,"formats":373,"provider":236,"createdAt":388,"updatedAt":388,"previewUrl":218,"alternativeText":369,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL5_4973547b9b.jpg","L5_4973547b9b","L5.jpg",15.1,355,532,{"small":374,"thumbnail":381},{"ext":210,"url":375,"hash":376,"mime":213,"name":377,"path":218,"size":378,"width":379,"height":226,"sizeInBytes":380},"\u002Fuploads\u002Fsmall_L5_4973547b9b.jpg","small_L5_4973547b9b","small_L5.jpg",13.71,334,13712,{"ext":210,"url":382,"hash":383,"mime":213,"name":384,"path":218,"size":385,"width":386,"height":234,"sizeInBytes":387},"\u002Fuploads\u002Fthumbnail_L5_4973547b9b.jpg","thumbnail_L5_4973547b9b","thumbnail_L5.jpg",2.57,104,2565,"2024-08-08T17:32:17.468Z",[390],{"text":140,"type":130},{"type":208,"image":392,"children":408},{"ext":210,"url":393,"hash":394,"mime":213,"name":395,"size":396,"width":397,"height":398,"caption":218,"formats":399,"provider":236,"createdAt":407,"updatedAt":407,"previewUrl":218,"alternativeText":395,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL6_19c1c2d162.jpg","L6_19c1c2d162","L6.jpg",8.82,297,373,{"thumbnail":400},{"ext":210,"url":401,"hash":402,"mime":213,"name":403,"path":218,"size":404,"width":405,"height":234,"sizeInBytes":406},"\u002Fuploads\u002Fthumbnail_L6_19c1c2d162.jpg","thumbnail_L6_19c1c2d162","thumbnail_L6.jpg",2.7,124,2703,"2024-08-08T17:32:17.393Z",[409],{"text":140,"type":130},{"type":126,"children":411},[412],{"text":413,"type":130}," Rééducation après ligamentoplastie du genou",{"type":132,"level":12,"children":415},[416],{"text":417,"type":130},"A) Mise en garde :",{"type":126,"children":419},[420],{"text":140,"type":130},{"type":126,"children":422},[423],{"text":424,"type":130},"Toute opération chirurgicale ne se décide pas « à la légère » ; la ligamentoplastie du genou en particulier.",{"type":126,"children":426},[427],{"text":428,"type":130},"Conscient des risques inhérents à la chirurgie et à l’anesthésie, le résultat d’une ligamentoplastie dépendra de « votre état psychologique » en vue de cet acte, de votre capacité à investir du temps dans la rééducation post-chirurgicale.",{"type":126,"children":430},[431],{"text":140,"type":130},{"type":126,"children":433},[434],{"text":435,"type":130},"En clair, ne décidez pas d’une ligamentoplastie si pour une raison quelconque vous êtes angoissés, stressés, « déprimés » et\u002Fou vous ne pourrez pas consacrer entre six à huit mois à la rééducation post-opératoire. Vous risqueriez, en effet, malgré un geste chirurgical parfait de provoquer des problèmes articulaires, tissulaires pouvant être irréversibles.",{"type":126,"children":437},[438],{"text":140,"type":130},{"type":126,"children":440},[441],{"text":442,"type":130},"La décision d’une ligamentoplastie sera donc le fruit d’une discussion avec votre chirurgien orthopédique et votre médecin du sport traumatologue ou rééducateur qui vous suivront tout au long de votre « marathon rééducatif »",{"type":132,"level":12,"children":444},[445],{"text":446,"type":130},"B) Objectif de la rééducation :",{"type":126,"children":448},[449],{"text":140,"type":130},{"type":126,"children":451},[452],{"text":453,"type":130},"Récupérer un genou aussi « performant » qu’avant l’opération.",{"type":132,"level":12,"children":455},[456],{"text":457,"type":130},"C) La rééducation : ",{"type":208,"image":459,"children":493},{"ext":460,"url":461,"hash":462,"mime":463,"name":464,"size":465,"width":466,"height":467,"caption":218,"formats":468,"provider":236,"createdAt":492,"updatedAt":492,"previewUrl":218,"alternativeText":464,"provider_metadata":218},".png","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL7_dec5acc87d.png","L7_dec5acc87d","image\u002Fpng","L7.png",49.19,787,192,{"small":469,"medium":476,"thumbnail":484},{"ext":460,"url":470,"hash":471,"mime":463,"name":472,"path":218,"size":473,"width":226,"height":474,"sizeInBytes":475},"\u002Fuploads\u002Fsmall_L7_dec5acc87d.png","small_L7_dec5acc87d","small_L7.png",90.81,122,90806,{"ext":460,"url":477,"hash":478,"mime":463,"name":479,"path":218,"size":480,"width":481,"height":482,"sizeInBytes":483},"\u002Fuploads\u002Fmedium_L7_dec5acc87d.png","medium_L7_dec5acc87d","medium_L7.png",186.98,750,183,186981,{"ext":460,"url":485,"hash":486,"mime":463,"name":487,"path":218,"size":488,"width":489,"height":490,"sizeInBytes":491},"\u002Fuploads\u002Fthumbnail_L7_dec5acc87d.png","thumbnail_L7_dec5acc87d","thumbnail_L7.png",24.14,245,60,24141,"2024-08-08T17:32:18.029Z",[494],{"text":140,"type":130},{"type":126,"children":496},[497],{"text":140,"type":130},{"type":126,"children":499},[500,502,504],{"text":501,"type":130}," 1",{"bold":298,"text":503,"type":130},") les 2 premiers mois",{"text":505,"type":130}," : récupérer une marche normale",{"type":126,"children":507},[508],{"text":140,"type":130},{"type":126,"children":510},[511],{"text":512,"type":130},"– éliminer rapidement le gonflement et l’inflammation du genou",{"type":126,"children":514},[515],{"text":516,"type":130},"– marche sous couvert de cannes anglaises et d’une attelle amovible",{"type":126,"children":518},[519],{"text":520,"type":130},"– récupération rapide de l’extension et de la flexion à 90°",{"type":126,"children":522},[523],{"text":524,"type":130},"– détente, réveil musculaire du quadriceps par le biais de contractions isométriques",{"type":126,"children":526},[527],{"text":528,"type":130},"– travail de verrouillage du genou en chaîne fermée",{"type":126,"children":530},[531],{"text":532,"type":130},"– travail de presse 0°-20° de flexion",{"type":208,"image":534,"children":550},{"ext":210,"url":535,"hash":536,"mime":213,"name":537,"size":538,"width":539,"height":540,"caption":218,"formats":541,"provider":236,"createdAt":549,"updatedAt":549,"previewUrl":218,"alternativeText":537,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL8_cd8fb80037.jpg","L8_cd8fb80037","L8.jpg",6.2,172,179,{"thumbnail":542},{"ext":210,"url":543,"hash":544,"mime":213,"name":545,"path":218,"size":546,"width":547,"height":234,"sizeInBytes":548},"\u002Fuploads\u002Fthumbnail_L8_cd8fb80037.jpg","thumbnail_L8_cd8fb80037","thumbnail_L8.jpg",5.12,150,5116,"2024-08-08T17:32:17.281Z",[551],{"text":140,"type":130},{"type":126,"children":553},[554,556,558],{"text":555,"type":130}," 2)",{"bold":298,"text":557,"type":130}," 3ème mois",{"text":559,"type":130}," : période de fragilité « du nouveau ligament croisé antérieur ». Utilisation symétrique de votre genou.",{"type":126,"children":561},[562],{"text":140,"type":130},{"type":126,"children":564},[565],{"text":566,"type":130},"Si le genou le permet (plus d’inflammation), reprise possible de l’activité professionnelle en fonction des contraintes physiques imposées par celle-ci.",{"type":126,"children":568},[569],{"text":140,"type":130},{"type":126,"children":571},[572],{"text":573,"type":130},"Nous rechercherons la symétrie parfaite du geste lors de la marche, de la course à pied sur terrain stabilisé et plat, du vélo et de la natation (crawl uniquement).",{"type":126,"children":575},[576],{"text":140,"type":130},{"type":126,"children":578},[579],{"text":580,"type":130},"Compte tenu de la fragilité du « néo-ligament », la musculation, à proprement parler, du quadriceps en leg (assis sur un fauteuil et soulèvement de charges) est interdite. Seule des techniques isométriques et dynamiques dites en chaînes fermées seront effectuées.",{"type":126,"children":582},[583],{"text":140,"type":130},{"type":126,"children":585},[586],{"text":587,"type":130},"De même les exercices dits de proprioception (travail permettant de maîtriser et corriger les positions d’instabilité d’une articulation dans l’espace) devront être effectués de préférence couchés ou assis.",{"type":126,"children":589},[590],{"text":140,"type":130},{"type":126,"children":592},[593,595,597],{"text":594,"type":130},"3)",{"bold":298,"text":596,"type":130}," à partir du 4ème mois ",{"text":598,"type":130},": solidité suffisante du néo-ligament, priorité au renforcement musculaire.",{"type":208,"image":600,"children":605},{"ext":460,"url":461,"hash":462,"mime":463,"name":464,"size":465,"width":466,"height":467,"caption":218,"formats":601,"provider":236,"createdAt":492,"updatedAt":492,"previewUrl":218,"alternativeText":464,"provider_metadata":218},{"small":602,"medium":603,"thumbnail":604},{"ext":460,"url":470,"hash":471,"mime":463,"name":472,"path":218,"size":473,"width":226,"height":474,"sizeInBytes":475},{"ext":460,"url":477,"hash":478,"mime":463,"name":479,"path":218,"size":480,"width":481,"height":482,"sizeInBytes":483},{"ext":460,"url":485,"hash":486,"mime":463,"name":487,"path":218,"size":488,"width":489,"height":490,"sizeInBytes":491},[606],{"text":140,"type":130},{"type":126,"children":608},[609],{"text":610,"type":130}," – mesure du déficit de force musculaire du quadriceps côté opéré par rapport à celui du côté « sain » grâce au test de Cybex",{"type":126,"children":612},[613],{"text":614,"type":130},"– renforcement musculaire jusqu’à combler le déficit",{"type":126,"children":616},[617],{"text":618,"type":130},"– intensification de la course à pied, piscine, vélo, sports dans l’axe pour améliorer la forme physique.",{"type":126,"children":620},[621],{"text":140,"type":130},{"type":126,"children":623},[624],{"text":140,"type":130},{"type":126,"children":626},[627],{"text":628,"type":130},"Attention : une mauvaise forme physique, ainsi qu’une compensation du travail du genou opéré sur le genou sain peut avoir pour conséquence « tragique » une rupture du ligament croisé antérieur côté sain ou bien une rupture du néo-ligament.",{"type":126,"children":630},[631],{"text":632,"type":130},"– proprioception ( planche d’instabilité , tampoline …..)",{"type":208,"image":634,"children":650},{"ext":210,"url":635,"hash":636,"mime":213,"name":637,"size":638,"width":639,"height":640,"caption":218,"formats":641,"provider":236,"createdAt":649,"updatedAt":649,"previewUrl":218,"alternativeText":637,"provider_metadata":218},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002FL10_defca40ead.jpg","L10_defca40ead","L10.jpg",9.45,197,271,{"thumbnail":642},{"ext":210,"url":643,"hash":644,"mime":213,"name":645,"path":218,"size":646,"width":647,"height":234,"sizeInBytes":648},"\u002Fuploads\u002Fthumbnail_L10_defca40ead.jpg","thumbnail_L10_defca40ead","thumbnail_L10.jpg",4.6,113,4599,"2024-08-08T17:32:17.279Z",[651],{"text":140,"type":130},"2024-08-08T17:28:40.445Z","2024-10-19T13:38:41.968Z","2024-08-08T17:39:14.882Z",[656,660,664,667,671,675,679,682,686,690,693,697,700,704,707,710,714,717,721,725,729,733,740,746,749,753,756,760,763,767,770,774,777,780,785,789,792,799,805,808,815,818,825,831,835,839,842,846,850,853,857,860,864,868,871,875,879,887,890,898,901,905,909,913,917,921,925,931,939,942,946,949,953,956,960,963,967,970,977,985,989,993,997,1000,1003,1007,1011],{"type":126,"children":657},[658],{"text":659,"type":130},"The stability of the knee, essential for its proper functioning, is ensured by the ligaments…",{"type":132,"level":133,"children":661},[662],{"text":663,"type":130},"Anatomy",{"type":126,"children":665},[666],{"text":140,"type":130},{"type":126,"children":668},[669],{"text":670,"type":130},"The knee is made up of three bones: the femur, the tibia and the patella. The stability of the knee, essential for its proper functioning, is ensured by:",{"type":126,"children":672},[673],{"text":674,"type":130},"– the lateral ligaments located on either side of the knee",{"type":126,"children":676},[677],{"text":678,"type":130},"– the cruciate ligaments, anterior and posterior, located in the middle of the knee and constituting what is called the central pivot",{"type":126,"children":680},[681],{"text":140,"type":130},{"type":126,"children":683},[684],{"text":685,"type":130},"The main role of the Anterior Cruciate Ligament is to fight against the anterior drawer, that is to say the anterior translation of the tibia under the femur",{"type":126,"children":687},[688],{"text":689,"type":130},"ACL rupture: Consequences",{"type":126,"children":691},[692],{"text":140,"type":130},{"type":126,"children":694},[695],{"text":696,"type":130},"Serious knee sprains with rupture of the Anterior Cruciate Ligament most often occur during sports trauma. It is “by twisting the knee”, that is to say by indirect trauma to the knee, that we rupture the Ligament.",{"type":126,"children":698},[699],{"text":140,"type":130},{"type":126,"children":701},[702],{"text":703,"type":130},"Most often patients feel a giving way in the knee, severe pain, and have a bad knee.",{"type":126,"children":705},[706],{"text":140,"type":130},{"type":126,"children":708},[709],{"text":140,"type":130},{"type":126,"children":711},[712],{"text":713,"type":130},"The clinical examination is most often sufficient to make the diagnosis. MRI is an essential complement to confirm the diagnosis, and especially to carry out a complete assessment of the knee, looking in particular for associated meniscal lesions.",{"type":126,"children":715},[716],{"text":140,"type":130},{"type":126,"children":718},[719],{"text":720,"type":130},"The absence of the anterior cruciate ligament exposes the patient to several risks:",{"type":126,"children":722},[723],{"text":724,"type":130},"– the occurrence of instability accidents, i.e. knee collapse followed by pain and effusions. The occurrence of these accidents prevents the practice of sport, particularly pivotal sports such as football.",{"type":126,"children":726},[727],{"text":728,"type":130},"– in the long term, the knee will deteriorate, and it is currently scientifically proven that ACL rupture causes osteoarthritis.",{"type":132,"level":133,"children":730},[731],{"text":732,"type":130},"Ligament surgery",{"type":208,"image":734,"children":738},{"ext":210,"url":211,"hash":212,"mime":213,"name":214,"size":215,"width":216,"height":217,"caption":218,"formats":735,"provider":236,"createdAt":237,"updatedAt":237,"previewUrl":218,"alternativeText":214,"provider_metadata":218},{"small":736,"thumbnail":737},{"ext":210,"url":221,"hash":222,"mime":213,"name":223,"path":218,"size":224,"width":225,"height":226,"sizeInBytes":227},{"ext":210,"url":229,"hash":230,"mime":213,"name":231,"path":218,"size":232,"width":233,"height":234,"sizeInBytes":235},[739],{"text":140,"type":130},{"type":208,"image":741,"children":744},{"ext":210,"url":242,"hash":243,"mime":213,"name":244,"size":245,"width":246,"height":247,"caption":218,"formats":742,"provider":236,"createdAt":256,"updatedAt":256,"previewUrl":218,"alternativeText":244,"provider_metadata":218},{"thumbnail":743},{"ext":210,"url":250,"hash":251,"mime":213,"name":252,"path":218,"size":253,"width":254,"height":234,"sizeInBytes":255},[745],{"text":140,"type":130},{"type":126,"children":747},[748],{"text":140,"type":130},{"type":126,"children":750},[751],{"text":752,"type":130},"The decision for an intervention is made on a case-by-case basis, based on numerous criteria: age, sporting and professional activities, associated injuries, etc.",{"type":126,"children":754},[755],{"text":140,"type":130},{"type":126,"children":757},[758],{"text":759,"type":130},"Suturing a cruciate ligament is ineffective because, once ruptured, the ligament cannot heal. The torn ACL must therefore be replaced: this is called ligamentoplasty.",{"type":126,"children":761},[762],{"text":140,"type":130},{"type":126,"children":764},[765],{"text":766,"type":130},"Artificial ligaments have always failed until now, and are therefore no longer used.",{"type":126,"children":768},[769],{"text":140,"type":130},{"type":126,"children":771},[772],{"text":773,"type":130},"We use a tendon autograft, that is to say we take a tendon which will replace the ruptured ligament. Basically there are two different techniques:",{"type":126,"children":775},[776],{"text":140,"type":130},{"type":126,"children":778},[779],{"text":140,"type":130},{"type":132,"level":107,"children":781},[782,783],{"text":296,"type":130},{"bold":298,"text":784,"type":130},"the patellar tendon technique (Kenneth Jones)",{"type":126,"children":786},[787],{"text":788,"type":130},"It is part of the patellar tendon that will be removed (around 1\u002F3) and which will allow the ACL to be replaced. Through a short incision which runs from the tip of the patella to the top of the tibial tuberosity, one third of the patellar tendon with its bony attachments is removed. The rest of the intervention takes place under arthroscopy: a camera is introduced into the joint which will allow a complete assessment (menisci and cartilages) to be carried out. The remnants of the injured ACL are removed, then the tendon transplant is placed in exactly the same place as the old ligament. It is fixed by bio-resorbable systems, that is to say non-metallic.",{"type":132,"level":107,"children":790},[791],{"text":140,"type":130},{"type":208,"image":793,"children":797},{"ext":210,"url":309,"hash":310,"mime":213,"name":311,"size":312,"width":313,"height":314,"caption":218,"formats":794,"provider":236,"createdAt":330,"updatedAt":330,"previewUrl":218,"alternativeText":311,"provider_metadata":218},{"small":795,"thumbnail":796},{"ext":210,"url":317,"hash":318,"mime":213,"name":319,"path":218,"size":320,"width":321,"height":226,"sizeInBytes":322},{"ext":210,"url":324,"hash":325,"mime":213,"name":326,"path":218,"size":327,"width":328,"height":234,"sizeInBytes":329},[798],{"text":140,"type":130},{"type":208,"image":800,"children":803},{"ext":210,"url":335,"hash":336,"mime":213,"name":337,"size":338,"width":339,"height":340,"caption":218,"formats":801,"provider":236,"createdAt":349,"updatedAt":349,"previewUrl":218,"alternativeText":337,"provider_metadata":218},{"thumbnail":802},{"ext":210,"url":343,"hash":344,"mime":213,"name":345,"path":218,"size":346,"width":347,"height":234,"sizeInBytes":348},[804],{"text":140,"type":130},{"type":126,"children":806},[807],{"text":140,"type":130},{"type":126,"children":809},[810,811,813],{"text":296,"type":130},{"bold":298,"text":812,"type":130},"the hamstring tendon technique (DIDT)",{"text":814,"type":130},"The tendons taken are the tendons of the internal rectus and semitendinosus muscles. To do this, a short incision is made on the inner part of the tibia. The rest of the procedure is identical to that previously described.",{"type":126,"children":816},[817],{"text":140,"type":130},{"type":208,"image":819,"children":823},{"ext":210,"url":367,"hash":368,"mime":213,"name":369,"size":370,"width":371,"height":372,"caption":218,"formats":820,"provider":236,"createdAt":388,"updatedAt":388,"previewUrl":218,"alternativeText":369,"provider_metadata":218},{"small":821,"thumbnail":822},{"ext":210,"url":375,"hash":376,"mime":213,"name":377,"path":218,"size":378,"width":379,"height":226,"sizeInBytes":380},{"ext":210,"url":382,"hash":383,"mime":213,"name":384,"path":218,"size":385,"width":386,"height":234,"sizeInBytes":387},[824],{"text":140,"type":130},{"type":208,"image":826,"children":829},{"ext":210,"url":393,"hash":394,"mime":213,"name":395,"size":396,"width":397,"height":398,"caption":218,"formats":827,"provider":236,"createdAt":407,"updatedAt":407,"previewUrl":218,"alternativeText":395,"provider_metadata":218},{"thumbnail":828},{"ext":210,"url":401,"hash":402,"mime":213,"name":403,"path":218,"size":404,"width":405,"height":234,"sizeInBytes":406},[830],{"text":140,"type":130},{"type":126,"children":832},[833],{"text":834,"type":130},"Rehabilitation after knee ligamentoplasty",{"type":132,"level":12,"children":836},[837],{"text":838,"type":130},"A) Warning:",{"type":126,"children":840},[841],{"text":140,"type":130},{"type":126,"children":843},[844],{"text":845,"type":130},"Any surgical operation is not decided “lightly”; knee ligamentoplasty in particular.",{"type":126,"children":847},[848],{"text":849,"type":130},"Aware of the risks inherent in surgery and anesthesia, the result of a ligamentoplasty will depend on “your psychological state” in view of this procedure, on your ability to invest time in post-surgical rehabilitation.",{"type":126,"children":851},[852],{"text":140,"type":130},{"type":126,"children":854},[855],{"text":856,"type":130},"Clearly, do not decide on ligamentoplasty if for any reason you are anxious, stressed, “depressed” and\u002For you will not be able to devote between six to eight months to post-operative rehabilitation. You risk, in fact, despite a perfect surgical procedure, causing joint and tissue problems that may be irreversible.",{"type":126,"children":858},[859],{"text":140,"type":130},{"type":126,"children":861},[862],{"text":863,"type":130},"The decision to have a ligamentoplasty will therefore be the result of a discussion with your orthopedic surgeon and your trauma or rehabilitation sports doctor who will follow you throughout your “rehabilitation marathon”",{"type":132,"level":12,"children":865},[866],{"text":867,"type":130},"B) Objective of rehabilitation:",{"type":126,"children":869},[870],{"text":140,"type":130},{"type":126,"children":872},[873],{"text":874,"type":130},"Recover a knee as “performing” as before the operation.",{"type":132,"level":12,"children":876},[877],{"text":878,"type":130},"C) Rehabilitation:",{"type":208,"image":880,"children":885},{"ext":460,"url":461,"hash":462,"mime":463,"name":464,"size":465,"width":466,"height":467,"caption":218,"formats":881,"provider":236,"createdAt":492,"updatedAt":492,"previewUrl":218,"alternativeText":464,"provider_metadata":218},{"small":882,"medium":883,"thumbnail":884},{"ext":460,"url":470,"hash":471,"mime":463,"name":472,"path":218,"size":473,"width":226,"height":474,"sizeInBytes":475},{"ext":460,"url":477,"hash":478,"mime":463,"name":479,"path":218,"size":480,"width":481,"height":482,"sizeInBytes":483},{"ext":460,"url":485,"hash":486,"mime":463,"name":487,"path":218,"size":488,"width":489,"height":490,"sizeInBytes":491},[886],{"text":140,"type":130},{"type":126,"children":888},[889],{"text":140,"type":130},{"type":126,"children":891},[892,894,896],{"text":893,"type":130},"1",{"bold":298,"text":895,"type":130},") the first 2 months",{"text":897,"type":130},": recover normal walking",{"type":126,"children":899},[900],{"text":140,"type":130},{"type":126,"children":902},[903],{"text":904,"type":130},"– quickly eliminate swelling and inflammation of the knee",{"type":126,"children":906},[907],{"text":908,"type":130},"– walks under cover of English canes and a removable splint",{"type":126,"children":910},[911],{"text":912,"type":130},"– rapid recovery of extension and flexion to 90°",{"type":126,"children":914},[915],{"text":916,"type":130},"– relaxation, muscular awakening of the quadriceps through isometric contractions",{"type":126,"children":918},[919],{"text":920,"type":130},"– closed chain knee lock work",{"type":126,"children":922},[923],{"text":924,"type":130},"– press work 0°-20° flexion",{"type":208,"image":926,"children":929},{"ext":210,"url":535,"hash":536,"mime":213,"name":537,"size":538,"width":539,"height":540,"caption":218,"formats":927,"provider":236,"createdAt":549,"updatedAt":549,"previewUrl":218,"alternativeText":537,"provider_metadata":218},{"thumbnail":928},{"ext":210,"url":543,"hash":544,"mime":213,"name":545,"path":218,"size":546,"width":547,"height":234,"sizeInBytes":548},[930],{"text":140,"type":130},{"type":126,"children":932},[933,935,937],{"text":934,"type":130},"2)",{"bold":298,"text":936,"type":130},"3rd month",{"text":938,"type":130},": period of fragility “of the new anterior cruciate ligament”. Symmetrical use of your knee.",{"type":126,"children":940},[941],{"text":140,"type":130},{"type":126,"children":943},[944],{"text":945,"type":130},"If the knee allows it (no more inflammation), possible resumption of professional activity depending on the physical constraints imposed by it.",{"type":126,"children":947},[948],{"text":140,"type":130},{"type":126,"children":950},[951],{"text":952,"type":130},"We will look for perfect symmetry of movement when walking, running on stabilized and flat ground, cycling and swimming (crawl only).",{"type":126,"children":954},[955],{"text":140,"type":130},{"type":126,"children":957},[958],{"text":959,"type":130},"Given the fragility of the \"neo-ligament\", bodybuilding, strictly speaking, of the quadriceps in the leg (sitting on a chair and lifting loads) is prohibited. Only isometric and dynamic techniques called closed chains will be performed.",{"type":126,"children":961},[962],{"text":140,"type":130},{"type":126,"children":964},[965],{"text":966,"type":130},"Likewise, so-called proprioception exercises (work to control and correct unstable positions of a joint in space) should preferably be carried out lying down or sitting.",{"type":126,"children":968},[969],{"text":140,"type":130},{"type":126,"children":971},[972,973,975],{"text":594,"type":130},{"bold":298,"text":974,"type":130},"from the 4th month",{"text":976,"type":130},": sufficient strength of the neo-ligament, priority for muscle 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