Restoration after plastic PKS knee. PKS Knee Sustav Rehabilitation after surgery

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Damage to the knees of the knee joint is often called sports injury. This is quite explained, since durable elastic fabrics forming a binder apparatus providing articular functionality are damaged only at excessive loads or with contact hard effects (blows, drops). An experienced traumatologist can determine the nature of the injury from the jumper, the skier, tennis player, a sprinter, a basketball player, a gymnast, based on the accumulated experience and knowledge of the specifics of sports loads.

Reasons for breaking ligaments

In atypical loads, partial injury may occur (ligaments) or a complete violation of the integrity of the articular and ligament complex (ligament breaks). Being impressed by the success of athletes developing a huge speed on ski descents, which are not allowed to imagine records in height and length, we can not even imagine what overloading is withstanding the muscle system, tendons, ligaments.

Only in one knee joint to ensure flexion, mobility, turns and fixation in the same position and participates four groups of ligaments:

• Front cruciform;
• Internal side;
• Rear cruciforms;
• Medical collateral.

Each of the ligaments is vulnerable to certain types of external influences, after which a conservative or surgical treatment is required. According to the statistical data of official medicine, the most common operation on an anterior cross-shaped bundle, which is subjected to a serious traumatic effect. The oversight and breaks of the front ligament happen 20 times more often than injuries of the rear ligament complex, and women get damage, on average, 6 times more often than men.

PKS injuries (front cruciform ligament)

The supervision or complete break of the front cruciform knee bundles is associated with several types of atypical effects. The front bundle holds the shin from excessive displacement and backward, allowing a certain excess of the physiological norm of the amplitude of movements due to the elasticity of the tissues of it forming.

The causes of the rupture of knee ligaments of the front group are:

1. Sharp contact impact (blow to the lower leg or hip);
2. Subjective impact (sudden braking, landing after jumping);
3. Shiny shift in the outside when the thigh turns into the inner plane (basketball player injury when jumping with a turn);
4. The shinency in the inner side when the thigh turns outwards;
5. Phantom Stop, or Trauma of the skier (bundle break when the shin is rotated and the position of the joint at right angles).

The gap of PKS skiers and slalomists is connected with the specifics of sports equipment. During the fall back, the upper edge of the shoe transmits an effort into the top of the tibia of the tibia. This type of load in which the femoral bone is shifted back, and the shin is held by the edge of the boot, causes a break of an anterior cross-shaped ligament.

Back Conductive Bag

The rupture of the back crucible bundle of the knee joint happens much less frequently. Basically, the damage to this department of the articular apparatus leads a direct mechanical impact, which happens during car accidents, applying direct strikes under the knee (hockey injury), falling from the mountain, raising greater weight (injury of weightlifter).

With this injury, the strongest pain syndrome occurs, which patients are often compared with the effect of electric current. The knee quickly swells, the skin in the area of \u200b\u200binjury is blushing. Movement forward, flexion or knee extension becomes impossible. Sometimes the swelling extends far beyond the joint, dropping towards the leg and ankle.

Combined injuries

Cross-shaped knee bundle It is often combined when meniscus, vascular complex, soft fabrics are damaged. If the nature of the damage to the ligaments is an experimental traumatologist will quickly determine the pronounced symptoms and circumstances of injury, then the attached pathological processes are determined by radiographs, arthroscopy, CT and MRI. A severe case in medical practice is considered multiple injury, when the knee fracture occurs, stretching the tendons and bursts in several places.

Strong operation on the knee joint bundles

In surgical practice there are several techniques and philosophical approaches to conducting breakdowns. The specialist chooses equipment, based on the nature of damage, age, patient state, clinical indications.

The urgent ligament restoration operation is carried out within 2-5 days after injury. The patient is delivered to the hospital with complaints of severe pain in the knee area, loss of motor function.

First aid is carried out according to the standard scheme - removal of blood from the articular cavity, fixing the limb using a compression bandage. After the operational diagnosis, the surgeon assigns an operation to cross-linking broken ligaments (if during the examination was not revealed by a meniscus, the knee fracture and other damage, requiring special preparation for radical surgery).

Great importance is the efficiency of assistance, since torn ligaments quickly shorten, lose their elasticity, and their ends are absorbed. If the operation is not fulfilled in the coming days after the injury, further will require more serious intervention - plastic of the knee bundles.

The operation is appointed if the doctor found it inappropriate to carry out conservative treatment. Modern diagnosis makes it possible with a high degree of reliability to estimate the chances of successful treatment when using radical and conservative techniques.

Reconstruction of the knee bundles

Reconstruction, or plastic of the knee joint, is shown in old injuries, when more than two months have passed since damage to the articular device. By this time, the bundles are shortened, partially atrophy, completely loses the ability to stretch.

To replace the lost fragment, synthetic material or part of the tendon is used. Artificial substitutes are used in the treatment of elderly people, and in relation to young patients, plastic is carried out using a graft, taken from the bundle of a patella or tendon of semi-dry muscle. Own biological material is called an autotransplant, taken from the donor - Allhotransplant.

Standard scheme for plastic ligaments

For the operation on anterior cross-shaped bundle uses advanced access, for the surgery of the rear (ligament) - asshole. If you have to restore several bundles at the same time, assumesaneous access. An additional incision is carried out in the area of \u200b\u200bthe knee joint, and in the field of tissue extraction for the transplant (along the outer surface of the hip).

The patient lies on the back (anesthesia epidural or common anesthesia). On the surfaces of the shin and hips, holes for the transplant are drilled. From fibrous femoral tissue (fascia), a strip of 3 cm wide, a length of about 25 cm. The tape is pulled into the created holes and crossed over the binding break section, after which the transplant and ligament are stitching with a solid biopolymer material (absorbing fixators).

Wounds are in layers in layers, drainage is installed. The final stage is the immobilization of the limb plastic tire. There are other techniques for holding plastic ligaments - the choice of the method is carried out by the surgeon, based on the nature and scale of injury.

Reconstruction using a bunch of a patella is more complex, but it provides an excellent result (according to the stability and mobility of the knee). The essence of the operation is as follows: the surgeon cuts off part of the bundle together with bone fragments, which is necessary to secure the graft tissue into the joint bone. The battle of the bundle with the spongy bone is carried out within three weeks. The autotransplant fixation in bone channels is carried out using titanium or biopolymer (absorbing) screws.

Operation to restore ligaments using arthroscope

Arthroscopy is a small-acting operation at which the surgeon conducts manipulation under the control of a special apparatus, not exposing the joint. Surgical access - 2 small punctures (no more than 2 cm), through one of which the miniature optical camera is introduced, through the other tools. Optics gives an increase of 40-60 times.

With complex combined operations, partial resection of the meniscus and the restoration of the cross-shaped ligament is carried out at the same time. The most difficult moment is the determination of the degree of tension of the graft, which, complete with a ligament, must ensure flexion, extension, tension of the joint muscles within the atomic norm. Weak tension will lead to the breaking and instability of the joint, tight fixation entails the limitation of knee mobility.

Video: Plastic Front Cross-shaped Bundle of the knee joint

Preparation for the operation

The period of preparation for the operation -2 week. During this time, doctors constitute a treatment regimen, choose a methodology for surgery, taking into account the age of the patient and his lifestyle (most athletes are planning to return to previous loads). The patient tells in detail how the operation will be held, what actions should be taken in the first and subsequent days of staying in the hospital so that the restoration is carried out most effectively. The patient has analyzes, the diagnostic examination of specialists in the direction of the operating physician.

Contraindications for the operation on knee bundles

Contraindications are the same as with all other types of surgery:

Relative contraindications are the presence of degenerative changes in the articular tissue, muscle atrophy and ligaments.

Complications after surgery

After the operation on the PKS and the rear cruciform bunch of complications are rarely manifested. Operational treatment is carried out according to a well-developed scheme, using high-tech equipment and tools, which determines the impressive indicators of full rehabilitation of patients, even with complicated injuries. Nevertheless, the patient must know about the possible consequences. The following manifestations include side effects:

1. Pain syndrome for two days;
2. Swinging the knee;
3. Fever, temperature (response to surgical intervention);
4. Internal hemorrhages;
5. Transplant break (very rarely);
6. Infectious inflammation of bone fabric;
7. Numbness of the limb (partial loss of sensitivity);

To prevent the development of sepsis and the formation of thromboms after the operation, antibiotics and anticoagulants are prescribed in preventive doses. In compliance with the recommendations of the doctor relating to the preparation for operation and behavior after surgery, the risk of complications are minimized.

Rehabilitation

The rehabilitation program after surgery on the knee bundles is developed individually for each patient. Doctors paint classes and clock procedures, requiring accurate execution of all items. In the first days, the peace and cold on the operated region are shown. On the third day, exercises are prescribed for flexion-extension of the joint with the help of an elastic ribbon. On the 4th day, the leg be flexed in the knee at right angles.

To restore the strength of the four-headed muscle, electrostimulation and special simulators are used. Walking is allowed for the fourth day with crutches, and only in Ortez. Each week, the load increases by 25%.

The second phase of rehabilitation begins from the second week after the operation. The patient is allowed to train the joint, performing squats and dyeing to the side in the straightened and bent position. When the swelling and pain in the knee is enhanced, the load is rehabilitated again.

The main exercises are conducted on bending the knee extension. In the third and fourth recovery phase, training is carried out to strengthen all the muscles of the limb, Restoration of symmetric load (right-left foot). After 4 weeks, it is allowed to walk without orthyze and crutches if the functionality of the four-headed muscle is restored.

Therapeutic procedures include massage, physiotherapy, salt baths, taking vitamin complexes. The massage is carried out along the movement of lymph (bottom-up) from the foot, and to the knee. The injured area in the first weeks after the operation is not massaged.

Doctors warn about the inadmissibility of exceeding the loads during the passage of the rehabilitation rehabilitation. First, it can lead to a breakdown of graft tissue, secondly, disrupt the balance of the ligament. It will take a re-operation that is not always successful.

The long period of preservation of pain after the operation is a sign of the infringement of nerve endings, the tight extension of the knee - indicates an excessive tension of the transplant. It is necessary to notify the surgeon on unpleasant sensations and discomfort so that appropriate measures are taken to eliminate them.

It is unacceptable to increase the bending angle, if it is not provided for by the rehabilitation program. Recovery after injury passes in all differently (this applies to the personal sensations and duration of rehabilitation time). The restoration period does not affect the final result, but only indicates different capabilities of the body.

Video: Early rehabilitation after damage to the front crucible bundle - part 1

Video: Early rehabilitation after damage to the front cruciform ligament - part 2

Cost of operation

The urgent operation is free of charge (if the patient entered ambulance after injury). The task of the surgeon is to carry out emergency diagnostics, removal of blood from the articular cavity, crossing ligaments, or fixation of the limb (gypsum, plastic). Urgent help is aimed at eliminating factors that threaten the life and health of a person. In steel cases, the operation is paid.

Planned operation for the reconstruction of ligaments costs from 39 thousand rubles. The price depends on the chosen surgical equipment, the scale of injury, the status of the clinic, the conditions of stay (comfort). Rehabilitation is paid separately. Judging by the reviews of patients, most of which are athletes, the knee bundles operation allows you to fully restore the functionality of the joint, lead an active lifestyle, and even play sports at the professional level.

Video: Operation in damage to the front cruciform knee bundles

"The best operation that managed to avoid" is Nikolai Pirogov. But it happens that or too long "ran", or in principle, "run" / "escape" could not. It was in this situation that I hit a little more than a year ago, when, in the literal sense of the word, the selection of a surgeon with a request to get rid of the knee's constant pain. For almost 12 years I was treated conservatively. Successful, almost never limited to him - you can get used to everything. But the old sore caught me by surprise and did not give me more chance to choose from. Operation in 3 days and ...

Next, I have to make a mandatory remark. All written further - subjectively my personally opinion and my situation. In medicine, there is practically no identical occasion. All, even the most standard, diseases are purely individual. That is why I will often use words: "Almost", "probably", "most likely", "often", "happens", etc. Then why am I writing about this? I did not have a choice, but if he is? According to his experience, the stories of familiar and those who passed this path with me in the clinics, I did a clear conclusion - there are almost no operations without complications. Probably cannot be in principle. Only now the trouble - doctors (surgeons) do not talk about it, but if they say, then Casual. Yes, they can talk for hours about the techniques of the operation, about the history, statistics, on the details. But a minimum of complications and pairs, and if they say, only about the main or mandatory, or about those that are found more than 60% of patients. But there are another 40%. All this is on the background of a terrible stress and pain, which is even more affected by the understanding of what is happening. As it was correctly noticed in one of the articles on Geektimes, a quote: "Like most surgeons, they have lost interest immediately after the operation was recognized as successful." As a result, the patient often faces complications not only immediately after the operation, and often later, already forgetting about the ailment.

Surgical intervention itself, as it turns out, this is not such a big percentage in the success of recovery. Not, from the hands of the surgeon, of course, it all depends by 99%. But there is also anesthesia / anesthesia, rehabilitation, courses of drugs, exercises, physiotherapy, food / day mode and much more. Is there a claim to buttons? No - then it is not quite to the surgeon. This article is not about surgery and not even about medicine in the scientific sense of the word. And about what I want doctors to open your mouth more often and explained all possible risks and complications to the patient. This may not be especially important for them, the masters of this jewelry. This is important for us - patients, as we want to know what awaits us not only during the operation, but before and after. And there will be different problems: I repeat - there are practically no operations without complications. But first things first.

I have never been a professional athlete, but all my childhood passed at the stadium, where we were kicking the ball in the improvised gate from the portfolios. School years, studentism - I could not live without a game. He played several times a week: for the student team in football, for amateur - in hockey. Despite the old equipment or even partial absence, I managed to get off with bruises or small microtrams. Until until he finished up to a sharply swollen right knee. In those days, the usual diagnosis of MRI was not yet common. Maximum X-ray, inspection and words of the district traumatologist like "will heal before the wedding." Next was partially homemade orthosis on hinges. I actively played for another 2.5 years. Then Ortez already stopped helping. Thanks to good people, I was able to agree on consultation with a doctor of one professional club, where I was diagnosed with PKS gap, and even with round eyes were surprised how I was able to play all this time. In Russia, then the artoscopy did not do, but only the complete disclosure of the joint, and I didn't have a money to Germany in Germany. Then the decision was conservative treatment. Yes, I had to finish with sports, but I lived a long life for a long time while on one rainy evening the problem did not return. Repeated conservative treatment (on which I insisted) no longer helped, and as it turned out later, and could not help.

Now, in 2016, arthroscopy is a gold standard with operations on meniscus or plastic of knee joints. Not at all what was in 2003. Now this is a minimally invasive procedure, minimum of seams. And prices are not particularly biting. I will not stop on the issue of choosing a clinic and surgeon - this is not so important in this narration and purely individually. Everyone, with whom I met, spoke about the same thing - everything will be relatively easy, after 3-4 days home, after 3-4 weeks I will walk, albeit with crutches. After 3-4 months - swim and run. Six months later, I will be new, and in a year, so "I can play on the piano, although I did not know much before." Important! Now has passed a year since the 1st operation. In fact, I really run, I play ping pong and even swim. I go to fitness club. But then I did not even guess and did not understand how the thorny was this way. As far as it is often necessary to overplace through pain and fear, survive complications and get side effects. This is exactly what I was not particularly warned about (or did not focus on). As it turned out, there are many little things, which I would like to know before, and not after.

Starts still from collecting analyzes for entering the hospital. Depending on the required, complications here concern for the most part of the wallet. If you do not use a free clinic (and they do not do all tests and procedures), so in general the amount can come out decent. This is important, since the cost of the operation and stay in the hospital is already known before surrendering analyzes, but these additional costs have become an unpleasant surprise. The night before the operation and preparation for it is also not the most pleasant procedures, but obviously not the worst thing.

But further goes first, what should be thought of - anesthesia / anesthesia. The conversation with the anesthesiologist the day before the operation is for the most part information for it (the type of anesthesia, the choice of drugs, doses, etc.) so that everything goes safely. Yes, he will tell you about what and how will it go, that "can go wrong." But again, not in full. They will not always tell that it is possible and can not be on this day or the next day. Figuratively speaking, 99% of operations with such anesthesia (in my case - spinal) goes well. But somehow I do not want to get this negative 1%. The same spinate gives complications (and not even at the injection site) immediately after the procedure or far after. And it is not always clear that an anesthesia occurred in 3-4 months - this is the consequence of anesthesia, how to react to it and how to deal with it. I was lucky, both operations from the standpoint of anesthesia were almost good. Although I still remember with the shudder, as on the 2nd operation it was difficult to breathe on the operating table (anesthesia in the back in 1st times was lower, and the second time is higher). But after another month or two there were small dizziness and neurological pain without visible causes. And after 6 months, problems with vision appeared. Is there any connection with anesthesia - no doctor can answer either yes, nor no, but the fact that after 2 spinal anesthesia is a drop in immunity and the imbalance of the body functions is a fact that I can not prove it.

The second is pain after. Operation on plastic PCS has passed successfully. The process took about 1.5 hours. In theory, the worst behind. In theory. In fact, when the spinate was departed, the pain came. But not "bad" pain, but "good" - a sign that this is the first step towards recovery. But from the fact that she was "good," it did not cancel the fact that the knee was drowned and it took a few days in a row 24 hours a day. Yes, the nurses of hospitals worked excellent: they made all the necessary procedures, injections. I am very grateful for it. And from the third day, when they removed the dressings and put on a special orthosis (also the cheapest pleasure), it was necessary to start doing some light exercises. A pain from the seams was added to pain inside the knee (Ortez was attached next to the seam and pressed on it). On the 5th day I was already at home. But at home, naturally, there are no those drugs that are in the hospital under the supervision of doctors. You say - how do you want without pain? I will answer - I understood that it would be and that it should be through it. But I wanted to know or hear about it from doctors before.

Third - compensator. This is a very important point that you often forget about. But precisely because of this, I got on the second arthroscopic operation on another leg. Funny, but few people think about such things before. And I do not mean domestic inconvenience. In fact, for a month I was single-legged on crutches. Accordingly, the function of the right leg was distributed between two hands and a healthy left foot. But again, it turned out not always and the load on a healthy leg increased several times. No, knee, where there was a PKS plastic heals and in perfect order, but the lifestyle had changed at the time of the crutch, and a healthy leg, and his hands, and his back at that moment. As a result, on a healthy leg, with not the most complex television, he received a gap of meniscus. Most likely, I expected youth injury. But if I had not had to live on one leg, it would probably have not happened. In fact, compensator is not only the problem of traumatology. According to my acquaintances, I can say that there is a similar problem in essence and those who have made operations, for example, in front of or undergoing chemotherapy courses. No, compensator - this is again not contraindicated against the operation and not the main decision of the decision. You tell me that it's all and so understandable and it is logical that I am so stupid. I agree. But! I was lucky that I never went to the crutches before and did not guessed these problems. And it is logical if this problem is "on someone else's experience." But when everything rolls upside down, hurts and brains are still stupid, then such problems will be performed on the fore and interfere very much. Even a little change the worldview. For example, I understood how uncomfortable cities for people with disabilities ...

Fourth - rehabilitation (postoperative courses of pills, etc.). I was pre-warned about rehabilitation. Yes, it is often necessary, and in my case even critical. Accordingly, these deadlines were included in the hospital and vacation. But what will be in this course I learned only on the fact. Yes, during this time I was put on my feet, in fact, re-taught to walk. But as the time has shown, there was little. It took the second rehabilitation course. And this is again money, nerves, sick leave ... Yes, this item has no direct attitude towards underwent, but in fact, I'm not the first one who could not recover as standard. And if so, when time planning and money is being planned, it would also like to consider before. And another important point. In my case, knees are operated, and the muscles fly. In the sense that one thing - we treat, and the other to the chick. Yes, this side phenomenon is always with PCS, but with other operations, other organs may suffer, for example, located nearby.

The fifth - light operations does not happen. Yes, after the 1st course of rehabilitation, "surfaced" torn Menish on the other leg. Already passing a certain path, it was decided not to suffer and operate the second leg. Especially experience I thought at that time, rather positive. After a conversation with the same surgeons (the details do not matter) for some reason in my head it happened that after plastic PKS, arthroscopy on a meniscus is the little things. Yes, and the conversation with the doctor has taken no 2 hours, and a lot of 30 minutes. It was already clear, and there are not much to roll up and drill. And home on the third day, and without Ortse, and without complications - such as a tooth to strip. This is the key mistake. I emphasize - mine. I did not ask the necessary questions. For some reason, thought Menisk is the little things after PKS. Yes, and my doctor who has already spent a thousand operations on meniscus, did not consider this as Akhov. If I knew to what I know now, I would still make the second operation, but later. Gave the body more time to restore and compensator. But it came out what came out. Operation again passed successfully. Yes, everything went much easier. I went for a 2nd day and did not hurt anything. But by 4-5 days, side effects began. Not critical, but taking into account the surgical intervention, which caused almost a panic. It seems again this circle of hell passed, and at the exit if not better, then even worse. No, there is no complaints to the doctor - on the 5th day I asked all these questions and received answers on them. After some time, almost everything went. Keyword - almost. And as it became clear that it was "almost" - on the whole shattered. Although I make every effort to and it passed.

Sixth - recurrence or late complication. Here was a year. I would appreciate my kennels by 70-75% of the norm. I still care already in the gym. The funny thing is that now the knees are the most healthy part of the body. In the sense of the joints themselves. Yes, it is necessary to continue to swing muscles, then do yoga, stretching, etc. But recently got one complication after PKS plastic. Not deadly, the probability of operation is very small. So far, only injections and physiotherapy. I do not want to go into details, according to the surgeon, such complications were in the history of modern medicine (arthroscopy) in 3 cases (re-operated on 1). I - 4th. Of course, it is difficult to predict before, taking into account how many such operations are done daily. But from the moment this side climbed, until the consultation passed a couple of days that he added gray hair. The problem has been removed. I hope it will not happen again ... And I read it myself: what will be knees to whine in bad weather, that the crunch will remain, the problems with full flexion will not go anywhere. Whole pot and glued - these are still two different pots. It is important to understand, since a wonderful healing of 100% or a complete disappearance of the problem still achieve very difficult. The main thing is not hurting and practically does not prevent the usual way of life.

I want to emphasize again. History is private. I was very lucky that beautiful doctors worked with me and excellent medical staff hospitals. But even their magic hands and care cannot help before the characteristics of the body. Yes, I did not have a choice: I could not not do operations. But if someone has a question about surgical intervention, try to collect more information about it. Information, not even about the procedure itself (you will tell you about it from both before), namely, the fact that doctors say so often on so often. Complications and side effects are almost always. They may be more or less pronounced, but they will be. And better to them to be ready in advance. If not physically, at least psychologically. This will help you not only in making a decision, but calmly treat unexpected situations after surgery and, perhaps, quickly return to the usual way of life.

Every year, millions of patients around the world reconstruct damage to the anterior cross-shaped ligament. Surgical technique plastics front cruciform ligament is in most cases standard procedure. With adequate technical equipment, sufficient qualifications and conscientiousness of the surgeon, the implementation of such an operation does not represent a big problem. However, the operation is only one of the "three whales", which provide a good result of the entire recovery process after the increasing anterior cross-shaped ligament. Two other are the preparation for the operation and postoperative rehabilitation.

One of the important stages of recovery after damage to the anterior cruciform ligament is a preoperative period.

One of the complications of the operational treatment of the gaps of anterior condo-shaped ligament is to limit the volume of movements (contractures) of the joint, especially extension. The loss of extension leads to the hypotrophy of the four-headed muscle and constant pain in the front of the knee joint. Scientific studies have shown that the development of such complications is highly dependent on the preoperative state of the knee joint. The greatest risk of developing such complications occurs if the operation is carried out on the inflamed knee joint.

Therapeutic knee joint massage demonstration video

Current from the second week after surgery.

It is important not time after injury, but the condition of the knee joint at the time of the operation.

Therefore, for proper preparation for the operation, the following steps should be taken.

Knee immobilization (immobilization)

After receiving the injury, the immobilizer (brace) on the knee joint is necessary. Log on foot should be limited. This is achieved with the help of crutches. It is necessary to step on the leg with such an effort that does not cause pain.

Anti-inflammatory treatment.

To reduce pain and edema, ice compresses should be applied to the area of \u200b\u200bthe knee joint for 10 to 15 minutes 4 times a day. From "Primary" funds, you can apply a package with frozen fruits or vegetables, bought in the supermarket.

The use of anti-inflammatory drugs is shown from medications, such as an arcocusion of 90 mg x 1 time per day. In the absence of contraindications to the reception of these drugs (see the excerpts from the instructions below). When taking other anti-inflammatory drugs, you must familiarize yourself with the instructions.

Restoration of the volume of movements in the joint.

These exercises must be performed immediately after injury, if you feel overall.

Restoration of extension.

1) Passive knee extension.

Sit on a chair or on the chair, put the heel of the damaged leg on the edge of the chair or chairs opposite (Fig. 1).

Relax leg muscles.

Let the knee prick under your own weight up to the highest possible extension. It is necessary to ensure that the knee is not rejected.

Fig. 1. Schedules knee on a chair.

2) knee bending with a roller-folded towel (Fig. 2).

Fig. 2. Schedule knee on roller.

3) Extension in the knee on the edge of the bed lying on the stomach (Fig. 3).

Fig. 3. The knee extension is lying on the stomach.

Restoration of flexion:

1) Passive bending in the knee.

Sit on a high chair or bed. Relax leg muscles. Let the knee bend under its own weight (Fig. 4).

Fig. 4. knee bending under its own weight.

2) Slide on the wall (Fig. 5).

Lie on the back. Put the foot of the damaged leg on the wall in front of yourself. Bend the knee, sliding the feet on the wall. Attach the pressure of a healthy leg to enhance flexion

Fig. 5. Slide over the wall surface.

3) Sliding foot on the surface.

Flex a leg in the knee, gliding the heel on the surface (floor or bed). When achieving the maximum possible you can hold the position for 5 seconds possible. Slip the heel on the surface, break the leg in the knee to the highest possible position, hold out for five seconds (Fig. 6).

Fig. 6. Slide horizontal surface.

4) Bend the leg in the knee, as written in the exercise 3. When the maximum bending is reached, grab the shin and additionally bend the knee. Delay for 5 seconds (Fig. 7).

Fig. 7. Help with hand to increase the knee flexion.

Criteria of sufficient preparation for the operation.

1) Full control of pain (no pain periciting and within the limits of permitted loads).

2) restoration of muscle control over the foot (the ability to perform the recommended exercises in the recommended volume)

3) lack of significant swelling.

4) Restoring full extension and bending within 120 degrees.

Decision of organizational issues.

Each patient before performing the operation it is necessary to solve a number of organizational issues.

1) familiarize yourself with the plan of the upcoming treatment and its forecast.

2) Based on the recovery plan and the nature of professional activities, agree on the work of disability. Find out about the need to obtain a disability leaf (sick leave).

3) Familiarize family members and / or friends about the amount of assistance, which may be required in the treatment process.

Day operation - 2 day.

Immediately after the operation, the foot operation is placed in the tire (bar). The knee joint is folded with ice packages. The ice is applied for 30 minutes with a break for 30 minutes. Before performing and at the end of the operation, an anesthetic agent (MARKAIN or Bupivacaine) is introduced inside the knee joint. These non-toxic drugs block pain receptors and allow you to significantly reduce the amount of medication necessary for anesthesia. However, pain sensitivity every person is different. Therefore, when painting pain in the knee joint, medical staff should be informed.

After removing drugs from the body for anesthesia, stabilization of the overall condition and reduction of pain, the patient may be discharged from the hospital. This usually happens on the second day after the operation. It should be remembered that after such a operation, patients cannot alone drive. Therefore, it should be converted in advance about transportation.

After discharge.

3 - 14 day after surgery.

Prevent swelling and pain.

1) After discharge from the hospital, bed rests should be observed for 2 days. At this time, it is necessary to be in the tire with the sublime position of the leg (the foot should be higher than the level of the chest). You can move on the need (for meals or hygienic procedures), but the rest of the time the leg should be kept in an elevated position.

2) Do not lower the leg without the need. This leads to a knee joint and lower leg. If you need to sit for performing any work, your foot should be placed on a chair or stand, giving it an elevated position.

3) For anesthesia and reducing edema, it is necessary to accept the recommended drugs. If they are not enough, you should contact the doctor.

4) As pain decreases and edema, it is possible to increase their activity and spend more time in a sitting position.

5) The most efficient way to prevent the knee swelling is the unloading of the knee joint. Therefore, with increasing pain or edema in the joint, you should transfer most of the body weight to crutches.

Loads, dressings and hygienic procedures.

1) If you have the opportunity to study at the exercise bike, it can be done by adjusting the seat position so as to adapt it to the volume of bending in the knee (first raise higher). The minimum load should be applied, the main efforts torsion of pedals should be taken by a healthy foot, the operated foot should only follow the pedal.

2) If the skin wounds are discharged by a special plaster, in which you can take a shower. However, its protection is not enough to receive bath. Therefore, with such a need, the leg should be placed in a plastic bag. Wound It is not allowed to wet until the seams are removed (usually on day 14 after surgery). To safely take a shower, you need to do the following:

Sit on the floor of the bathroom towel in order to avoid slipping of crutches on wet tile

Go to the shower cabin in the bus

Unbutton bus

To take a shower

Wash the leg dry

Shine

Get out of the cab.

3) Usually patients who live in the Kiev region must come to inspection a week after surgery, and to remove seams - in 2 weeks. You can remove the seams at the place of residence, and come to the control examination after 1 month after surgery.

Recovery program after plastic front cross-shaped ligament.

Early recovery of movement.

1) Restoration of extension.

Passive extension of the knee joint (Fig. 1).

Sit on a chair or on a chair, the heel of the damaged legs put on the edge of the chair or chairs opposite

Relax the muscles of the leg

Let the knee prick under your own weight up to the highest possible extension.

Exercise spend 3 - 4 times a day to 10 - 15 minutes

Alternatively, you can perform:

beat fuses with a roller folded towel (Fig. 2).

2) Passive knee bending up to 90 degrees (Fig. 4).

Sit on the edge of the bed or table and let the knee smoothly get started to an angle of 90 degrees.

You can use a healthy leg to support and control the flexion. Unlike the previously described exercise, it is necessary to break the leg with the help of muscle contraction of the operated and healthy leg.

This exercise must be fulfilled 4 - 6 times a day for 10 minutes. It is important to reach 90 degrees of bending in the first 7 days after the operation.

Strengthening the four-headed muscles.

1) The voltage of the four-headed muscle without movement in the knee joint (isometric reduction) must be started immediately after the operation, as soon as it is physically possible (Fig. 8).

You need to do 3 approaches of 10 cuts 3 times a day. Each contraction of the muscles should be held to the account until 6.

Fig. 8. Isometric voltage of a four-headed muscle.

2) Lifting legs in the tire. In the position lying on the back strain the four-chapted muscle, lift the leg at an angle of 45 - 60 degrees, hold to the account to 6. Smoothly lower the leg, be sure to relax muscles. Repeat first. Perform 8 repetitions 3 times a day (Fig. 9).

Fig. 9. Cut the straight foot.

As soon as the power of the muscles is allowed, the exercise can be sitting or standing.

Exercises on the back grupp muscle

Patients who were performed from the tendons of the front crucible ligament from the tendons of gentle and semi-dry muscles should be avoided excessive stretching of the rear group of the thigh muscles for 6 weeks after the operation. Such a period is required for their final healing.

The uncontrolled stretching of these muscles occurs when the tilt forward and attempt to raise anything from the floor (or put socks, shoes). Therefore, when performing such movements, caution should be taken.

13 - 15 days after surgery (removal of seams)

1) Control inspection to remove seams (in the office or at the place of residence).

After removing the seams, you can take a shower and bath without protecting the wound with a plaster or package. To improve the condition of the skin scars, after 3 weeks after the operation, it was recommended to apply an oil solution of vitamin E. Postoperative scars also need to close from direct sunlight throughout the year after the operation.

Return to work

If your office type is required by the table, you can return to it 7-10 days after surgery, subject to confident movement on crutches and secure path to the place of work.

Patients whose work is associated with physical exertion (builders, workers, guards, etc.) should not start fulfilling their duties earlier than 8 weeks (solved individually in each case).

Third week after surgery

Therapeutic knee joint massage with mobilization demonstration video.

Continue isometric cuts from a four-headed muscle, lifting legs in the tire, passive bending with active extension as described above. It is necessary to reach 90 - 100 degrees of bending.

The development of muscle strength.

1) minipiromen.

Put the widths on the width, put a steady stool for insurance.

Holding to the table or wall, follow the squats in such a way as if you want to sit on the chair.

Squats do before the occurrence of pain in the knee, without touching the chair, keep 6 seconds, straighten up and repeat again.

Make 3 approaches of 10 repetitions daily (Fig. 10).

Fig. 10. Minipiromen.

2) Rises on socks.

Sticking to the edge of the table or Wall, carefully become on the socks. Hold on socks for 6 seconds, then smoothly put your heels to the floor. Make 3 approaches of 10 repetitions daily (Fig. 11).

Fig. 11. Rises on socks.

3) Continue to use the bus when walking.

4) Cropling from crutches can be returned to normal walking without chromotype.

5) Continue classes on the exercise bike.

FROMidengi.e. should be installed in such a way thats In the lowest position of the pedal stop completely It was in contact with her, and the knee was slightly bent.

Use 1 load level, save the correct posture when performingexercises.

After 5 - 6 weeks after the operation, the load on the simulator can be gradually tolerated by portability. The degree of increase in load can be monitored by the two-headed muscles of the thigh at the end of the lesson. With proper load in the muscle there is a feeling of "burning".

The duration of exercises on the exercise bike should be gradually increased from 5 to 20 minutes.

4 week after surgery

During this period, the volume of movements in the knee should be achieved from full extension up to 100 - 120 degrees of bending. Flexing should be developed by the exercise "Slide over the wall" (Fig. 5) and / or bending with hand (Fig. 7).

Continue isometric cuts of the four-headed muscle (Fig. 8) and the rise of the straight foot (Fig. 9).

Continue minipreened and lifts on socks (Fig. 10, Fig. 11).

If you visit the fitness club, you can do on the following simulators:

Exercise bike. The seat position must be such in which the knee is not inflicted or not bend over. Load - tolerability. It should be done 15 - 20 minutes a day.

Elliptical simulator (orbitrek)15 — 20 minutes a day.

Simulator forright feet in the sitting position.

Simulator for the back of the thigh muscles in the sitting position. Attention. If the plastic front cruciform ligament was carried out by a graft from tendons of tender and semi-dry muscles,dann.y Exercises should be started no earlier than after 8 - 10 weeks after surgery.

Lovese. training apparatus s for rapid parts of the body With initial position sitting. Using free weights is prohibited up to 8 weeks after surgery

Swimming: walking in the pool, jogging in the water, Mahi straight leg. Do not dive swimming without the use of legs up to 6 week after surgery.

5 - 6 week after surgery

1) The volume of movements from the full extension to 125 degrees of bending should be achieved.

2) Continue miniprides, climbing on socks, lifts of straight legs, exercise bike or elliptical simulator, hurry sitting, knee bending sitting.

3) Exercises for coordination. Performed on balancing board or balancing platform.

6 - 12 week after surgery

By 6 week after surgery, the volume of movements in the knee joint should be from the full extension to at least 135 degrees of bending.

1) Continue minipreened, lifting on the socks, lifts of straight legs, exercise bike or elliptical simulatory machine, sitting, knee bending sitting.

2) Continue coordination exercises. Performed on balancing board or balancing platform.

3) Patients whose PCS plastic is made with the help of tendons of the gentle and / or semi-dry muscle, can begin to perform exercises for bending legs in the simulator sitting. The load should be chosen such that after classes do not feel pain in the backyard of the thigh.

Such patients are forbidden to use simulators to flexing the legs in the position lying on the stomach, since on them the muscles of the back of the thigh are an increased load and excessive stretching, which can lead to their oversight.

4) Continue the navigation program. You can swim with the use of legs.

5) the beginning of a quick walk through the equal terrain (stadium).

6) Bicycle riding on a flat road. Riding over rough terrain is prohibited.

12 – 20 Week after surgery.

1) Continue all exercises 6 - 12 weeks.

2) Start the jogging with the transition to a quick run tolerability.

3) You can begin acceleration, zigzags, jogging with attachments.

6 months after surgery.

A period of time when you can return to sports activities.

Criteria for Returning to Sport

Power of a four-headed muscle at least 80% of a healthy leg

The power of the knee flexors is at least 80% of the healthy leg

Full volume of movements

Lack of edema

Good stability

Ability to engage in the general group

Human knee is the most complicated multifunctional element of the musculoskeletal system. It is thanks to his unusual design that we modem climb / descend on the stairs, it also provides the smoothness of the gait and the distribution of the load on the lower part of the leg. People do not notice how important the body is, while the bone tissue is not extended, and the most complex design will cease to perform their functions in full.

Any segment of the knee joint is daily by a huge load that contributes to its destruction. Overweight, lifting weights, bad habits, hereditary or acquired diseases - all this often becomes the cause of the disease, which in most cases is not treated with therapeutic methods. In 12% of cases during injuries, arthosis and osteoporosis suffers from the front cruciform bunch of the knee.

Also, you should not blindly trust the "effective" folk remedies. The row from the roots of the burdock or the juice of viburnum and plantain for the compression will not help. Contact the hospital, only the X-ray will show a real picture and find out the real causes of pain.

There is no need to fear the counseling of the orthopedist, in any case, the bitter truth about the state of the authorities will help preserve the limb in integrity. The most effective method of plastic ligaments is an endoprosthetics. Conservative medicine today shows high results, pharmaceuticals and a set of stationary events can slow down the process of destruction, remove pain symptoms, improve regeneration. All this is effective in the early stages.

In cases of hereditary defects, the steaming flow of arthrosis and osteoporosis, bundles, injuries and fractures are often the only possible option of knee elements: full or partial. Modern medicine uses innovative developments and high-precision equipment during implantation. Orthopedic surgeons have long considered such operations with routine. Watching plastics should not be fear, it is the fastest and effective way to return to active and full-fledged life.

Three components of an effective result at the PKS break

Ensuring a long-term trouble-free result of the reconstruction of parts of the musculoskeletal system stands on "three whales":

• competent diagnosis and preparation for the operation;
• highly qualified operational activities;
• postoperative recovery (rehabilitation).

Preparatory preoperative moment

Experience suggests that intervention provides a smaller percentage of performance, unless special training has been carried out. Often, a person is in charge of entering the hospital, inflammation and contracture (limiting the possible amount of movements) of ligaments are developing, which leads to the emergence of complications in the surgeon. To avoid problems before intervention, it is recommended to pass the following procedures:

• for the period of preparation, ensure the lability of the knee. The minimum load is provided with a cast brace and movement with crutches;
• the use of anti-inflammatory drugs. Medical treatment appoints a doctor. Ice compresses you can do yourself;
• massotherapy;
• restore the required volume of movements. For flexion / extension of the knee, a complex of special exercises is prescribed, which can be done for everyone.

The patient is ready for operation if:

• there are no pronounced pain symptoms;
• restored the volume of movements and control over the muscle mass;
• there is no strong swelling and inflammation.

Conducting an operation

Depending on the state of the joints, partial or complete endoprosthetics can assign. With the consequences of strong injuries, which led to complex breaks for anterior cross-shaped ligament, strong necrosis of bone tissues, or arthritious destruction joints change totally. One-pole implantation is carried out in cases of minor damage.

Rehabilitation time after PKS break

Postoperative

Stationary observation under the control of medical personnel is shown 4-14 days after the operation. During this period, depending on the presence / absence of postoperative complications, conservative drug treatment, therapeutic massage, physiotherapy are prescribed, treatment massage, physiotics. After complete consolidation of the artificial joint and the restoration of the patient's movements, they are discharged to pass the rehabilitation at home.

Home Restoration

After replacing cruciform ligaments, the rehabilitation period is from 4 months to six months. Rehabilitation activities are developed individually for each person, depending on the physical and anatomical indicators and consist of several stages:

Stages of recovery	Timing	Permissible and necessary actions
passive	Up to 14 days after surgery	Move only if necessary, do not overload the limb. The whole period is to keep your leg at the level of the chest. To remove painful symptoms and swelling to take drugs assigned by the attending physician.
Start of active movements	2-4 weeks	You can take a shower yourself. Continue medication treatment. During this period, special gentleborne physical education exercises are prescribed, contributing to the return of muscle tone. Massage and physiotherapy is recommended.
Active rehabilitation	4-16 weeks	Performing regenerating exercises in a sitting position (up to 8 weeks), the development and restoration of the total volume of movements in the bend / break mode (8-12 weeks). Moderate walking without the use of submitted means is allowed. Physical exercise on the simulators is shown from 12 weeks. Development of joints and the possibility of a full-fledged movement.
Finishing stage	16-26 weeks	The ability to actively up / down, drive car. It is impossible to lift gravity, heavily redirect the limb to prevent recurrence.

It should be remembered! Not only elderly people are at risk of breaking the front cruciform ligaments. Young people can get to the operating table as a result of the development of the disease or as a result of injury. It is not worth spending money on "miraculous" pharmaceuticals and "unique" techniques of folk cudesmen. Miracles in life, of course, happen, but is it worth waiting for a miracle if you can diagnose the problem in a timely manner and do "low blood"? In the early stages of the development of the disease, the operation takes less painfully, the artificial component is faster and is not perceived by the foreign body.

With a competent approach and competence of doctors, the disease is treated in the shortest possible time and not returns long. Endoprosthetics of the cartilage is a progressive method that will relieve pain and risk to lose the ability of independent movement. Do not wait for miracles! Look at the reality of a sensible look and consult an orthopedist as quickly as possible. Why endure pain if it can be removed for a long time?

Be sure to consult a doctor before treating diseases. This will help take into account individual tolerability, confirm the diagnosis, make sure that the treatment and eliminate the negative interactions of drugs. If you use recipes without a consultation with your doctor, then it is completely for your fear and risk. All information on the site is presented for informational purposes and is not a healing benefit. All responsibility for use lies with you.

Injuries and diseases of the knee joint are the regular problems of those people whose life is quite active, they are constantly engaged in sports and have increased physical exertion daily (running, gymnastics, etc.). Very often, with such diseases, people turn to those skilled in the art. To determine the source of pain, the newest research methods are used, among which the arthroscopy of the knee joint. Because this method is not only used for diagnostics, but also allows you to eliminate the gap of meniscus, remove the edema, return the functioning of the limb, as well as stabilize the front crucible ligament (PKS). The front cruciform bunch is the main knee controller holding the shin of offsets. Along with the gap of the meniscus, PKS breaks is one of the most frequent causes of operations on the knee joint.

Arthroscopy of the knee joint is a surgical examination and treatment of the affected area, which is carried out using the arthroscope. Using this tool, you can remove the gap of the meniscus and the joint swelling.

For the first time, the arthroscopic operation was made in the 60s of the last century. And since then, the arthroscopy of the knee joint has become affordable, and at the same time a simple way to study and treat the affected area (gap of the meniscus or swelling of the joint).

Nowadays, the arthroscopic operation can be carried out during the day, and the postoperative period and recovery do not take much time. And after a few days after resection was made, the patient can write home. At the same time, rehabilitation is carried out at a distance and outpatient.

The main advantage of the knee arthroscopy is that while a diagnostic operation occurs, a specialist can be resected (if there is a need for). The one of this knee arthroscopy has several advantages:

After the operation, if the state of the operated joint will not cause fears, and the recovery period will not delay for a long time, you can make the simplest exercises, for the development of muscle tissue.

Equipment for the operation

In order to effectively and qualitatively, therapeutic resection of the victim joint and PKS was carried out, it is necessary to use special equipment - arthroscope. Its basis is the system of lenses located in a rigid steel tube, which is connected to light cables. Rays pass through fiber, and the image of a sick place through a small chamber enters the monitor (for example, swelling and gap of the meniscus, the PCS breakdown). Such equipment gives a chance to explore all the elements of the joint and provide high-quality treatment.

It is worth noting that all arthroscopes have different viewing angles (0? 30? And 70?), 80-90 viewing fields? And the diameter of the tube (for the treatment of small joints, the minimum diameter is used). At the time when the arthroscopic operation is carried out by a specialist able to change the field of the review by turning the tool around the axis.

Indications for surgery.

The arthroscopy of the knee joint is carried out in the following cases:

• gap and damage to meniscus;
• damage to ligaments;
• pCS;
• swelling and inflammation of the synovial shell;
• dysplasia and dislocation of a cup;
• rheumatic diseases;
• diseases of the cartilage joint;
• necrosis of the femoral bone;
• hyperplasia;
• arthrosis;
• unclear clinical picture that cannot be clarified by passing tests or making x-ray;
• complaints after the previously perfect operational intervention.

Anesthesia of the victim joint

Whatever the damage of the limb (the gap of the meniscus or the pressure of PKS, swelling and so on.), Like any other operation, resection begins with the anesthesia of the knee.
Specialists use several methods of anesthesia:

• Local. The simplest anesthesia performed is not dangerous to health and does not require the involvement of specialists. It is applied less frequently than the rest, because its use lasts long.
• Conductive. For this anesthesia, 0.01 lidocaine solution is used, which blocks the main nervous endings. How many such anesthesia lasts, no one will say exactly. As a rule, its validity period is 1.5-2 hours.
• Spinal. To make such anesthesia use Marcain - the most popular anesthetic. Its dignity is that applying a catheter can be extended to the effects of anesthesia, as well as preserving communication with the patient.
• Total. This anesthesia should do a specialist, while there is an opportunity to control the anesthesia time.

Anesthesia should be done taking into account the method of carrying out the operation and the level of its complexity.

Possible complications

It is worth noting that any operation (gap of meniscus or PCS damage, swelling) implies a professional intervention, but it provides that complications may arise during rehabilitation.
These include:

• complications after anesthesia that are not related to the disease;
• problems with vessels, if there were veins or arteries;
• stretching caused by an increase in distance between meniscus and bone tissues;
• arthritis, occurs if pathogenic bacteria fall into the wound;
• hemarthrosis arises due to hemorrhage in the joint.

In addition, it is worth noting that if you do everything right, the risk of all complications is minimal. Therefore, treatment, postoperative period, recovery (exercises and running) should be carried out under the supervision of professionals.

Consequences of the operation and rehabilitation

Therapeutic and diagnostic rehabilitation, postoperative period and recovery include several factors. This is a massage, stretching exercises, slow run, treated physical culture and stimulation of femoral muscles using electrical waves.

The postoperative period and recovery include special exercises (running, squats, etc.), which are selected by a specialist, taking into account all factors. Exercises must be simple so that they can be easily done independently.

The consequences of the operation (gap of meniscus or PKS, swelling of the joint), if a specialist agreed to do it, as well as the postoperative period and recovery, will not give you the inconvenience. Otherwise, complications may occur.

If the postoperative period and recovery pass with complications, then you must refer to a professional who will tell you what should be done to remove pain.

Often the question arises, how much is such an operation? Is there a quota for her? What should be the postoperative period and recovery? What exercises should be included in the leaf, how to do them? Will the joint hurt running?

Only a specialist can answer all these questions. And then only after it will hold a full examination of the sick joint.

2016-06-14

Rehabilitation after PCS plastics is very important. If the patient does not follow the recommendations of the doctor, he risks forever to remain chrome. You need to do all the necessary exercises to gradually restore the mobility of the knee joint. Rehabilitation will take at least 30 weeks.

First days after plastic

It is impossible to immediately begin the exercise. Within 5-7 days after surgery, the patient must comply with bed regime. He can get up to go to the toilet. It is impossible to rely on the sore leg, so the patient should be used by crutches. It is necessary to fix the leg so that it is above the head. If not to do this, edema is formed. Still a patient will have to wear ortes, which will not give the knee to bend. You can remove it in 3 months.

5 days after the operation, the patient must start walking, leaning on crutches. At this stage of recovery, a slow walk through the chamber or by the corridor is the main exercise. Stop sick legs should lightly touch the floor. You can carry part of the load on it when the doctor confirms that rehabilitation is successful. At the same time, pain should not occur.

2 weeks after the operation, it is necessary to start developing the joint and bend the knee:

1. Lying on the bed, you need to slowly and smoothly pull the leg, gliding the heel on the sheet. During this exercise, a weak new pain may appear.
2. Two times a day you need to get out of bed and raise your leg over the floor by 10 cm. Before starting the workout, you need to remove orthosis. To restore after the operation, it was successful, each movement should be done carefully and slowly.

The first 2 weeks after the operation can not be sitting, lowering the foot on the floor. She must lie on the bed or on a chair. Otherwise, swelling is formed. You can apply to the knee package with ice.

If there is a strong pain, you need to immediately interrupt the exercise and seek medical attention.

We must not forget about drug treatment. Within 2 weeks after surgery, you need to take preparations that take pain and inflammation. Another doctor must prescribe a medicine that will prevent the formation of thrombus.

A month after surgery

Rehabilitation after plastic front cruciform bundles during this period should include more active exercises. One of the main - lifting legs. You need to do it, lying on your back. It is necessary to raise the leg in 3 stages with small breaks. It is impossible to bend the knee. It is also necessary to lower in the 3 stages. It is worth abiding care and not to make sharp movements.

Another useful exercise is a partial squat with a support. It is better to do in Ortez.

Very useful classes in the pool. The program should be an experienced trainer, because at this stage of recovery the incorrect or too sharp movement can lead to a new knee injury.

The patient can walk, relying on the crutches.

It is important to monitor that swelling is not formed. Instead of medicines, a specialist should appoint an ointment that, if necessary, remove pain and inflammation.

In 5-6 weeks after surgery

The rehabilitation program after plastic PCS at this stage will include the same exercises that the patient did before. It is important to continue to develop a joint to return full mobility to him. There should be no lessons in the pool, but can not dive and swim the patient.

3 months after the operation, the crutches can be removed. If the patient feels that he is still hard to walk on his own, he must rely on a cane. It is no longer necessary to take medication, but you can still use ointment and gels if necessary.

Effective classes on the exercise bike. Loads must be increased gradually. It should be started with an approach that will last no longer than 5 minutes. In this case, the pedals should spin freely. Resistance must be increased gradually, otherwise it can lead to injury. Another useful exercise is the steps. Using blocks, a 10-20 cm height simulates the staircase.

During the following classes, it is necessary to use a special rubber loop:

1. The patient must stand near the wall, rely on her back and put on a rubber loop on the feet. Then you need to slowly raise and lower the sore leg, without bending it into the knee.
2. The patient should lie down the side and throw the rubber loop on his knees. After that, the injured foot should be lifted, to hold in that position and slowly omit.

These exercises with rubber loop effectively strengthen the muscles.

7 weeks after plastic

The rehabilitation program takes 7-8 weeks, but it will take much more time for full recovery. For this reason, it is important to be careful for 30 weeks after surgery.

It is necessary to continue classes in the gym and pool. Special attention needs to be paid to the bike barbecue, because it is useful for those who survived such an injury. Crutches and cane will no longer need a patient, he will be able to freely make hiking. They are needed that the mobility of the joint is fully recovered.

You can engage in special aerobics by posting the leaf group.

The pain in the joint at this stage should not occur, but it is necessary to temporarily refrain from runs and long trips to the forest or mountain. Inhibit the leg after 7 weeks after the operation is already much more complicated, but the knee may not withstand heavy loads.

It should be remembered that rehabilitation will take a lot of time and some exercises will cause discomfort. Taking strong painkillers during this period is impossible, because the pain is an important signal. If it appears, you need to interrupt classes, otherwise there will be a big risk of getting a new injury. It is necessary to discuss with a specialist all stages of recovery.

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All you need to know about plastic front cruciform knee bundles

In the process of intensive sports, as well as domestic injuries or bruises obtained as a result of work, there are often damage to the intra-articraft structures of the joint joints, namely meniscovs and cruciform ligaments. The knee joint is not only one of the largest in the body of every person, but also one of the most difficult. Therefore, during injuries or tears, the maximum efficient treatment method is surgical intervention, namely plastic.

What is the knee

This is the biggest joint in the human body. The bones on top and bottom are separated by disks that are called meniscus. The surface of the bones from the inside of the knee is covered with a cartilage, which shocks all external influences (blows and bruises). When the joint is moving, the external smooth structure of the surface of the cartilage contributes to its slip.

The main functions of the knee joint is bending, extension and support. On the joint, located in the knee, the entire load of the body is placed when walking or standing. In order to withstand the weight of the entire body, and also to perform your knee problems has certain structures (bone, binders and cartilage).

The joint, located in the field of the knee, contains four main bones:

• hip bone;
• tibia;
• kneecap;
• fibula.

The strips of compacted fibrous fabric combine all bones among themselves, and their knees are also four: front, rear, medial and side collateral.

Bundles, located behind and in front of the knee, provide rotary stability of the joint. Medial and lateral ligaments ensure the stability of the knee in the foot and in the process of walking.

The tendons are also fibrous strips, but they are connected between themselves no bones, but attach muscles to them.

Crying - these are peculiar structural formations in the knee joint, providing joint depreciation.

Reasons for breaking ligaments

The rupture of the front cruciform knee bundles is not uncommon among athletes engaged in professionally. In addition, the gap is not uncommon in people whose profession implies frequent injuries and is associated with heavy physical exertion (for example, movers). Such problems are also found among lovers of outdoor activities.

The main causes of the gap are:

1. A sharp turn of the bone of the thigh, without a concomitant shift in the same side of the foot and the legs. The stop remains stationary, and the thigh turns outward, the shin can also stay in place, as well as the stop, or turn inside.
2. The front bunch can be broken in the process of hitting the knee area from behind.
3. Impact on the knee in front can cause not only the bundle break in the front, but also in the back.
4. Falling back, while the stop and the shin remain in a constant position (horizontally land). Such injury is not uncommon from skiers, as their legs are fixed in ski boots.
5. Injury in the process of jumping from height, when a person lands on straight legs.

Injury and the gap itself will be directly dependent on the strength of impact of impact or fall. In the course of this gaps can be both partial and complete.

Symptoms of damage

Each person, and especially athletes and amateurs of outdoor activities, should understand which symptoms indicate a bundle of a bundle in order to seek medical care as soon as possible and avoid unpleasant consequences.

Symptoms of injuries and discontinuities is:

• strong and sharp pain in the knee field;
• eyefather in the area of \u200b\u200binjury, not to notice that it is impossible;
• during impact or fall, a characteristic crackle is heard, which indicates a rupture;
• the patient is difficult to move, the joint is limited in motion;
• the victim cannot transfer body weight with a healthy leg on a damaged limb;
• with a complete break, the pathological mobility of the knee pads arises.

If the patient has at least a few of the above symptoms, then he needs to immediately apply for consultation into the medical insurance. About how to give first aid when breaking the knee bundles can be read here.

Diagnostics

Very often, when the cruciform ligament in the cavity of the scene itself can get blood - this is called hemarthrosis. In the process of such an injury in the first few days, the patient experiences such strong painful sensations that the palpation of the damaged area of \u200b\u200bthe knee by the doctor becomes simply impossible. After all, it is precisely by means of visual inspection and tackling a doctor can put an intended diagnosis. A few days later, the pain becomes not so pronounced and leaves swelling. If there is an opportunity in the first hour after the injury to visit the Cabinet of the traumatologist, then the correct diagnosis will be delivered very quickly and the treatment will begin on time.

After visual inspection and familiarization with the mechanism of the injuries itself, the doctor conducts testing of the knee joint. At the initial stage, a specialist examines a healthy knee. This is necessary to familiarize the patient with the inspection technique, as well as comparing healthy and damaged ligaments.

To determine the nature of the injury, a number of specific tests are carried out. To do this, the traumatologist provokes a damaged leg, shiny the shin on the sides. If the tissue is torn and does not fulfill its basic functions, then the shin will be affected and shifted in different directions.

In some cases, when there is an assumption for the presence of accompanies or fractures, the doctor may assign additional research: X-ray, MRI of the knee.

What implies plastic front cruciform ligament (PKS)

With different damage, which are characterized by the breaks of the knee ligaments, the operation is recommended - arthroscopic plastic PKS knee joints. This procedure involves the replacement of broken fibers on the graft, which can be made of artificial or natural tissues, by strength not inferior to damaged tissues.

Before the operation, the doctor when collecting anamnesis takes into account all factors in the history of the patient's disease, which can cause contraindications or, on the contrary, indicating the upcoming operation.

References for plastic ligaments are as follows:

• a break that occurred through the entire width of the fiber;
• partial gaps, treatment with drugs of which did not bring the desired result;
• damage, after which there was a long time causing discomfort when walking;
• after unsuccessful surgical interventions, recurrence after treatment.

Contraindications to operation include the following situations:

1. Conduct to fully plastic PCS does not allow the elements arose in the knee.
2. The overall health of the patient, which may be the consequence of most chronic diseases, also does not allow the use of this method of treatment.
3. Anesthesia allergies used in operational intervention is a ban on any operational interventions.
4. Purpose skin diseases in the field of operation are contraindications until they are eliminated.
5. In hypotrophy, the tendons do not seem to be operated possible.

Restoration of the cruciform ligament can be carried out in several ways. As natural grafts are used:

1. Autotransplant is a patient's own tendon, which is taken as a replacement damaged. A small fragment of the borrowed tendons is inserted into the pre-drilled hole. In most cases, a fallated tendon or a lunch of a patellane is used. The autotransplant is most preferable, since it does not arise the risk of developing side effects. The disadvantage of the method is the duration of the operation and donation of secondary tendon. Already a few months later, the bundle begins to fully function.
2. Allotransplant is a prosthesis, that is, the donor tendon, which is taken from the donor. The donor can be both relatives and completely unfamiliar people. The material is often removed from the recent time of the deceased person. The donor implant may not take care of (rejected by the body), even though it is pre-exposed to a high degree of cleaning and preparation.

Ligamis method

During the operation by the Ligamis method, a completely synthetic implant is used. It is a fibrous polyethylene structure, at the end of which a metal retainer is located. This design is implanted into the joint on the knee and is fixed reliably. The operation allows the bundle to recover on their own.

About what other operations are spent on the knee can be found here.

What complications may arise

After the surgery for the reconstruction of the cross-shaped ligament, complications are possible, as after any other surgical intervention.

Complications after plastic cruciform ligaments may be the following:

• sustav's contracture, subject to all the prescriptions of the attending physician during the rehabilitation period, the problem is eliminated;
• arthrosis area of \u200b\u200bthe knee with accompanying painful sensations, which requires additional treatment;
• in the process of increasing the loads, a transplant is possible;
• transplant rejection;
• allergic response to the anesthesia.

Rehabilitation after plastic PKS knee joint

After surgery, the patient is recommended to perform a comprehensive rehabilitation program. With a successful operation and compliance with all prescriptions of the attending physician, rehabilitation takes no more than 4 months.

In the first weeks after the operation, it is necessary to reduce all the loads on the operated leg. At the beginning of the period after the operation, the patient is superimposed by a special fixing bandage on the knee.

The first few weeks after the plastics of the knee joint, the patient is recommended to move with crutches, it reduces the load on the leg. Only a month later it is allowed to walk without crutches, but without much effort and loads on the operated leg.

Every day the load on the operated leg increased with the help of physical exercise (exercise). The exercise complex is developed individually for each individual case and only attending physiotherapist. In addition to physical exercises in the process of rehabilitation, magnetic therapy, massage, warm compresses and electrophoresis are prescribed to the patient.

In the last stages of recovery after plastic PKS, the patient was recommended several times a week clagging at the exercise bike or treadmill, but only after consulting with his attending physician. Do not independently begin such exercises, as you can harm your body.

Forecast

After holding a successful operation, as well as compliance with all the requirements of its attending physician and physiotherapist, the complete recovery is observed about 90% of patients. Already a few months later (at least three), the patient returns to the usual way of life.

The complete reduction of adjacent muscles to the joint depends on the intensity of physical exertion, which are included in the exercise complex.