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1 Sports Injury: Rehabilitation Principle and our Program after Anterior Cruciate Ligament Reconstruction Operation Setsuro KURIYAMA,*1 Mikihiko WATANABE,*1 Hiroki ISHIKAWA,*1 Toshio KAWASHIMA*2 Abstract: The anterior cruciate ligament (ACL) injury is popular and famous in sports injury, because it is difficult to heal naturaly and to return to the competition level. The natural anatomical function of the ACL makes that difficulty. The ACL combines the femur and tibia, and it limits the anterior dislocation of tibia mainly. The quadriceps (Quad) muscles attach to the anterior end of the tibia, so, the Quad makes anterior dislocation of the tibia. But in sports training, athletes make their Quad muscles very strong by the heavy training. The ACL works as a brake system to this strong Quad muscles. So, "the stronger Quad muscles are the killer of the ACL", is an important point in sports training. Another anatomical point is that the ACL and PCL (posterior cruciate ligament) are the only "intra capsular (joint) ligaments" in human joints. So, when it is injured, the ACL is necrotized rapidly. So, the ACL reconstruction operation is a main treatment method. In rehabilitation technique, we must understand these anatomical characteristics of the ACL. In this paper, I explain the anatomical and biomechanical points of the ACL, and explain "our rehabilitation program after the semitendinosus and gracilis tendon reconstruction" from "our clinical study results". Orthopedics Surgery,*1 Rehabilitation Medicine,*2 Nippon Kokan Hospital
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8 3) Fu FH, Bennet CH, Lattermann C, Benjamin C: Current trends in anterior cruciate ligament reconstruction. Am J Sports Med 1999; 27: ) Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA: Arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 1999; 27: ) Bach BR Jr, Levy ME, Bojchuk J, Tradonsky S, Bush-Joseph CA, Khan NH: Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Am J Sports Med 1998; 26: ) Shelbourne KD, Gray T: Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. Am J Sports Med 1997; 25: ) Arms SW, Pope MH, Johnson RJ, Fischer RA, Arvidsson I, Eriksson E: The biomechanics of anterior cruciate ligament rehabilitation and reconstruction. Am J Sports Med 1984; 12: ) Henning CE, Lynch MA, Glick KR Jr: An in vivo strain gage study of the anterior cruciate ligament. Am J Sports Med 1985; 13: ) Beynnon BD, Johnson RJ, Fleming BC, Stankewich CJ, Renstrom PA, Nichols CE: The strain behavior of the anterior cruciate ligament during squatting and active flexion-extension. Am J Sports Med 1997; 25: ) MacDonald PB, Hedden D, Pacin O, Huebert D: Effect of an accelerated rehabilitation program after anterior cruciate ligament reconstruction with combined semitendinosus-gracilis autograft and a ligament augmentation device. Am J Sports Med 1995; 23: ) Shelbourne KD, Nitz P: Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 1990; 18: ) Brown CH Jr, Steiner ME, Carson EW: The use of hamstring tendons for anterior cruciate ligament reconstruction : technique and results. Clin Sports Med 1993; 12: ) Schatzmann L, Brunner P, Staubli HU: Effect of cyclic preconditioning on the tensile properties of human quadriceps tendons and patellar ligaments. Knee Surg Sports Traumatol Arthrosc 1998; 6: S 56-S 61 15) Rowden NJ, Sher D, Rogers GJ, Schindhelm K: Anterior cruciate ligament graft fixation. Am J Sports Med 1997; 25:
9 16) Wasilewski SA, Covall DJ, Cohen S: Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction. Am J Sports Med 1993; 21: ) Shelbourne KD, Klootwyk TE, Wilckens JH, Carlo MSD: Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation 30) Marder RA, Raskind JR, Carroll M: Prospective in accelerated rehabilitation program. Am J Sports evaluation of arthroscopically assisted anterior Med 1995; 23: cruciate ligament reconstruction. Am J Sports Med 1991; 19: ) Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, 19) Ohashi Y, Ohkoshi M, Nagasaki S, Ono A, Hashimoto Kaneda K: Graft site morbidity with autogenous T, Yamane S: The effect of cryotherapy semitendinosus and gracilis tendons. Am J Sports on intraarticular temperature and postoperative Med 1995; 23: care after anterior cruciate ligament reconstruction. Am J Sports Med 1999; 27: ) Bynum EB, Barrack RL, Alexander AH: Open versus closed chain kinetic exercise after anterior 21) Ohkoshi M, Yasuda K, Wada T, Yamanaka M: cruciate ligament reconstruction: a prospective Biomechanical analysis of rehabilitation in the randomized study. Am J Sports Med 1995; 23: standing position. Am J Sports Med 1991; 19: ) Yack HJ, Collins CE, Whieldon TJ: Comparison of closed and open kinetic chain exercise in the anterior cruiate ligament-deficient knee. Am J Sports Med 1993; 21: ) Palmitier RA, An K, Scott SG, Chao EYS: Kinetic chain exercise in knee rehabilitation. Sports Med 1991; 11: ) Jurist KA, Otis JC: Anteroposterior tibiofemoral displacements during isometric extension efforts. J Sports Med 1985; 13: ) Vergis A, Gillquist J: Sagital plane translation of knee during stair walking. Am J Sports Med 1998; 26:
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