Protocolo de reabilitação para as reconstruções isoladas do ligamento cruzado posterior

Abstract

To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, basedRev Bras Ortop. 2012;47(4):421-7 on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.

Treatment of isolated lesions of the posterior cruciate ligament

“…According to the protocol developed at the Holy House of Mercy in São Paulo (HSCSP), the range of motion respects the angles of 0-70° in the first four weeks, up to 90° by the sixth week and, after that, there are progressive gains in amplitude (C). 42 Quelard et al advocate gradual passive mobilization, performing a range of 0-60° in the first six weeks, 0-90° on the sixth to eighth weeks, and 0-120° from the eighth week on (D). 43 McAllister and Hussain (C) 44 begin mobilization between the third and sixth weeks, Fanelli et al (D) 15,41 between the fifth and tenth weeks, and Edson et al (D) 45 in the fifth week.…”

“…41 According to the national protocol, developed by Cury et al, closed kinetic chain exercises should start from the second week, limiting the range of motion to 0-45°, progressing to open kinetic chain exercises through isometric contraction with an angle of 45-70° in order to spare the PCL from exaggerated tensions and protect the patellofemoral joint (C). 42 The protocols usually postpone the introduction of exercises directed at the hamstrings aimed at not tensioning the graft during the initial post-operative period. The group of Brazilian authors either disagrees or has no agreement as to when to start working the hamstrings (C).…”

“…41 Proprioceptive training should be undertaken on stable ground with static exercises, progressing to unstable ground with dynamic exercises and increasingly specific to the functional goal. The predicted discharge for sports activities occurs from the sixth postoperative month on (D) 15 (C) 39,40,42,43,44 (D). 41,45,46 Recommendation: C There are no level A studies indicating a standard protocol for rehabilitation of PCL injuries, but most authors reach about 70% success in rehabilitation with different protocols, providing activity levels similar to the pre-injury period.…”

Processos de intervenção em fisioterapia e terapia ocupacional 3

“…Dessa forma, os protocolos utilizados trabalham com a mobilização nos primeiros dias pós-operatórios com exercícios isométricos. Nas primeiras semanas a liberação parcial da carga, a mobilizações passivas para trabalhar a ADM do joelho, conforme a reabilitação progride é trabalhada a força muscular e o treino sensório-motor (CURY et al, 2012). Além disso, podem ser trabalhados protocolos de exercícios associados a outros recursos podendo ser elétricos, a crioterapia e a hidroterapia.…”

Incidência de lesões de joelho na população de São José do Rio Preto encaminhada para reabilitação / Incidence of knee injuries in the population of São José do Rio Preto referred for rehabilitation

“…A incidência de lesões de ligamento cruzado posterior varia de 2 a 44% das lesões ligamentares do joelho, e lesões isoladas são menos frequentes e menos sintomáticas quando comparadas com lesões múltiplas (CURY et al, 2012). Segundo Barros et al, (2014), o (LCP) tem atuação na estabilidade da articulação por ser restritor primário da translação posterior da tíbia em relação ao fêmur.…”