J Orthop Sports Phys Ther. 2011 Sep;41(9):675-86. doi: 10.2519/jospt.2011.3453. Epub 2011 Sep 1.
Case report.
Joint stiffness, also called arthrofibrosis, remains the primary complication following any reconstructive knee surgery. Acute anterior cruciate ligament surgery, performed with concomitant multiple ligamentous repair and/or reconstruction, further increases the likelihood of developing impaired knee motion following surgery. The purpose of this case report is to present a criteria-based approach to the postoperative management of a multiligament knee injury.
A 25-year-old male professional football player sustained a contact injury to his right knee while making a tackle during a regular season game in 2007. He underwent an acute anterior cruciate ligament reconstruction, with concomitant posterolateral corner repair, biceps femoris/iliotibial band repair, lateral collateral ligament repair, and a medial meniscocapsular junction repair. He completed 17 weeks of a multiphased rehabilitation program that emphasized immediate range of motion, low-load long-duration stretching, therapeutic exercise, neuromuscular reeducation/perturbation training, plyometrics, and sport-specific functional drills. Electrical neurostimulation was implemented during the early stages of rehabilitation to control postoperative pain and to promote a steady progression of therapeutic exercise activity.
The patient was cleared to begin sport-specific activity 7 months after major multistructure reconstructive knee surgery. He began the 2008 season on the physically-unable-to-perform list, but was activated midseason and played in every game thereafter. During the 2009 and 2010 seasons, he played all regular season games and all playoff games as a starter, and continues to start as a defensive cornerback in the National Football League.
This case report highlights the clinical decision-making process and management involved in an acute multiple ligamentous knee injury/reconstruction.
Therapy, level 4.
病例报告。
关节僵硬，又称关节纤维强直，是任何重建膝关节手术后的主要并发症。急性前交叉韧带手术，如果同时进行多韧带修复和/或重建，会进一步增加术后膝关节运动受限的可能性。本病例报告的目的是介绍一种基于标准的多韧带膝关节损伤术后管理方法。
一名 25 岁的男性职业足球运动员在 2007 年的一场常规赛中因铲球而受伤。他接受了急性前交叉韧带重建术，同时进行了后外侧角修复、股二头肌/髂胫束修复、外侧副韧带修复和内侧半月板-囊结合部修复。他完成了 17 周的多阶段康复计划，强调立即进行活动范围练习、低负荷长时间拉伸、治疗性运动、神经肌肉再教育/干扰训练、增强式训练和专项功能性训练。在康复的早期阶段实施电神经刺激，以控制术后疼痛并促进治疗性运动活动的稳步进展。
该患者在接受多结构重建膝关节手术后 7 个月后被允许开始进行专项运动。他在 2008 赛季开始时因身体无法参赛而被列入伤病名单，但在赛季中期被激活，并在此后的所有比赛中出场。在 2009 赛季和 2010 赛季，他打满了所有常规赛和季后赛的比赛，并作为首发球员继续参赛，在国家橄榄球联盟中担任防守角卫。
本病例报告强调了急性多韧带膝关节损伤/重建的临床决策过程和管理。
治疗，4 级。
