Sports Injuries
17.4K views | +0 today
Follow
Sports Injuries
Sports injuries occur when participating in sports or physical activities associated with a specific sport, most often as a result of an accident. Sprains and strains, knee injuries, Achilles tendonitis and fractures are several examples of frequent types of sport injuries. According to Dr. Alex Jimenez, excessive training or improper gear, among other factors, are common causes for sport injury. Through a collection of articles, Dr. Jimenez summarizes the various causes and effects of sports injuries on the athlete. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444. http://bit.ly/chiropractorSportsInjuries Book Appointment Today: https://bit.ly/Book-Online-Appointment
Your new post is loading...
Your new post is loading...
Scooped by Dr. Alex Jimenez
Scoop.it!

LARS: Rehabilitation Strength Conditioning | El Paso Back Clinic® • 915-850-0900

LARS: Rehabilitation Strength Conditioning | El Paso Back Clinic® • 915-850-0900 | Sports Injuries | Scoop.it

In part I Chiropractor, Dr. Alexander Jimenez discussed the post-operative rehab requirements following a Ligament Advanced Reinforcement System (LARS) procedure. In part II he explains the specific staged ‘criteria’ driven rehabilitation process, with an emphasis on specific strength and conditioning principles that need to be considered throughout the reconditioning process.

 

Returning an athlete following a ‘LARS- reconstructed knee’ back to competitive status requires much more than simply restoring muscle strength and range of movement. An integrated approach encompassing full kinetic chain function enhancement is required. Additionally, an in-depth knowledge of strength and conditioning principles and how these apply to the systematic rehabilitation process and the long-term reconditioning of a LARS reconstructed knee is essential. Furthermore, ensuring the athlete remains injury-free requires ongoing management and regular monitoring.

Key Considerations

Return to competition following a LARS procedure differs significantly compared to a standard graft repaired knee (see Tracy Ward’s article elsewhere in this issue). Due to the unique nature of the LARS reconstruction, time frames are compressed and accelerated. Table 1 below compares the ‘expected’ time frames for return to competition for a LARS reconstructed knee versus a traditional ACL reconstruction. This topic has received a significant amount of media attention in Australia, with some professional Australian Rules Football players returning as fast as 14 weeks post injury.

 

The primary reason for the delayed return to competition in traditional ACL reconstructed knees with an autograft such as the hamstring or patella-bone-patella graft is the time it takes for the autograft to re-vascularize. Furthermore, the autograft has a harvested site that leads to donor site morbidity. Therefore the graft and the harvest site have to be protected until both have sufficient strength to be loaded. Conversely a LARS reconstructed knee is immediately protected by the nature of the artificial ligament matrix. The remaining ACL stump regrows through the matrix; however the knee is essentially stable during this process.

Stages Of Rehabilitation

When planning and delivering the stages of rehabilitation programs, an understanding of the influence of load exposure, load attenuation and force generation is critical to provide clinicians with a clear understanding of the milestones that need to be achieved – and the rate at which they can pursued. The best way to approach the process, therefore, is to stage the approach to high performance and load resilience using a ‘phased’ or ‘milestone- based’ strategy, with each stage feeding into the next. In keeping with the exit-criteria approach, we do not move between stages according to the passage of time, but the accomplishment of functional goals.

 

The four primary stages of knee rehabilitation following LARS reconstruction are:

 

1. Protection and healing

2. Restoring muscle strength and range of movement

3. Integrated functional adaptation

4. Sports-specific retraining

 

The time frame in each stage will depend primarily on the pathology we are dealing with. A simple LARS reconstruction will progress faster than a LARS that has associated meniscal repair, or if the femoral condyles and/or tibial plateau have residual bone oedema. The key objectives for each are discussed in more detail below.

Phase 1 – Protection & Healing

A critical early intervention following a LARS reconstruction is to protect the joint from further damage and to allow a supportive environment in which healing can take place. Dependent on the injury, this may require bracing, taping or even use of crutches. As soon as possible however, we want to restore normal gait mechanics as this has positive effects on proprioception and muscle activation. An effective way of graduating this is through an altered weight-bearing environment such as a pool.

The Importance Of Removing Effusions

Due to the nature of the arthroscopic surgery to repair a torn ACL with a LARS prosthetic, it is common for the patient to demonstrate a knee effusion post operatively. A knee joint effusion is an excessive amount of fluid within the synovial capsule of the knee indicating that the knee is inflamed or irritated (see Figure 1).

 

The exact patho-physiological mechanisms for an effusion and the necessary medical interventions are genuine concerns for the rehabilitation practitioner. Even small volumes of fluid (20-30mls) can result in a 50-60% reduction in maximal voluntary muscular activation(1-4), a process commonly referred to as ‘arthrogenic inhibition’(5). Moreover, small increases in intra- articular fluid (as modest as 5mls) increases the pressure within the knee joint. This can be a source of discomfort and concern for the athlete.

Furthermore, it has also been found that knee joint effusions will also alter the knee joint mechanics during landing tasks(6). Those individuals with a knee effusion tend to land with greater ground reaction forces and in greater knee extension, resulting in more force being transferred to the knee joint and its passive restraints.

 

Removing the effusion does make a demonstrable difference to quadriceps function. This can be a frustratingly slow process, however, and so a number of interventions should be prioritized:

 

  1. Regular assessment performed prior to loading the knee joint, and in the subsequent 24 hours – particularly if the load is new and more progressive.
  2. Remove the effusion if present.This can be done with conventional methods such as elevation, compression with donut felt, effusion massage and reduced weight bearing. There are also more medically directed interventions such as non-steroidal anti-inflammatory medication (NSAIDs) or direct needle aspiration if indicated. Removing the internal fluid will significantly reduce the internal pressure within the knee as well as improving quadriceps strength.
  3. Exercise selection – quadriceps setting exercises that are performed in positions of partial (20°) knee flexion or isometric squats in 20-30° flexion, will allow muscle recruitment without increasing the intra-articular pressure associated with full knee extension.
  4. Early pool work provides us with the opportunity to take advantage of hydrostatic pressure to aid with effusion drainage.

Reactivation Of Muscles In Early Phase Rehabilitation

Since effective muscle function helps absorb joint loads, a restoration of contractile activity must be seen as a priority, and so in the early stages of knee rehabilitation the focus is on:

 

  • Quadriceps setting exercises
  • Quadriceps-hamstring co-contraction exercises
  • Isolated hip muscle exercises (particularly gluteals and hip external rotators) in a non-weight bearing (lying down or sitting) or protected-weight bearing situation (altered gravity treadmills or pools if available).

 

It should be noted that the LARS reconstructed knee usually does not need a major period of protected weight-bearing, so in most cases, weight bearing quadriceps, hamstring and hip muscle strength work can be included very soon after surgery.

 

There are many ways to accelerate the return of muscle bulk and gross muscle strength in the early rehabilitation setting. Occlusion training (see Figure 2) and electrical muscle stimulation can be very helpful in gaining muscle hypertrophy in the early stages of rehabilitation where high mechanical and joint compressive loads are inappropriate. For a thorough piece on occlusion training, refer to an article written by Luke Heath in Issue 157 of Sports Injury Bulletin.

Restoring Range Of Motion

Limitations in range of motion (ROM) are common following a LARS reconstructive procedure, particularly in terminal extension. The primary mechanisms that limit the final 5-10° of extension can be broken down into mechanical (intra- articular) and myogenic (muscle tone) reasons. Dependent on the cause, manual therapy aimed at restoring accessory joint motion, effusion aspiration, soft tissue massage, trigger point releases and dry needling / acupuncture may help correct ROM restrictions.

Phase 2 – Strength & Motion

The second phase of rehabilitation is geared towards the introduction of strength work. This can be broken down simply into knee- dominant and hip-dominant movements. These are essentially exercises done in a sagittal plane and involve the combination movements of ankle dorsiflexion/ plantar flexion, knee flexion/extension and hip flexion/extension. In simple terms, examples of the following are:

 

  • Knee dominant: single leg squat, single leg lunge, leg press, Bulgarian (rear foot elevated) squat, Nordic hamstring curls
  • Hip dominant: Romanian deadlift, glute-ham raise, hip thruster

 

These are initially performed using bodyweight only and with slow controlled tempo. Load/speed and complexity is added as the athlete progresses through the rehabilitation setting. The key feature in this stage is that the joints of the lower limb (knee joint included) are engaging in a co-ordinated manner that satisfies the kinetic chain requirements of the lower limb.

 

The joints initially absorb force (slowly in the early stages of rehabilitation) through the eccentric component. They are then required to hold, stabilise and control a loaded position, before finally propelling away from the loaded position whilst maintaining kinetic chain alignment.

 

The benefit of a LARS reconstructed knee is the fact that no donor site morbidity exists as would be present in a PTB or hamstring graft ACL reconstruction. Therefore, strength work is usually progressed much quicker in a LARS reconstruction. Some rules/guidelines to follow when considering the implementation of these traditional clinical/gym based movements are:

 

1. Propulsion/acceleration forces – The joints and movements involved in the propulsion phase of locomotion are ankle plantar flexion, knee extension and hip extension (triple extension phase). This capacity is generally the easiest and safest to develop early, involves concentric muscle force, and requires the least work capacity and the safest joint reaction forces.

 

2. Absorption/deceleration forces–The joints and movements involved are ankle dorsiflexion, knee flexion and hip flexion (triple flexion phase). This capacity requires the highest amount of force production as the muscles are working eccentrically and the downward effect of gravity and the resultant upward ground reaction force are greatest. Joint stress on the knee is maximized and thus is the hardest to develop. However because knee injuries usually occur in the landing/ cutting/deceleration type situations, it is these absorbing/decelerating forces that need to be trained to a high level prior to return to competition.

 

3. Early plyometrics – Introduction of higher intensity movements, with the aim of perfecting technique for latter stages (where load is increased). These can be added early in the rehabilitation setting via safe joint-sparing alternatives such as unloaded fast eccentric exercises and pool plyometrics.

 

4. Bilateral transfer – Training the contralateral limb can result in measurable strength and performance gains in the affected limb. Early strength work on the unaffected side will assist in earlier functional recovery in the affected side.

Phase 3 – Return To Function

The third phase is an extension of the second. However, the emphasis is now on sport-specific movements that need to be retrained prior to return to full training and subsequent competition. This is the stage that is characterised by return-to-running protocols and the introduction of agility and cutting movements. There are a plethora of factors need to be considered and integrated into a return to running program.

Developing The Capacity To Decelerate

Getting the athlete to repeat box landings are helpful in training the ability to arrest body weight. The progression sequence for a LARS reconstruction would be;

 

1. Two legged jumps onto a box

 

2. Two legged jumps off the box

 

3. One legged hops onto box

 

4. One legged hops off the box

 

5. One legged hops with increasing height (maximum height 40cm)

 

This progression should take place over the course of a month. Do not try to ‘tick all these boxes’ in too short a period, as the risk of developing patellar tendinopathy is high if there is a sudden spike in loading.

 

Clinicians also need to be acutely aware of the importance of well-structured running/agility programs that incorporate the development of the deceleration forces such as cutting, turning, slowing down, landing and pivoting. Generally speaking, the athlete should be exposed to a number of weeks of increasing volumes of acceleration, deceleration and top-speed drilling before integration into open-skilled training is considered.

 

To allow progression to phase 4 of rehabilitation, we suggest the following exit criteria are passed (this can be as fast as 9 weeks post operative):

 

1. Maintenance of an effusion-free joint

 

2. Full range of movement (may lack 10% flexion)

 

3. Good control of single leg landing from a 40cm box

 

4. More than 85% hamstring and quadriceps strength compared to contralateral side

 

5. Good control of 50-degree change of direction to either side

 

6. Return to more than 85% of pre-injury maximum running speed

Phase 4 – Return To Performance

In the final stage of rehabilitation and reconditioning, the athlete progressively returns to sport-specific skill training. In this stage, high-level rehabilitation exercises that incorporate functional kinetic chain integration (ankle, knee, hip, pelvis, spine and upper limb) need to be implemented in a manner that challenges the athlete’s proprioceptive abilities and reactive abilities. The purpose is to condition the neuro-sensori-motor system to a wide spectrum of unpredictable stimuli so that maximal ‘CNS wiring’ can occur. The variables that can be manipulated to provide broad spectrum challenges are:

 

1. Surface – stable (floor) to unstable (sand, balance boards, trampoline, mats)

 

2. Body movement – stable on feet to unstable (rolls to stand, jump variations)

 

3. External load – eg cables, dumbbells, weight vests, asymmetrical weight barbells, kettle bells, suspension trainers, medicine balls

 

4. Sensory cues – variations in responding to sound, vision and touch

 

5. Speed–slow speed to fast movement

 

6. Environmental obstacles – other athletes, cones, hurdles etc..

There exists a plethora of different training modalities that an athlete may be subjected to in this stage of the rehabilitation/ reconditioning process. Two modalities that have been used to great effect are sand-based training and gymnastics – based training.

Sand-Based Training

A 5m x 10m sand pit can provide a fantastic and challenging rehabilitation environment for the knee-injured athlete. Simple drills that are also done in stable- base training (eg grass or gym) can also be used in the sandpit. The benefit of the sandpit is that due to the shifting surface, it provides a greater proprioceptive challenge. Furthermore, the sand absorbs much of the downward reaction force, which is a positive benefit to the load-compromised knee:

 

1. Running drills – all of the running drills used in ground-based running can be used in a sandpit. Furthermore, as well as forwards running the athlete can perform backwards running. Carioca drills, stepping and cutting drills and lateral movement drills can also be performed in the sandpit.

 

2. Jump, hop and landing drills – forward hops, sideways, lateral hops, two leg to one leg, single hops vs multiple hops are all variations that can be used.

 

3. Sand displacement drills – using the planted feet, the athlete can be encouraged to ‘move’ through the sand by using a twisting motion to displace sand away from the feet. This encourages the development of hip/knee rotation, ankle stability and foot stability. The athlete can move forwards by stepping/lunging into the sand and then twisting the foot prior to the next step. Alternatively they can keep the feet buried and twist side to side to move laterally through the sand.

Trampoline Drills

Full-size trampolines also provide a difficult balance environment for the knee injured athlete:

 

1. Run and stop drills – have the athlete running on the spot and stop on an auditory or visual cue. This will not only develop reactive abilities to external stimuli, it will also create greater proprioceptive and balance integration due to the unstable surface the trampoline provides.

 

2. Hop and landing drills – single hops, double-leg jumps, forwards, sideways, backwards are all variations that can be used with hop drills.

 

3. Rolls to balance – forwards and backwards rolling to a squat stance or single leg stance provides an enormous strength, balance and range of movement challenge. Although not exactly specific in its application, the crossover effect of this type of balance training can provide immeasurable benefit to the knee injured athlete.

Return To Contact Training

Staging a knee-injured athlete back to a full competitive training situation requires a stepwise progression of drills and skills that resemble the demands of the competition, whilst still allowing appropriate protection of the knee at critical stages of recovery. A logical way to prepare the athlete to develop match readiness is to modify the training environment from safe and controlled situations initially, to more advanced game-specific events as they progress. For example, starting in kneeling positions and then progressing to standing, walking and running positions allows the athlete to confidently practice contact components without fear of further knee injury.

Functional Tests

The highest risk for a knee injury is a previous knee injury(7). In order to do everything we can to reduce this risk to a minimum – and be confident that the athlete is not just fit to play but fit to perform – a series of functional sports-specific test should be employed. The test should be an objective, measurable and quantifiable test that includes an element of:

 

  • Strength
  • Agility
  • Power
  • Balance
  • Neuromuscular status

 

The above factors can be incorporated into functional tests such as hops and agility/ movement tests. The more common hop tests include (seeFigure3):

 

1. Single hop for distance

 

2. Triple hops

 

3. Crossover hop

 

4. 6-meter timed hop

 

It is beyond the scope of this article to discuss these functional hop tests in detail.

The Load Compromised Athlete

Unfortunately for the athlete returning from a LARS reconstruction, the knee joint pathology needs to be respected for the remainder of the athlete’s career. This essentially makes the athlete ‘load Injury classification compromised’ against a similar athlete with no previous history of knee injury. From a knee perspective, the practical interventions that need to be considered once the athlete is back to competition are:

 

  • Regular assessment of effusion, particularly after a major change has been implemented such as a new skill, extra load, plyometric type training, frequent exposure to competition/ training etc.
  • Regular assessment of functional tests to ensure the athlete stays within acceptable levels.
  • Load monitoring – this can be direct volume and impact monitoring using GPS or, if unavailable, carefully selecting the training sessions the athlete will be involved in. Athletes may need to miss the occasional session to allow knee joint recovery.
  • Regular soft tissue therapy (to ensure the myogenic elements of tissue are not reacting adversely to load).
  • Education for both athlete and coaches. All interested parties need to be aware that the knee may require periods of de-loading to restore a healthy homeostasis.

Summary

A LARS reconstructed knee is a controversial topic and is still relatively new and unknown in the world of sports medicine. Further long-term studies are needed to evaluate the implications regarding re-injury rates and other complications following a LARS reconstruction. However, the limited available empirical research does show promise in returning an athlete back to full competition status much faster than traditional ACL reconstructions.

 

References
1. The Journal of Bone and Joint Surgery, 1988. 70-B(4): p. 635 – 638.
2. Journal of Athletic Training, 2010. 45(1): p. 87-97. 3
3. Quarterly Journal of Experimental Physiology, 1988. 73: p. 305-314.
4. Clinical Physiology. 1990. 10(5): p. 489-500.
5. Annals of Rheumatic Diseases, 1993. 52: p. 829-834.
6. American Journal of Sports Medicine. 2007. 35(8): p. 1269-1275.
7. British Journal of Sports Medicine. 2006. 40(2): p. 158-162.
8. J Strength and Cond Research. 2002. 16(4); 617-622

Dr. Alex Jimenez's insight:

The specific staged ‘criteria’ driven rehabilitation process, with an emphasis on specific strength and conditioning principles. 

For Answers to any questions you may have please call Dr. Jimenez at 915-850-0900

No comment yet.
Scooped by Dr. Alex Jimenez
Scoop.it!

LARS: A New System Of ACL Reconstruction | El Paso Back Clinic® • 915-850-0900

LARS: A New System Of ACL Reconstruction | El Paso Back Clinic® • 915-850-0900 | Sports Injuries | Scoop.it

In part one of this ‘Rehabilitation Masterclass’ article, chiropractor, Dr. Alexander Jimenez evaluates the post- operative rehab requirements following a unique ACL reconstruction method – a Ligament Advanced Reinforcement System (LARS) procedure...

 

Anterior cruciate ligament (ACL) rupture is a common injury suffered by many athletes in a variety of sports. It typically affects athletes involved in sports that require sharp deceleration and cutting/pivoting type movements such as all the football sports (soccer, rugby, AFL, NFL), basketball, netball, golf and tennis. It may also occur as the result of a direct blow to the outside of the knee, which causes a valgus knee collapse, imposing large tensile and torsional forces to both the medial collateral ligament (MCL) and ACL.

 

It has been estimated that 80% of all ligament reconstructions of the knee relate to the ACL(1). It is accepted that ACL ruptures have poor intrinsic healing capabilities due to the fact that the ACL is enveloped by synovial fluid and lacks significant vascularisation(2). This makes healing of this intra-articular ligament impossible due to the inability of the torn ligament to re-vascularize.

 

In many case therefore, this precipitates the need to reconstruct the ACL to achieve functional stability to withstand anteroposterior shear forces and to prevent rotational forces on the knee. This course of action will prevent any further meniscus breakdown, and early onset osteoarthritis due to the excessive shearing forces encountered by the ACL deficient knee(3,4).

 

Surgical techniques vary from surgeon to surgeon and from country to country. Indeed, it is not uncommon for two orthopedic surgeons from the same sports medicine clinic to differ in their surgical choices. The options the surgeon has include:

 

1. Arthroscopic versus open surgery.

2. Intra versus extra-articular reconstruction.

3. Femoral tunnel placement.

4. Number of graft strands.

5. Single versus double bundle.

6. Fixation methods.

The use of grafts falls into three different subtypes:

1. Autologous grafts such as the patella- bone-patella (PTB) graft and the quadruple gracilis/hamstring graft techniques. These are the most commonly used as the graft is taken from the patient thus eliminating the risk of graft rejection(5). The major drawback of these grafts is possible donor site problems and the length of time it takes for the graft to re-vascularise (6-9 months)(6).

 

2. Allografts are harvested from a human tissue bank and the common allograft tendons to use are tibialis posterior, Achilles tendon or peroneus tendon and hamstring. The benefit is that there is no donor site morbidity at the knee. However the risk of graft rejection is quite high, the recovery rate is longer, post-operative infections more common and there are higher failure rates(5,6).

 

3. Synthetic grafts using Polyethylene Terephthalate, Polypropylene, Polytetrafluroethene (PTFE), Carbon Fibre or Dacron. The original grafts used in the 1980s had high rates of failure and reactive synovitis so they fell out of favour(7).

 

However synthetic grafts are now in their third generation and in the last 20 years the Ligament Advanced Reinforcement System (LARS) procedure has gained more popularity with orthopaedists(8).

What Is The LARS Procedure?

The LARS system was developed in France by a French surgeon called Professor JP Laboreau. This was developed over a lengthy period of time, finding a material and technique that would prevent the failure rates seen with other synthetic grafts, and to also avoid the morbidity seen with human tissue grafts involving the patella tendon and hamstring grafts.

 

LARS has been used successfully to reconstruct ACL ruptures in countries such as Australia, United Kingdom, France, Germany and Canada. However, the United States has still not approved the use of LARS in the USA, with the result that American athletes often seek surgical treatment in other countries.

 

A LARS is an intra-articular scaffold consisting of an interosseous component of multiple parallel fibres of Polyethylene Terephthalate (PET) polyester (see Figure 1). The intra-articular segment is unique and different to other synthetic grafts in that it is twisted at 90 degree angles.

 

Biomechanically, this artificial ligament mimics the natural ligamentous structure of the ACL and this design reduces shearing forces by specifically orientating the intra-articular fibres either clockwise for right knees or counter- clockwise for left knees. The porous nature of the PET fibres allow ingrowth from surrounding osseous tunnels and the remaining ACL stump. The ingrowth of the tissues into this scaffold gives the graft greater viscoelasticity and also protects against friction at the opening of the bony canal and between the fibres themselves(2).

 

The LARS artificial ligament is sterilized and chemically treated to remove any potential machining residues. Also, the emulsion of fat enzymes that may prevent soft tissue ingrowth and the sterility reduces the risk of reactive synovitis and fibre breakdown associated with other synthetic grafts(7,910).

 

In a LARS procedure, the synovial lining and the torn ACL fibres are left intact, whereas in other ACL reconstructive procedures the ACL is debrided to allow osseous tunnel drilling for the autologous graft. The osseous tunnels are positioned under image intensifier x-ray and this allows the torn ACL stump to remain. The proposed advantage of this technique is reduced trauma to the soft tissues of the knee and less surgical time(8). The remaining ACL stump is anchored to the meshwork of the LARS to support it in an optimum position while healing. Figure 2 shows a summary of a typical LARS operative procedure.

 

Overall, the LARS surgical technique aims to maximize in-growth of the original ACL tissue, thus preserving some vascular and proprioceptive nerve supply. The biggest advantages of this procedure are immediate graft stability, reduced rehabilitation time and quicker return to pre-injury function. Over time, the existing ACL stump regrows into the matrix and eventually replaces the LARS. Therefore it is not used a stand- alone graft. It has been proposed that the benefit of the LARS procedure is that it allows early post-operative loading because the scaffold protects the ACL stump during its revascularization phase, with less chance of post-operative breakdown(6).

 

The biggest potential problem faced when using a LARS procedure is the quality of the remaining ACL stump(8). A viable stump is needed to allow new ligamentous tissue, and surgery needs to occur as soon as possible after injury to preserve the native ACL stump(11). Therefore, the LARS reconstruction may be best suited to patients with acute ruptures who possess a viable cruciate stump. This allows the ligamentous and neurovascular tissues to regenerate along the synthetic scaffold. Furthermore, placement and tensioning of the LARS is crucial to prevent failure, emphasizing the need for an experienced surgeon to perform this procedure. Finally, it may not be appropriate in ACL ruptured knees that have co-existing pathologies such as large meniscal tears or osteochondral defects; these patients are generally delayed in return to sport, making the benefit of the fast return with LARS pointless.

Summary

Part one of this 2-part Rehabilitation Masterclass has focused on the innovative (and at times controversial) LARS procedure as a means of reconstructing the ruptured ACL. It is still a relatively new procedure that lacks long-term follow-up studies assessing success and failure rates c o m p a r e d t o t r a d i t i o n a l A C L reconstruction. Due to the unique synthetic properties of the LARS, it is proposed that athletes will return to competition much faster than with traditional ACL reconstruction. Therefore, the post-operative rehabilitation will differ significantly in both time and content compared with the traditional ACL reconstruction. Part two of this article therefore discusses in depth the postoperative process following a LARS reconstruction.

 

References
1. J Sci Med Sport 2009, 12:622-627
2. World J Orthop. 2015 Jan 18; 6(1): 127–136
3. Br J Hosp Med (Lond) 2008; 69: 459-60, 462-463
4. Am J Sports Med 2006, 34(12):2026-37
5. J Arthroscopic & Related Surg 2009, 25(9):1006-1010
6. J Arthroscopic & Related Surg 2009, 25(6):653-85
7. Eur Surg Res 2004, 36:148-151
8. Operative Techniques in Sports Medicine 1995, 3(3):187-20
9. British Medical Bulletin 2010, 1-24
10. Chin Med J 2010, 123(2):160-164
11. Knee surgery, Sports Traumatology, Arthroscopy 2010. 18, 797-804
12. Int Orthop 2013; 37: 321-326
13. J Arthroscopic & Related Surg 2010, 26(4):515-523
14. International Orthopaedics. 2010, Jan; 34(1): 45–49
15. J Bone Joint Surg Br 2002; 84: 356-360
16.Eur J Orthop Surg Traumatol 2013; 23: 819-823

Dr. Alex Jimenez's insight:

Dr. Alexander Jimenez evaluates the post- operative rehab requirements following a unique ACL reconstruction method or L.A.R.S. For Answers to any questions you may have please call Dr. Jimenez at 915-850-0900

No comment yet.