Early proprioceptive physiotherapy intervention in atheletes with anterior cruciate ligament injury

Anterior cruciate ligament (ACL) injury is considered one of the most frequent and costly injuries in adolescents. Anterior cruciate ligament reconstruction (ACLR) is a commonly performed surgical procedure in active individuals.
The aim of our exercise therapy was to increase muscle strength and stretching with closed kinematic exercises based on ACL rehabilitation international protocols. Further aim was to introduce instable equipments and to regain preinjury physical conditions and improve the quality of life.
A 26 year-old female handball player was observed in this case study trial. This study employed a single prospective controlled case study trial design. The baseline testing session consisted of background information (time since surgery, type of graft and orthopedic surgeon, and level of sporting ability); perceived measures of ability and range of motion, jumping on one/two legs and muscle diameter measurements. Parameters were detected on 3rd, 6th, 9th and 12th weeks. Moreover, functional status was detected (3rd and 12th weeks) by The Oxford Knee Score (OKS) and ACL-quality of life questionnaire. Closed kinematic exercise therapy (3 times/week) was developed and implemented, focusing on proprioception.
Pain of the patellar and ischiocrural tendons was diminished. Pain was measured 90 points on VAS (0-100) at 3rd week; however it diminished by the end of exercise therapy. Flexion and extension reached physiological degrees. Physiological extension (0°) was developed by 6th week. Diameters above and under the tibiofemoral joints were almost equal in both side. Number of jumping was the same in both legs by 12th week. ACL-quality of life questionnaire had score of 55 points at 3rd week, by the 12th week it was almost at full (100 points), 95,8. OKS was measured 40 points at the 3rd week by the 12th week it was measured 48 points, showing satisfactory joint function.
International protocols require athletes/patients to reach physiological, physical and functional status of the knee after ACL reconstruction during 6 months. In this case, using closed kinematic proprioceptive exercises, the patient gains normal knee conditions by the 3 month.