14.6 ACL ligamentoplasty
Ruptures of the Anterior Cruciate Ligament (ACL) of the knee are among the most common accidents in
sports trauma.
Reconstructive surgery of the ACL has been subject to continuous developments in recent decades, with
considerable progress, in particular owing to the use of arthroscopic techniques.
Associated with the improvement in the rehabilitation treatment of injured athletes, the return time to
athletic activity continues to decrease significantly, and today is practically half what it was around ten
years ago.
The return to athletic activity requires both satisfactory solidity of the tendon graft, which must be capable
of supporting significant mechanical stresses, and, more importantly, good active joint stability.
This active joint stability requires muscles capable of opposing sometimes phenomenal stresses in the
shortest time periods possible, by activating the proprioceptive reflex.
One of the potential consequences of the operative procedure is significant disuse atrophy of the
quadriceps muscles, the treatment of which is one of the primary objectives of the rehabilitation therapist.
However, during the first 3 - 4 months of quadriceps rehabilitation, there must be no open kinetic chain
exercises due to the anterior drawer component of the tibia, which can endanger the tendon graft during
the avascularisation phase.
The method described in this chapter is intended to describe an NMES protocol suitable for this particular
problem of ACL ligamentoplasty, avoiding any risk of a secondary lesion to tissue.
This safety is ensured by using specific ACL programmes that consist of appropriate sequential stimulation
of the quadriceps and hamstrings.
Note
This particular stimulation mode does not allow for work with mi-ACTION.
For ligamentoplasty using the patellar tendon as the graft, the NMES can be started promptly. When using
doubled semitendinosus and gracilis tendons for ligamentoplasty, NMES must not be used before the
standard healing period of these tendons.
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