Résultats anatomiques et fonctionnels après ligamantoplastie antérieure du genou
Stéphane Fabri, Isabelle Vic, Franck Lacaze, Claire Morana
Kinésithér Scient 2013,0547:35-40 - 10/10/2013
Les techniques opératoires de ligamentoplastie antérieure du genou ne cessent d'évoluer. Les suites postopératoires ont également été optimisées. Toutefois, les protocoles de rééducation ne sont pas homogènes, avec deux attitudes qui s'opposent. La littérature a souvent comparé les deux types de rééducation (classique versus accéléré). Les clinical guidelines, publiées aux États-Unis en 2010, montrent que la rééducation de type «accéléré» est supérieure mais certains kinésithérapeutes préfèrent employer la démarche classique afin de protéger le transplant et obtenir un bon résultat fonctionnel. L'objectif de notre étude était de tester l'existence ou non d'une corrélation entre la laxité antérieure du genou et l'évaluation fonctionnelle. Nous avons testé 22 patients volontaires opérés d'une ligamentoplastie antérieure du genou. Le recul était de 5,5 ± 0,6 ans. Un arthromètre de genou était utilisé pour apprécier la laxité antérieure du genou. Chaque participant a répondu au score de Lysholm et au score IKDC 2000. La corrélation a été calculée entre la différence de laxité antérieure des genoux opérés versus sain aux différentes forces, et chacun des deux scores. Une absence de corrélation était observée entre le score de Lysholm et la différence de laxité antérieure du genou entre le côté opéré et le côté sain. Il en était de même entre le score IKDC 2000 et la différence de laxité. Kocher et al. avaient déjà démontré, à 2 ans postopératoire, l'absence de corrélation entre la laxité antérieure du genou et l'évaluation fonctionnelle. Nos travaux confirment ces résultats. Néanmoins, le recul de seulement 2 ans pouvait laisser un doute sur les résultats à long terme, car l'évolution histologique et mécanique du transplant n'est terminée qu'au terme de la 3e année postopératoire. Notre travail avec un recul supérieur à 5 ans permet d'éliminer ce biais. Notre étude et les travaux de la littérature montrent qu'il est possible de privilégier le protocole de rééducation dit «accéléré». La détente potentielle du transplant n'aurait pas d'impact sur le résultat fonctionnel.
ACL ligamentoplasty operational mode never stops developing. Post surgery effects have also been maximize. However, rehabilitation protocols are not standard, with two different attitudes. Literature has often compared these two kinds of rehabilitation (classical vs. speeded up). The clinical guidelines, published in the United States of America in 2010, show that the accelerated rehabilitation is superior, but some physcial therapist prefers to use the classical way, in order to protect the transplant and succeed in getting good functional results. The aim of our study was to test the reality or not of a relationship between knee anterior laxity and functional assessment. We tested 22 voluntary patients, they have been operated on an anterior knee ligamentoplasty. Recoil was 5.5 ± 0.6 years. A knee arthrometer was used to assess knee anterior laxity. Each participant answered to the Lysholm test and to the IKDC 2000 score. The correlation had been calculated by the difference between operated knee anterior laxity vs. healthy knee at different strength, and each scores. A lack of correlation had been observed between Lysholm score and difference of knee anterior laxity, between operated and healthy side. It was the same with IKDC 2000 score and difference of laxity. Kocher had already showed, at two years post-surgery, a lack of correlation between knee anterior laxity and functional assessment. Nonetheless, only two years recoil could leave some doubt on long term results, because the histological and mechanical transplant's evolution is only done at the end of the third year postsurgery. Our work, with a recoil superior of five years, permits to suppress this way. Our study and literature works show it is possible to favor the accelerated rehabilitation protocol. Potential transplant's desertion wouldn't have an impact on functional result.
ACL ligamentoplasty operational mode never stops developing. Post surgery effects have also been maximize. However, rehabilitation protocols are not standard, with two different attitudes. Literature has often compared these two kinds of rehabilitation (classical vs. speeded up). The clinical guidelines, published in the United States of America in 2010, show that the accelerated rehabilitation is superior, but some physcial therapist prefers to use the classical way, in order to protect the transplant and succeed in getting good functional results. The aim of our study was to test the reality or not of a relationship between knee anterior laxity and functional assessment. We tested 22 voluntary patients, they have been operated on an anterior knee ligamentoplasty. Recoil was 5.5 ± 0.6 years. A knee arthrometer was used to assess knee anterior laxity. Each participant answered to the Lysholm test and to the IKDC 2000 score. The correlation had been calculated by the difference between operated knee anterior laxity vs. healthy knee at different strength, and each scores. A lack of correlation had been observed between Lysholm score and difference of knee anterior laxity, between operated and healthy side. It was the same with IKDC 2000 score and difference of laxity. Kocher had already showed, at two years post-surgery, a lack of correlation between knee anterior laxity and functional assessment. Nonetheless, only two years recoil could leave some doubt on long term results, because the histological and mechanical transplant's evolution is only done at the end of the third year postsurgery. Our work, with a recoil superior of five years, permits to suppress this way. Our study and literature works show it is possible to favor the accelerated rehabilitation protocol. Potential transplant's desertion wouldn't have an impact on functional result.