Training in water
REHAB BACKGROUND TO REMEMBER AND CONSIDER PHASE I: PROLIFERATION PROTECTION, 0-6 WEEKS PHASE II: TRANSITION PROGRESSION, 7-12 WEEKS PHASE III: REMODELLING FUNCTION, 13-32 WEEKS PHASE IV: MATURATION OPTIMIZING, 9-15 MONTHS
Functional exercises
Low impact activities after 6 months
REHAB BACKGROUND TO REMEMBER AND CONSIDER PHASE I: PROLIFERATION PROTECTION, 0-6 WEEKS PHASE II: TRANSITION PROGRESSION, 7-12 WEEKS PHASE III: REMODELLING FUNCTION, 13-32 WEEKS PHASE IV: MATURATION OPTIMIZING, 9-15 MONTHS
RETURN TO FOOTBALL GRADUALLY Individual training without and with ball Training with the team without and with ball Gradually into competitive training with the team RETURN TO PLAY possible between 12-15 months.
Arthroscopic Assessments of 46 patients DEFECT SCORE (MAXIMAL 12 POINTS) Fem.Cond. N Mean + SEM (range) Isolated 20 10,3 + 0.3 (4-12) ACL 13 10,9 + 0.0 (8-12) OCD 13 10,5 + 0.4 (4-12)
MRI EVALUATION
NR - 13 1.5T Slice for analysis Sl 4 980 814 648 482 316 150
NR - 6 1.5T Slice for analysis Sl 5 980 814 648 482 316 150
Biomechanical Indentation Measurements Arthroscopy and repair site indentation - 35 patients Repair site biopsy - 16 patients Artscan-2000 2mm Core Biopsies
5 STIFFNESS TO INDENTATION (Range Healthy cartilage = 2,5-7,3 N) INDENTER FORCE Newton 4 3 2 1 p=0.14 NS p=0.01 0 Control Repair: Hyaline Repair: Fibrous TISSUE CHARACTERISTICS
In collaboration with: Dr Evy Lundgren Åkerlund, Department of Cell Biology LUNDS UNIVERSITY, Lund SWEDEN Immunohistochemistry for Collagen I, II, Cartilage Oligomeric Matrix Protein (COMP) and Aggrecan Results from 22 biopsies analyzed Normal: Hyaline cartilage Repair: Fibrous cartilage Repair: Hyaline cartilage Type I - (+) ++ +++ - (+) Type II +++ - ++ +++ COMP +++ + ++ ++ +++ Aggrecan +++ + ++ ++ +++ N= 3 6 13
RESULT OF ACL-RECONSTRUCTION AND ACI 46 Patients (average age at op 31.1 (17.5-50.5)) 42 one stage 4 previous ACL 37 MFC lesions 13 LFC lesion 9 2-4 lesions Size MFC 4.5 cm² (10) LFC 4.6 cm² (10.5)
RESULT OF ACL-RECONSTRUCTION AND ACI PETERSON et al. 2000: GOOD TO EXCELLENT 75% 2 to 9 years PETERSON et al. 2002: GOOD TO EXCELLENT 84% 5 to 11 years PETERSON et al. 2010: GOOD TO EXCELLENT 84% 10 to 20 years 91% (41/46) would have the surgery again
ACT IN FOOTBALL PLAYERS 45 PLAYERS TREATED WITH ACT WERE FOLLOWED FOR 12-92 MONTHS POSTOP SINGLE MFC 93% GOOD/EXCELLENT 71% OF PLAYERS YOUNGER THAN 26 RETURNED TO FOOTBALL 83% OF HIGH-SKILL PLAYERS RETURNED TO FOOTBALL EARLY SURGERY AT 12-18 MONTHS AFTER INJURY EARLY RETURN TO FOOTBALL Mithoefer et al. AJSM 2005
ACT IN ADOLESCENT ATHLETES 20 Adolescent patients 47 months postop follow-up Tegner activity 0-10: 4 8 96% returned to impact sports, including football 60% at the same or higher level than preinjury Surgery within 12 months since acute injury 100% return to preinjury sport, including football Mithoefer et al. AJSM
RESULT REPORTED BY MITHOEFER 2013 (ICRS) ISOLATED CARTILAGE LESIONS MICROFRACTURE: Return to play 9 months, duration of play 2-3 years AUTOLOGOUS OSTECHONDRAL GRAFTS (MOSAICPLASTY): Return to play 6 months, duration of play 5 years AUTOLOGOUS CHONDROCYTE IMPLANTATION: Return to play 12-15 months, duration of play 7 years
Summary ACT/ACL ger G/E långtidsresultat(10-20år) i 84% vid isolerade fem.cond skador och OCD i 90% /fotbollsspelare. Adekvat rehab. är av största betydelse för resultaten vägledda o understödda med objektiva parametrar. Vid rehab är progressivt ökad belastning anpassad faserna -tiden för regeneration, vävnadsmognad av leden avgörande
Summary REHAB anpassad till läkning efter ACT med cellmitos,matrixproduktion Coll2,GAG med progressiv broskregeneration och vävnadsmognad avgörande för slutresultatet.kunskap om brosk:uppbyggnad,funktion,läkning efter skada viktig,behandlingsalternativ, fas I-IV, objektiv utvärdering av läkning möjlig med MR -d GEMRIC(GAG). Åter till fotboll i över 80% möjlig till samma nivå vid tidig op inom 12-15mån. Fortsatt spel 7 år efter ACT i genomsnitt. BELASTNING PROGRESSIV!