Isfahan university of medical siences physiotherapy department faculty of rehabilitation

 انقباض های ایزومتریک یک شکل استاتیک از انقباض عضله هستند که force را بدون تغییر محسوس در طول عضله و بدون حرکت مفصلی قابل مشاهده فراهم می کنند. گرچه از لحاظ مکانیکی کار انجام نمیگردد ولی مقداری force و tension تولید می شود. در این انقباض كار عضلانی مساوی با صفر خواهد بود. 

 :  انقباضاتی ایزوکینتیک یک شکل داینامیک از انقباضات است که سرعت کوتاه و طویل شدن عضله و سرعت زاویه ای اندام از قبل تعیین شده و بوسیله ی یک وسیله ی محدود کننده سرعت که به ایزوکینتیک داینامومتر معروف است hold می شود. اصطلاح ایزوکینتیک اشاره به حرکتی دارد که با سرعت ثابت اتفاق می افتد. این انقباض مفیدترین نوع انقباض در ورزش است. میزان آسیب عضله حداقل است.

 شامل تولید تنش در عضله به منظور ایجاد یا کنترل حرکت در مفصل می باشد. تغییرات تنش در عضله به واسطه تغییر در زاویه مفصل رخ می دهد. انقباض ایزوتونیک شامل انقباض کانسنتریک واکسنتریک می باشد. در این انقباض نیرویی كه با بار عضله وارد می شود ، كمیتی ثابت داشته و در طول عمل انقباض تغییر نمی كند.

The injury mechanism is a valgus/external rotation trauma with a slightly bend knee Because the ACL is a primary stabilizer of the knee, a rupture can lead to functional instability

In the long term, an ACL rupture can cause further intraarticular damage like meniscal tears cartilage defects and osteoarthritis The younger and more active the patient, the earlier surgical reconstruction is chosen

medication, exercises, postsurgical compression wraps and elevation, cryotherapy is advised as it significantly reduces postsurgical pain

The results clearly indicated that an accelerated protocol without postoperative bracing, in which reduction of pain, swelling and inflammation, regaining range of motion, strength and neuromuscular control are the most important aims, has no important advantages and does not lead to stability problems.

 controlling pain,swelling and inflamation  recovery of ROM and neuromuscular control  There are no long-term advantages of bracing  Aggressive control  of pain, swelling and inflammation prevents quadriceps inhibition  maintains full knee extension and makes  immediate weight bearing possible

 exercises  postsurgical compression  wraps and elevation  Cryotherapy   reduces postsurgical pain

 Immediate recovery of passive and active ROM  (emphasis on full extension)  reduces pain  stimulates the homeostasis of cartilage  prevents patellofemoral problems  alterations in gait pattern  quadriceps atrophy and arthrofibrosis

 patellar immobility leads to  decreased ROM and quadriceps inhibition  Initioted Muscul control: by isometric exs  closed chain (CC, safe range 0_–60_) open chain (OC)safe range (90_–40_) without additional weight.  muscle setting exercises  straight leg-raising (SLR)  heel slides

Heels slide

 mini squads (0_30 flexion)  OC extension (90_40)  shifting body weight  OC flexion (isolated hamstring) exercises   Full weight-bearing without crutches within 10 days

 Cryotherapy should be continued  Flexion can be increased gradually  while full extension and patellar mobility will be maintained

 Quadriceps and hamstring strength  by isometric isotonic and isokinetic exs  Isotonic strength training in a safe range  (CC: 0–60, OC: 90–40),

 Increasing endurance and strength of quadriceps significantly has no negative effect  on anterior knee pain and knee laxity

 safe range (CC: 0–90, OC: 90–0)  neuromuscular training for loss of proprioception  prevention (re-rupture)

 Quadriceps atrophy  persistent quadr lag with SLR  incomplete extension  and gait impairmentsin  week 5 are predisposing factors for quadrice weekness after 6 month

 gentle non-complex exercises using minimal weight  developing from static to dynamic balance training  plyometric exercises into agility training  sport specific exercises  Gait training on a treadmill or flat surface without  crutches is still necessary

 walking on a treadmill  cycling on an ergometer  swimming from week 3  stair-stepping machine from week4  jogging in a straight line  outdoor cycling from week8

o obtaining and maintaining full ROM o increased further with CC and OC o Neuromuscular control: o slowly increasing functional dynamic balance training o plyometric exs

 Plyometric exs agility training  variation in visible input  surface stability  speed of exercise  performance  complexity of the task  Resistance  One or  two-legged performanc  etc

 normalization of runing  (gradually increasing duration and speed to  decrease neuromuscular adaptation and recovery time)  from week 9, jogging outdoors starts in week13

 Maximizing endurance and strength of the knee stabilizers  optimizing neuromuscular control with plyometric exercises  agility training and sport-specific exs:  with variations in running, turning and cutting maneuvers  acceleration and deceleration, improves arthrokinetic reflexes

 CC and OC exercises form the  ideal basis for sport-specific functional training in phase 4

 (VAS): for pain  Goniometer:active and passive ROM  Measurements  (IKDC): a knee-specific questionnaire  Hop tests: measures total leg function.  Isokinetic tests:objective measurement of strength and  endurance of the knee stabilizers

 if  full ROM is achieved,  the hop tests and strength of the  hamstrings and quadriceps are at least 85% compared to  the contralateral side  hamstring/quadriceps<15%  compared to the contralateral side  patient tolerates sport-specific  activities (no increase in pain and swelling).

Thanks for your attention