Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Mayo 9 de 2013
LCA
Ligamento mas estudiado en Biomecnica tisular (Valey et al., 2001) - Aun no existe una solo tcnica quirrgica que sea Garanta de xito o fracaso de un tratamiento.
- Portal Medial? - Doble Banda ? - Triple Banda ????
Vahey et al. Tensions in the anterior and posterior cruciate ligaments of theknee during passive loading: predicting ligament loads from insitu measurements. J Orthop Res. 1991;9(4):529-38. Gustavsson et al. A test battery for evaluating hop performance in patients with an ACL injury and patients who haveundergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006: 14(8):778-88.
Roturas de LCA
LCA, 47% de las roturas Ligamentosas de Rodilla. 30 /100.000 sujetos-ao > 50% de Rotura de LCA sucede en Jugadores de Futbol Particularmente entre 15 25 aos 2-8 veces mayor lesin en Mujeres atletas
Sd. de Hipermobilidad Compromiso Estabilizador Dficit Estabilizador Sobrestabilizadores Limitacin de RoM? Dficit de Fuerza Alteracin / Insuficiencia del control NM Predisposicin de osteoartritis Asociacin a Lesin Muscular Recurrente Perdida de la Performance
Objetivo final: Restaurar la funcin del ligamento reconstruido en un ambiente neuromuscular especifico del deporte (Della Villa et al., 2012)
Herrington et al. Systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency. Knee. 2006 ;13(4):260-5. Williams et al. Quadriceps femoris muscle morphology and function after ACL injury: a differential response incopers versus non-copers. J Biomech. 2005 ;38(4):685-93. Della Villa et al. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health. 2012;4(1):17-24. Quatman et al. A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports Med. 2010;40(9):729-46
Della Villa et al. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health. 2012;4(1):17-24. Herrington et al. Systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency. Knee. 2006 ;13(4):260-5. Gokeler et al. Abnormal landing strategies after ACL reconstruction. Scand J Med Sci Sports. 2010;20(1):e12-9.
Una sola evaluacin no es suficiente para determinar el estatus funcional de individuos con Dficit de ACL (Herrington et al., 2006).
Lachman Pivot Shift Artrometria Lunge test Shuttle run test Hop Test Tiempo de Hop Cross over hop Single hop Triple hop Figura en 8 Hop up/down hop batera de tiempo de hop, distancia de hop, fig en 8, up down y side CVIM Drop Jump con doble single hop square hop vertical Jump KOS, KOOS, Lysholm, IKDC Global Knee Function
Sensibilidad 38 52%
Puntajes
Herrington et al. Systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency. Knee. 2006 ;13(4):260-5. Gustavsson et al. A test battery for evaluating hop performance in patients with an ACL injury and patients who haveundergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):778-88.
Evidencia Ia (CEBM)
Herrington et al. Systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency. Knee. 2006 ;13(4):260-5.
Quatman et al. A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports Med. 2010;40(9):729-46
Quatman et al. A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports Med. 2010;40(9):729-46
Quatman et al. A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports Med. 2010;40(9):729-46
Clnico
Biomecnica
Funcional
Balance Muscular Fatigabilidad Muscular Cocontracion Qstiffnes Steadiness Posturografia Estrategias de Aterrizaje / Carrera Respuestas Protectoras Articulares (electrofisiologa)
Las principales evaluaciones se centran en la evaluacin: Unidimensional Tareas motoras lineales (menor demanda Frontal & rotacional) Medicin de Fuerzas Mximas (baja corr F(x))
(Czerniecki et al., 1988; Rudolph at al., 2001; Lindstrm et al., 2010)
Gua Convencional: Historia clnica, test funcionales, lachman, pivot shift y kt 1000 (Shelbourne et al., 1999) Recomendaciones Trabajo en Cancha:
Score Clnico Fitness Test F Marc Test Battery Lachman Cajn Anterior Pivot Shift Hop test
Della Villa et al. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health. 2012;4(1):17-24.
Giving Way Dolor 0 <3 Sin o Min. Derrame RoM Completo o dficit flexor >10 Isokinetica < 20% contralateral Artrometria
(Chmielewski et al., 2001; Tashman et al., 2004; Lindstrm et al., 2010; Quatman et al., 2010).
La literatura sugiere que el enfoque en el movimiento del plano sagital no revela el espectro de adaptaciones neuromusculares de los atletas con RACL (Pappas et al., 2012).
Evidencias de asimetras neuromusculares que son predisponentes de lesion de ACL una vez identificados pueden ser enrolados a programas preventivos.
Zampeli et al. Correlation Between Anterior Cruciate Ligament Graft Obliquity and Tibial Rotation During Dynamic Pivoting Activities in Patients With Anatomic Anterior Cruciate Ligament Reconstruction: An In Vivo Examination . The Journal of Arthroscopic and Related Surgery, Vol 28, No 2 (February), 18 2012: pp 234-246. Lam et al. Knee Rotational Stability During Pivoting Movement Is Restored After Anatomic Double-Bundle Anterior Cruciate Ligament
Demandas Mecnicas
La rotacin tibiofemoral aumenta durante la marcha a mayores velocidades y posee baja correlacin con fuerzas maximas ISQ-CUA.
Shelbourne et al. Evaluation of knee and after participation in functional sports agility programduring rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 1999;27(2):156-61.
stability
before
Fatigabilidad Muscular
Estrategias de Aterrizaje
Estrategias de Aterrizaje
Patrones de Co-contraccin
Co-contraccion: Actividad simultnea de varios msculos que actan alrededor de una articulacin1.
Presencia de actividad muscular antagonista2. Co-contraccin de msculos antagonistas, aumentara la estabilidad articular3: Incrementando la compresin entre las superficies articulares3,4. Adems, disminuye la tensin sobre los ligamentos4,5.
1Kellis,
E., Arabatzi, F., Papadopoulos, C. (2003). Muscle co-activation around the knee in drop jumping using the co-contraction index. Journal of Electromyography and Kinesiology, 13: 229-238. 2Fonseca, S., Silva, P., Ocarino, J., Guimaraes, R., Oliveira, M., Lage, C. (2004). Analyses of dynamic co-contraction level in individuals with anterior cruciate ligament injury. Journal of Electromyography and Kinesiology, 14: 239-247. 3Winter, D. (2005). Chapter 5: Mechanical Work, Energy and Power. En Winter, D. Biomechanics and Motor Control of Human Movement (3ra Ed). Canada: John Wiley & Sons. p 118-133. 4Podraza, J., White, S. (2010). Effect of knee flexion angle on ground reaction forces, knee moments and muscle co-contraction during an impactlike deceleration landing: Implications for the non-contact mechanism of ACL injury. The Knee, 17: 291-295. 5O'Connor, J. (1993). Can muscle co-contraction protect knee ligaments after injury or repair? Journal of Bone and Joint Surgery, 75: 41-48.
Reproduccin Articular
Reproduccin Articular
Rodilla derecha 45,5 43.6 Rodilla Izquierda 47,9 43,3
45,0
44,8 46,7 45,7 Media: 3,7
38,9
38,0 45,2 36,8 Media:12
Propiocepcin Propiocepcin
Propiocepcin
Control Neuromuscular
Control Neuromuscular
Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train. 2002;37:7179.