Revista de Medicina Desportiva (English) November 2018 | Page 23

COXA
unlikely to reproduce the normal
knee biomechanics with only one
femoral insertion. 9,16 The anatomic
techniques are based on the recon-
struction of the principal stabilizing
structures of PLC in a way to better
reproduce the posterior-lateral bio-
mechanics.
Arciero described an anatomic
reconstruction technique of the LCL
and of the popliteus-peroneal liga-
ment with a unique graft through
a peroneal tunnel but restoring the
sites of femoral insertion of the LCL
and of the popliteus-peroneal liga-
ment. 38
LaPrade introduced a technique
with distal insertion, not only at
the peroneus, but also at the tibia,
in order to reconstruct the three
primaries stabilizers ligaments (with
reconstruction of the popliteus-per-
oneal ligament). 39
Cadaveric biomechanics studies,
performed either by Ho et al 40 or
by Miyatake et al 41 , are concord-
ant about the efficacy of both
techniques to control the laxity on
varus. However, they also concluded
that the rotational stability signifi-
cantly gets better with the anatomic
techniques. Several studies 42-45
demonstrated that variations on
the isometric technique results on a
significant clinical improvement and
also of the functional clinical scores
(Lysholm, Tegner, IKDC) on patients
with PLC injuries. However, there is
an increase on residual laxity.
The reconstruction of the pop-
liteus muscle tendon is a recent
debate in the literature. Although
the biomechanics studies point to a
better control of the external rota-
tion, that is not seen on the clinical
evaluation. Yoon et al published a
comparative study with functional
and clinical results of both anatomic
techniques where they could
demonstrate the lack of benefit on
the reconstruction of the popliteus
muscle tendon. 42
patella-femoral mobility, control of
pain and edema e restauration of
the quadriceps strength. 1,2,6,8
It is allowed passive mobilization
from 0° to 90° during the first two
weeks, with gradual progression
as tolerated. At six weeks, weight
bearing is allowed, exercises on the
bike are introduced and the external
support is removed as tolerated. The
return to sports is allowed when
the results of strength, mobility and
stability are comparable to ones on
the contralateral knee, which usu-
ally occurs about 6 to 9 months after
surgery. 1,2,6,8
Correspondence
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Rehabilitation after surgery
The rehabilitation can and it should
be adopted according the associated
ligament injuries and proceedings
for simultaneous meniscal pres-
ervation. Rehabilitation stars with
recovering the tibia-femoral and
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Revista de Medicina Desportiva informa november 2018 · 21