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 Avançando para o seu bem estar! COM PLACAS TERMOPLÁSTICAS PERNEIRA COXA 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 Avançando para o seu bem estar! Revista de Medicina Desportiva informa november 2018 · 21