{"id":7735,"date":"2023-10-22T17:02:59","date_gmt":"2023-10-22T17:02:59","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/acl-rehabilitation-acute-management-after-surgery-fr\/"},"modified":"2026-02-12T01:25:38","modified_gmt":"2026-02-12T01:25:38","slug":"acl-rehabilitation-acute-management-after-surgery-fr","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/fr\/acl-rehabilitation-acute-management-after-surgery-fr\/","title":{"rendered":"R\u00e9\u00e9ducation apr\u00e8s une reconstruction du LCA \u2013 La phase aigu\u00eb"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\">\n<p><b>R\u00e9dactrice originale <\/b>&#8211; <a title=\"User:Mariam Hashem\" href=\"\/User:Mariam_Hashem\">Mariam Hashem<\/a><\/p>\n<p><b>Principaux collaborateurs <\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Wanda van Niekerk\" href=\"\/User:Wanda_van_Niekerk\"><bdi>Wanda van Niekerk <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Mariam Hashem\" href=\"\/User:Mariam_Hashem\"><bdi>Mariam Hashem <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Tarina van der Stockt\" href=\"\/User:Tarina_van_der_Stockt\"><bdi>Tarina van der Stockt <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Chelsea Mclene\" href=\"\/User:Chelsea_Mclene\"><bdi>Chelsea Mclene<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Tony Lowe\" href=\"\/User:Tony_Lowe\"><bdi>Tony Lowe <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Leana Louw\" href=\"\/User:Leana_Louw\"><bdi>Leana Louw<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Robin Tacchetti\" href=\"\/User:Robin_Tacchetti\"><bdi>Robin Tacchetti <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jorge Rodr\u00edguez Palomino\" href=\"\/User:Jorge_Rodr%C3%ADguez_Palomino\"><bdi>Jorge Rodr\u00edguez Palomino<\/bdi><\/a> et <a class=\"mw-userlink\" title=\"Utilisateur:Rachael Lowe\" href=\"\/User:Rachael_Lowe\"><bdi>Rachael Lowe<\/bdi><\/a><\/p>\n<\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenu<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduction<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Pre-Surgical_Rehabilitation\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">R\u00e9\u00e9ducation pr\u00e9-chirurgicale<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-3\"><a href=\"#Considerations_Before_Designing_a_Post-Surgical_Rehabilitation_Programme\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">\u00c9l\u00e9ments \u00e0 prendre en compte avant de concevoir un programme de r\u00e9\u00e9ducation post-chirurgicale<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-4\"><a href=\"#Acute_Management_and_Goals\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Prise en charge en phase aigu\u00eb et objectifs<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Protecting_the_Surgical_Repair\/Reconstruction\"><span class=\"tocnumber\">4.1<\/span> <span class=\"toctext\">Protection de la r\u00e9paration\/reconstruction chirurgicale<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-6\"><a href=\"#Homeostasis\"><span class=\"tocnumber\">4.2<\/span> <span class=\"toctext\">Hom\u00e9ostasie<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-7\"><a href=\"#Monitoring_Pain_and_Swelling\"><span class=\"tocnumber\">4.2.1<\/span> <span class=\"toctext\">Surveillance de la douleur et de l&rsquo;\u0153d\u00e8me<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-8\"><a href=\"#Red_Flags_-_When_to_Seek_Medical_Consultation\"><span class=\"tocnumber\">4.3<\/span> <span class=\"toctext\">Signaux d&rsquo;alerte &#8211; Quand consulter un m\u00e9decin<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-9\"><a href=\"#Scar_Management_and_ROM\"><span class=\"tocnumber\">4.4<\/span> <span class=\"toctext\">Gestion des cicatrices et mobilit\u00e9 articulaire<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-10\"><a href=\"#Early_ROM_Strategies\"><span class=\"tocnumber\">4.4.1<\/span> <span class=\"toctext\">Strat\u00e9gies pr\u00e9coces de mobilit\u00e9 articulaire<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-11\"><a href=\"#Loss_of_Extension\"><span class=\"tocnumber\">4.4.1.1<\/span> <span class=\"toctext\">Perte d&rsquo;extension<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-12\"><a href=\"#Restoring_Quadriceps_Strength\"><span class=\"tocnumber\">4.5<\/span> <span class=\"toctext\">Restaurer la force du quadriceps<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-13\"><a href=\"#Rehabilitation_Planning\"><span class=\"tocnumber\">4.6<\/span> <span class=\"toctext\">Planification de la r\u00e9adaptation<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-14\"><a href=\"#Progression_to_the_Next_Phase\"><span class=\"tocnumber\">4.6.1<\/span> <span class=\"toctext\">Progression vers la phase suivante<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-15\"><a href=\"#References\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">R\u00e9f\u00e9rences<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduction<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:MRI_for_ACL_tear.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/1\/10\/MRI_for_ACL_tear.jpg\" alt=\"MRI for ACL tear.jpg\" width=\"300\" height=\"197\" data-file-width=\"300\" data-file-height=\"197\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>Les <a title=\"Anterior Cruciate Ligament (ACL) - Structure and Biomechanical Properties\" href=\"\/Anterior_Cruciate_Ligament_(ACL)_-_Structure_and_Biomechanical_Properties\">l\u00e9sions du ligament crois\u00e9 ant\u00e9rieur (LCA)<\/a> sont fr\u00e9quentes &#8211; plus de 200 000 l\u00e9sions se produisent chaque ann\u00e9e aux \u00c9tats-Unis,<sup id=\"cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\">(1)<\/a><\/sup> <sup id=\"cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\">(2)<\/a><\/sup> avec des co\u00fbts de sant\u00e9 d\u00e9passant les 2 milliards de dollars par an.<sup id=\"cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\">(3)<\/a><\/sup> Les athl\u00e8tes professionnels sont plus \u00e0 risque, avec des taux d&rsquo;incidence annuels de 0,21 \u00e0 3,67 %, contre 0,03 % dans la population g\u00e9n\u00e9rale.<sup id=\"cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\">(4)<\/a><\/sup> Ces blessures entra\u00eenent de longues p\u00e9riodes sans pouvoir pratiquer leurs sports pour les athl\u00e8tes de tous niveaux.<sup id=\"cite_ref-:3_5-0\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup> La reconstruction chirurgicale du LCA permet de r\u00e9tablir la stabilit\u00e9 passive du genou, mais seuls 65 % des athl\u00e8tes retrouvent leur niveau de performance d&rsquo;avant la blessure.<sup id=\"cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\">(6)<\/a><\/sup> Les femmes sont plus \u00e0 risque<sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup> <sup id=\"cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\">(8)<\/a><\/sup> en raison de facteurs tels qu&rsquo;un <b>stress en valgus plus \u00e9lev\u00e9<\/b>, des patrons de <b>sollicitation modifi\u00e9s<\/b> et des <b>d\u00e9s\u00e9quilibres de force<\/b>,<sup id=\"cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\">(9)<\/a><\/sup> bien que les m\u00e9canismes de blessure puissent diff\u00e9rer selon le sexe biologique (hommes : plus de blessures avec contact ; femmes : plus de blessures sans contact).<sup id=\"cite_ref-:2_10-0\" class=\"reference\"><a href=\"#cite_note-:2-10\">(10)<\/a><\/sup><\/p>\n<p>Les cons\u00e9quences \u00e0 long terme sont importantes, quelles que soient les approches de traitement choisies. L&rsquo;arthrose post-traumatique se d\u00e9veloppe dans 37,9 % des cas chirurgicaux et 40,5 % des cas non chirurgicaux dans les 20 ans qui suivent la blessure.<sup id=\"cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\">(11)<\/a><\/sup> Globalement, le risque de d\u00e9velopper de l&rsquo;arthrose apr\u00e8s une blessure au LCA est multipli\u00e9 par 7.<sup id=\"cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\">(12)<\/a><\/sup> On pense que l&rsquo;alt\u00e9ration de la m\u00e9canique de mise en charge apr\u00e8s la blessure y contribue.<sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup> <sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup> Parmi les autres cons\u00e9quences, on peut citer l&rsquo;instabilit\u00e9, l&rsquo;impossibilit\u00e9 de reprendre le sport et la r\u00e9cidive.<\/p>\n<p>Les approches chirurgicales modernes privil\u00e9gient et facilitent une mobilisation pr\u00e9coce plut\u00f4t qu&rsquo;une immobilisation prolong\u00e9e.<sup id=\"cite_ref-:1_15-0\" class=\"reference\"><a href=\"#cite_note-:1-15\">(15)<\/a><\/sup> Les r\u00e9sultats positifs d\u00e9pendent \u00e9galement de la mise en \u0153uvre de programmes de r\u00e9\u00e9ducation efficaces et de qualit\u00e9.<sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup><sup id=\"cite_ref-:5_17-0\" class=\"reference\"><a href=\"#cite_note-:5-17\">(17)<\/a><\/sup><sup id=\"cite_ref-:6_18-0\" class=\"reference\"><a href=\"#cite_note-:6-18\">(18)<\/a><\/sup><\/p>\n<h2><span id=\"Pre-Surgical_Rehabilitation\" class=\"mw-headline\">R\u00e9\u00e9ducation pr\u00e9-chirurgicale <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Pre-Surgical Rehabilitation\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=2\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Pre-Surgical Rehabilitation\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=2\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La reconstruction ou la r\u00e9paration du LCA chez les athl\u00e8tes ayant une bonne fonction du genou avant la blessure est associ\u00e9e \u00e0 de bons r\u00e9sultats post-chirurgicaux.<sup id=\"cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\">(19)<\/a><\/sup> Par cons\u00e9quent, le renforcement musculaire et l&rsquo;am\u00e9lioration des mouvements avant la chirurgie sont importants pour une r\u00e9\u00e9ducation r\u00e9ussie.<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup> Il convient de commencer imm\u00e9diatement apr\u00e8s la blessure et d&rsquo;\u00e9valuer soigneusement l&rsquo;\u00e9tat du patient \u00e0 l&rsquo;aide de mesures objectives afin de suivre les progr\u00e8s et les changements.<\/p>\n<p>Les \u00e9l\u00e9ments suivants sont des objectifs de la r\u00e9\u00e9ducation pr\u00e9-chirurgicale pour une l\u00e9sion du LCA et sont pr\u00e9dictifs de bons r\u00e9sultats post-op\u00e9ratoires<sup id=\"cite_ref-:3_5-1\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup>:<\/p>\n<ul>\n<li>mobilit\u00e9 compl\u00e8te en extension du genou<\/li>\n<li>absence d&rsquo;\u00e9panchement ou \u00e9panchement minime<\/li>\n<li>absence \u00ab lag d\u2019extension \u00bb de pendant le SLR<\/li>\n<\/ul>\n<p>La r\u00e9\u00e9ducation pr\u00e9-chirurgicale doit s&rsquo;appuyer sur un renforcement agressif du quadriceps afin d&rsquo;augmenter l&rsquo;<b>indice du quadriceps &gt; 90%<\/b><b>(indice du quadriceps = le rapport entre la force des quadriceps du c\u00f4t\u00e9 bless\u00e9 et la force des quadriceps du c\u00f4t\u00e9 controlat\u00e9ral<\/b>).<sup id=\"cite_ref-:1_15-1\" class=\"reference\"><a href=\"#cite_note-:1-15\">(15)<\/a><\/sup><sup id=\"cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\">(21)<\/a><\/sup><\/p>\n<p>La r\u00e9\u00e9ducation pr\u00e9-chirurgicale d&rsquo;une l\u00e9sion du LCA doit, si possible, \u00eatre bas\u00e9e sur la fonction et non sur le temps. Un programme ax\u00e9 sur la restauration de la force musculaire, l&rsquo;hypertrophie du quadriceps et l&rsquo;am\u00e9lioration des performances aux sauts permet d&rsquo;am\u00e9liorer la fonction du genou apr\u00e8s la chirurgie.<sup id=\"cite_ref-:3_5-2\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup><sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup><sup id=\"cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\">(23)<\/a><\/sup><\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/BdBVFZ0b8fk?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\">(24)<\/a><\/sup><\/p>\n<p>La recherche a montr\u00e9 que la r\u00e9\u00e9ducation apr\u00e8s une l\u00e9sion du LCA am\u00e9liore les r\u00e9sultats rapport\u00e9s par le patient concernant le genou et les r\u00e9sultats de l&rsquo;examen physique, et aide pour un retour plus rapide au sport.<sup id=\"cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\">(25)<\/a><\/sup> Les patients qui ont b\u00e9n\u00e9fici\u00e9 d&rsquo;une r\u00e9\u00e9ducation pr\u00e9-chirurgicale ont obtenu de meilleurs r\u00e9sultats \u00e0 l&rsquo;International Knee Documentation Committee (IKDC, questionnaire d\u2019\u00e9valuation subjective du genou) et au \u00ab The Knee injury and Osteoarthritis Outcome Score \u00bb (KOOS, questionnaire sur les cons\u00e9quences d&rsquo;une blessure au genou et de la gonarthrose) que ceux qui n&rsquo;ont pas b\u00e9n\u00e9fici\u00e9 d&rsquo;une r\u00e9\u00e9ducation pr\u00e9-chirurgicale et ont montr\u00e9 une plus grande probabilit\u00e9 de reprendre le sport qu&rsquo;ils pratiquaient avant leur blessure.<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup><\/p>\n<p>Assurez-vous que votre patient est mentalement pr\u00e9par\u00e9 \u00e0 la chirurgie. Prenez le temps d&rsquo;informer votre patient sur sa blessure, l&rsquo;intervention chirurgicale, le programme \u00e0 domicile, le processus de r\u00e9adaptation et les r\u00e9sultats.<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\">(27)<\/a><\/sup> La recherche sugg\u00e8re que la r\u00e9adaptation pr\u00e9-chirurgicale peut aider les patients \u00e0 se pr\u00e9parer mentalement \u00e0 la chirurgie.<sup id=\"cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\">(28)<\/a><\/sup><\/p>\n<h2><span id=\"Considerations_Before_Designing_a_Post-Surgical_Rehabilitation_Programme\" class=\"mw-headline\">\u00c9l\u00e9ments \u00e0 prendre en compte avant de concevoir un programme de r\u00e9\u00e9ducation post-chirurgicale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Consid\u00e9rations avant de concevoir un programme de r\u00e9adaptation post-chirurgicale\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=3\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Consid\u00e9rations avant de concevoir un programme de r\u00e9adaptation post-chirurgicale\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=3\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Les l\u00e9sions du LCA surviennent souvent en m\u00eame temps que d&rsquo;autres l\u00e9sions, telles que les l\u00e9sions du m\u00e9nisque, les l\u00e9sions du ligament collat\u00e9ral m\u00e9dial, les contusions osseuses et les l\u00e9sions chondrales.<sup id=\"cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\">(29)<\/a><\/sup> Les taux de r\u00e9cidive sont \u00e9lev\u00e9s : environ un joueur de football professionnel masculin sur cinq peut subir une deuxi\u00e8me l\u00e9sion du LCA,<sup id=\"cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\">(30)<\/a><\/sup> et les athl\u00e8tes f\u00e9minines ayant d\u00e9j\u00e0 subi une l\u00e9sion du LCA ont un risque de r\u00e9cidive 4 \u00e0 7 fois plus \u00e9lev\u00e9.<sup id=\"cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\">(31)<\/a><\/sup> En outre, de nombreux joueurs peuvent ne pas \u00eatre en mesure de retrouver leur niveau de performance ant\u00e9rieur, ce qui r\u00e9duit la long\u00e9vit\u00e9 de leur carri\u00e8re ou les obliger \u00e0 concourir \u00e0 un niveau inf\u00e9rieur.<sup id=\"cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\">(32)<\/a><\/sup><sup id=\"cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\">(33)<\/a><\/sup><sup id=\"cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\">(34)<\/a><\/sup> <b>L&rsquo;autorisation de retour au sport devrait donc \u00eatre bas\u00e9e sur des crit\u00e8res de performance, et pas seulement sur des crit\u00e8res de temps.<\/b><\/p>\n<p>Une \u00e9quipe pluridisciplinaire est n\u00e9cessaire pour aider les athl\u00e8tes \u00e0 r\u00e9cup\u00e9rer et \u00e0 maintenir leur niveau de performance. <b>En tant que physioth\u00e9rapeute, vous devez garder les canaux de communication ouverts avec les professionnels suivants et savoir quand orienter votre patient vers eux.<\/b><\/p>\n<ul>\n<li><b>Chirurgien orthop\u00e9dique<\/b>: la communication entre le chirurgien et le th\u00e9rapeute traitant est essentielle &#8211; les chirurgiens doivent faire confiance \u00e0 leur \u00e9quipe de physioth\u00e9rapie et une collaboration \u00e9troite am\u00e9liore les soins aux patients.<sup id=\"cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\">(35)<\/a><\/sup><\/li>\n<li><b>Psychologue du sport<\/b>: des caract\u00e9ristiques psychologiques telles que l&rsquo;auto-efficacit\u00e9, la r\u00e9silience, la kin\u00e9siophobie et la catastrophisation de la douleur peuvent influencer la r\u00e9cup\u00e9ration. Les interventions psychologiques peuvent aider certains patients \u00e0 retrouver leur niveau d&rsquo;activit\u00e9 d&rsquo;avant la blessure.<sup id=\"cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\">(36)<\/a><\/sup><\/li>\n<li><b>Nutritionniste ou di\u00e9t\u00e9ticien pour les sportifs<\/b>: les blessures, l&rsquo;immobilisation, la chirurgie et les niveaux d&rsquo;activit\u00e9 r\u00e9duits n\u00e9cessitent des strat\u00e9gies nutritionnelles individualis\u00e9es. Une approche structur\u00e9e, bas\u00e9e sur des phases align\u00e9es sur les changements physiologiques tout au long de la r\u00e9\u00e9ducation peut r\u00e9duire les complications, favoriser une gu\u00e9rison optimale et faciliter le retour au sport.<sup id=\"cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\">(37)<\/a><\/sup><\/li>\n<\/ul>\n<p><b>La communication entre le th\u00e9rapeute et le patient est essentielle pour l&rsquo;engagement et la motivation du patient<\/b>. La r\u00e9adaptation prend du temps. Elle peut \u00e9galement \u00eatre \u00e9puisante et mentalement \u00e9prouvante pour le patient. Sans motivation ad\u00e9quate, les patients risquent de se d\u00e9sengager ou d&rsquo;abandonner.<sup id=\"cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\">(38)<\/a><\/sup> La relation th\u00e9rapeute-patient est un facilitateur important de l&rsquo;adh\u00e9sion th\u00e9rapeutique.<sup id=\"cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\">(39)<\/a><\/sup> L&rsquo;<b>\u00e9ducation du patient, la fixation d&rsquo;objectifs et l&rsquo;\u00e9valuation r\u00e9guli\u00e8re des r\u00e9sultats<\/b> <b>en vue d&rsquo;une r\u00e9troaction<\/b> contribuent \u00e0 maintenir l&rsquo;engagement.<sup id=\"cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\">(40)<\/a><\/sup><\/p>\n<h2><span id=\"Acute_Management_and_Goals\" class=\"mw-headline\">Prise en charge en phase aigu\u00eb et objectifs <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Acute Management and Goals\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=4\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Acute Management and Goals\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=4\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La r\u00e9\u00e9ducation vise \u00e0 r\u00e9tablir une performance maximale tout en minimisant le risque de r\u00e9cidive. Ce processus est guid\u00e9 par des \u00e9tapes et des mesures de r\u00e9sultats qui permettent de structurer le programme et de suivre les progr\u00e8s accomplis.<sup id=\"cite_ref-:1_15-2\" class=\"reference\"><a href=\"#cite_note-:1-15\">(15)<\/a><\/sup><\/p>\n<p>\u00c0 ce stade (0-6 semaines) apr\u00e8s l&rsquo;op\u00e9ration, l&rsquo;objectif est de <b>prot\u00e9ger la r\u00e9paration\/reconstruction chirurgicale<\/b> et de pr\u00e9parer le patient \u00e0 retrouver sa fonction. Les <b>objectifs <\/b> de la prise en charge aigu\u00eb comprennent<sup id=\"cite_ref-:4_41-0\" class=\"reference\"><a href=\"#cite_note-:4-41\">(41)<\/a><\/sup>:<\/p>\n<ol>\n<li><b>R\u00e9tablir l&rsquo;hom\u00e9ostasie articulaire<\/b><\/li>\n<li><b>Traitement des cicatrices<\/b><\/li>\n<li><b>R\u00e9tablissement de l&rsquo;amplitude des mouvements dans toutes les directions<\/b><\/li>\n<li><b>R\u00e9entra\u00eenement du quadriceps \u00e0 travailler de mani\u00e8re ind\u00e9pendante et atteindre une extension terminale<\/b><\/li>\n<li><b>Cr\u00e9er un plan \u00e0 long terme<\/b> pour les 6 \u00e0 9 mois de r\u00e9tablissement<\/li>\n<\/ol>\n<h5><span id=\"Protecting_the_Surgical_Repair.2FReconstruction\"><\/span><span id=\"Protecting_the_Surgical_Repair\/Reconstruction\" class=\"mw-headline\">Prot\u00e9ger la r\u00e9paration\/reconstruction chirurgicale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Prot\u00e9ger la r\u00e9paration\/reconstruction chirurgicale\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=5\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Prot\u00e9ger la r\u00e9paration\/reconstruction chirurgicale\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=5\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>La protection du greffon au cours de la p\u00e9riode postop\u00e9ratoire pr\u00e9coce implique la gestion de l&rsquo;amplitude de mouvement, le port d&rsquo;une orth\u00e8se et la mise en charge progressive.<sup id=\"cite_ref-:4_41-1\" class=\"reference\"><a href=\"#cite_note-:4-41\">(41)<\/a><\/sup><\/p>\n<p><b>Consid\u00e9rations concernant l&rsquo;amplitude articulaire :<\/b> Commencer les exercices de mobilit\u00e9 imm\u00e9diatement apr\u00e8s la chirurgie (jour 1).<sup id=\"cite_ref-:3_5-3\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup><sup id=\"cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\">(42)<\/a><\/sup> Limiter la flexion du genou \u00e0 90\u00b0 jusqu&rsquo;\u00e0 ce que le bloc nerveux f\u00e9moral et\/ou adducteur disparaisse (ce qui prend g\u00e9n\u00e9ralement 48 \u00e0 72 heures) afin d&rsquo;assurer une r\u00e9troaction pr\u00e9cise du patient et d&rsquo;\u00e9viter une tension excessive.<sup id=\"cite_ref-:4_41-2\" class=\"reference\"><a href=\"#cite_note-:4-41\">(41)<\/a><\/sup> Une fois que le patient retrouve une sensibilit\u00e9 ad\u00e9quate, <a title=\"Amplitude articulaire\" href=\"\/Range_of_Motion\">la mobilit\u00e9 articulaire<\/a> peut progresser en fonction de la tol\u00e9rance &#8211; d&rsquo;abord en passif, puis en actif-assist\u00e9 et en active en fonction du confort du patient et du contr\u00f4le du quadriceps.<sup id=\"cite_ref-:3_5-4\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup> Il est important d&rsquo;obtenir une extension compl\u00e8te du genou.<sup id=\"cite_ref-:3_5-5\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup><\/p>\n<p><i>Note : Bien que les dispositifs de mouvement passif continu de type \u00ab CPM \u00bb peuvent apporter des avantages \u00e0 court terme en ce qui concerne la douleur et le gonflement au cours des trois premiers jours postop\u00e9ratoires, les donn\u00e9es actuelles ne montrent aucun avantage suppl\u00e9mentaire \u00e0 son utilisation par rapport aux exercices de mouvement actif, et cela prend beaucoup de temps et est co\u00fbteux.<\/i><sup id=\"cite_ref-:6_18-1\" class=\"reference\"><a href=\"#cite_note-:6-18\">(18)<\/a><\/sup><\/p>\n<p>Immobiliser le genou \u00e0 l&rsquo;aide d&rsquo;une <b>attelle de type Zimmer<\/b> jusqu&rsquo;\u00e0 ce que l&rsquo;effet du bloc nerveux f\u00e9moral\/adducteur se dissipe, puis passer \u00e0 une orth\u00e8se articul\u00e9e du genou pendant 3 \u00e0 7 jours ou jusqu&rsquo;\u00e0 ce que le patient puisse effectuer une extension terminale du genou.<sup id=\"cite_ref-:4_41-3\" class=\"reference\"><a href=\"#cite_note-:4-41\">(41)<\/a><\/sup> Les donn\u00e9es actuelles ne justifient pas l&rsquo;utilisation syst\u00e9matique d&rsquo;une orth\u00e8se postop\u00e9ratoire du genou apr\u00e8s une reconstruction du LCA. Si les attelles et orth\u00e8ses peuvent procurer un sentiment de s\u00e9curit\u00e9 psychologique aux patients, ils n&rsquo;offrent pas d&rsquo;autres avantages tels que l&rsquo;am\u00e9lioration des r\u00e9sultats chirurgicaux (y compris l&rsquo;asym\u00e9trie des membres, la laxit\u00e9 ant\u00e9ro-post\u00e9rieure du genou et l&rsquo;\u00e9panchement).<sup id=\"cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\">(43)<\/a><\/sup><\/p>\n<p>Une <b>mise en charge partielle<\/b> est recommand\u00e9e pendant les deux semaines suivant la chirurgie afin de minimiser l&rsquo;enflure et de permettre \u00e0 l&rsquo;\u00e9panchement de se r\u00e9sorber. Parvenir \u00e0 la <b>mise en charge compl\u00e8te<\/b> dans les 6 premi\u00e8res semaines postop\u00e9ratoires est associ\u00e9e \u00e0 des scores du International Knee Documentation Committee (<a class=\"external text\" href=\"http:\/\/www.orthopaedicscore.com\/scorepages\/international_knee_documentation_comitee.html\" rel=\"nofollow\">IKDC<\/a>, questionnaire d\u2019\u00e9valuation subjective du genou) \u00e9lev\u00e9s.<sup id=\"cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\">(44)<\/a><\/sup><\/p>\n<p>Le <b>v\u00e9lo stationnaire sans r\u00e9sistance<\/b> peut \u00eatre introduit au 10e jour ou lorsque le patient atteint &gt;110\u00b0 de flexion passive.<sup id=\"cite_ref-:0_45-0\" class=\"reference\"><a href=\"#cite_note-:0-45\">(45)<\/a><\/sup><\/p>\n<p><b>L\u2019entra\u00eenement musculaire avec mise en charge compl\u00e8te<\/b> n\u2019est d\u00e9but\u00e9 seulement qu\u2019\u00e0 la 6e semaine.<\/p>\n<p>Consultez <a class=\"external text\" href=\"https:\/\/www.researchgate.net\/profile\/Brett_Bousquet\/publication\/324780653_POST-OPERATIVE_CRITERION_BASED_REHABILITATION_OF_ACL_REPAIRS_A_CLINICAL_COMMENTARY\/links\/5ae1ebc4aca272fdaf8e84cd\/POST-OPERATIVE-CRITERION-BASED-REHABILITATION-OF-ACL-REPAIRS-A-CLIN\" rel=\"nofollow\">cet article<\/a> pour plus d&rsquo;informations sur les diff\u00e9rentes phases de la r\u00e9\u00e9ducation suite \u00e0 une l\u00e9sion du LCA (en anglais original).<\/p>\n<p><i><b>Note : Les protocoles varient selon les chirurgiens et les \u00e9tablissements. Il faut toujours respecter les directives du chirurgien tout en comprenant les raisons de ces restrictions.<\/b><\/i><\/p>\n<h3><span id=\"Homeostasis\" class=\"mw-headline\">Hom\u00e9ostasie<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Homeostasis\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=6\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Homeostasis\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=6\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Une articulation dont l\u2019hom\u00e9ostasie est anormale est typiquement douloureuse, \u0153d\u00e9mati\u00e9e et raide. La sollicitation d&rsquo;une articulation post-chirurgicale inflamm\u00e9e peut entra\u00eeenr des r\u00e9actions inflammatoires excessives qui prolongent la gu\u00e9rison. \u00c9valuer r\u00e9guli\u00e8rement les activit\u00e9s et ralentir d\u00e8s qu&rsquo;un signe de surmenage appara\u00eet est n\u00e9cessaire pour r\u00e9tablir l&rsquo;hom\u00e9ostasie le plus rapidement possible.<sup id=\"cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\">(46)<\/a><\/sup><\/p>\n<p>Le r\u00e9tablissement de l&rsquo;hom\u00e9ostasie est essentiel pour <b>pr\u00e9venir les cons\u00e9quences suivantes :<\/b><\/p>\n<ul>\n<li>Mobilit\u00e9 articulaire limit\u00e9e, en particulier la flexion. L\u2019extension peut \u00eatre limit\u00e9e par d\u2019autres facteurs tels qu\u2019une l\u00e9sion du m\u00e9nisque;<\/li>\n<li>Sch\u00e8me d\u2019activation neuromusculaire inhib\u00e9 du quadriceps;<\/li>\n<li>Cicatrisation anormale \u00e0 cause d\u2019une phase inflammatoire prolong\u00e9e;<\/li>\n<li>Tout le processus de r\u00e9\u00e9ducation peut \u00eatre plus lent lorsque l\u2019hom\u00e9ostasie n\u2019est pas r\u00e9tablie.<\/li>\n<\/ul>\n<p>Il convient de respecter le processus physiologique de gu\u00e9rison et de solliciter progressivement les tissus en cours de gu\u00e9rison dans les limites de leur tol\u00e9rance afin d&rsquo;\u00e9viter toute perturbation de l&rsquo;hom\u00e9ostasie articulaire.<sup id=\"cite_ref-:0_45-1\" class=\"reference\"><a href=\"#cite_note-:0-45\">(45)<\/a><\/sup> Diverses modalit\u00e9s peuvent \u00eatre int\u00e9gr\u00e9es au programme de r\u00e9\u00e9ducation afin de r\u00e9sorber l&rsquo;\u00e9panchement articulaire et de r\u00e9tablir l&rsquo;hom\u00e9ostasie articulaire, telles que le massage lymphatique, les dispositifs de compression pneumatique, l&rsquo;\u00e9l\u00e9vation et les exercices actifs de pompage musculaire (contractions des quadriceps et des mollets). <sup id=\"cite_ref-:0_45-2\" class=\"reference\"><a href=\"#cite_note-:0-45\">(45)<\/a><\/sup> Un gonflement inf\u00e9rieur \u00e0 0,5 cm par rapport au genou oppos\u00e9 constitue un jalon important ; une fois cet objectif atteint, les exercices de mobilit\u00e9 et d&rsquo;\u00e9quilibre peuvent \u00eatre progressivement intensifi\u00e9s.<sup id=\"cite_ref-:0_45-3\" class=\"reference\"><a href=\"#cite_note-:0-45\">(45)<\/a><\/sup><\/p>\n<h4><span id=\"Monitoring_Pain_and_Swelling\" class=\"mw-headline\">Surveillance de la douleur et de l&rsquo;\u0153d\u00e8me<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Surveillance de la douleur et de l'enflure\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=7\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Surveillance de la douleur et de l'enflure\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=7\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p><b>\u00c9valuation de la douleur <\/b> : utiliser une \u00e9chelle num\u00e9rique \u00e0 11 points (0 = aucune douleur ; 10 = pire douleur imaginable) pour les t\u00e2ches fonctionnelles, telles que s&rsquo;asseoir et se lever, marcher un certain nombre de pas ou monter des escaliers, afin de surveiller la douleur et d&rsquo;ajuster les sollicitations.<sup id=\"cite_ref-:3_5-6\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup><\/p>\n<p><b>Surveillance de l&rsquo;\u0153d\u00e8me<\/b>: surveiller r\u00e9guli\u00e8rement le gonflement en mesurant la circonf\u00e9rence du genou et en effectuant le test de la vague (Stroke test).<sup id=\"cite_ref-:3_5-7\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup> Les patients peuvent mesurer eux-m\u00eames la circonf\u00e9rence de leur genou ; des augmentations de plus de 1 cm au niveau de la rotule sont cliniquement significatives et indiquent une sollitication articulaire excessive.<sup id=\"cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\">(47)<\/a><\/sup><\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/DLzvaHG35z4?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\">(48)<\/a><\/sup><\/p>\n<p>Si la douleur et le gonflement augmentent, il faut imm\u00e9diatement adapter le programme de r\u00e9\u00e9ducation. Souvent, le probl\u00e8me n&rsquo;est pas la th\u00e9rapie structur\u00e9e, mais l&rsquo;activit\u00e9 du patient en dehors des s\u00e9ances. Il faut sensibiliser les patients \u00e0 la gestion de la sollicitation et envisager un suivi de l&rsquo;activit\u00e9 \u00e0 l&rsquo;aide d&rsquo;un compteur de pas ou d&rsquo;un journal d&rsquo;activit\u00e9.<sup id=\"cite_ref-:3_5-8\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup><\/p>\n<h3><span id=\"Red_Flags_-_When_to_Seek_Medical_Consultation\" class=\"mw-headline\">Signaux d&rsquo;alerte &#8211; Quand consulter un m\u00e9decin ?<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Signaux d'alerte (\"red flags\") - Quand consulter un m\u00e9decin ?\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=8\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Signaux d'alerte (\"red flags\") - Quand consulter un m\u00e9decin ?\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=8\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Des consultations m\u00e9dicales fr\u00e9quentes (au moins tous les 10 \u00e0 15 jours) permettent de suivre l&rsquo;\u00e9volution du patient et de traiter rapidement les complications post-chirurgicales. Parmi les complications postop\u00e9ratoires, on peut citer <sup id=\"cite_ref-:3_5-9\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup>:<\/p>\n<ul>\n<li>diminution de l&rsquo;extension passive du genou \u00e0 la 3e semaine post-chirurgie<\/li>\n<li>gonflement mod\u00e9r\u00e9 persistant et signes inflammatoires<\/li>\n<li>gonflement, rougeur et douleur de la jambe op\u00e9r\u00e9e<\/li>\n<li>gonflement important du genou, fi\u00e8vre et autres sympt\u00f4mes syst\u00e9miques<\/li>\n<li>retard de cicatrisation et infection superficielle de la plaie<\/li>\n<\/ul>\n<h3><span id=\"Scar_Management_and_ROM\" class=\"mw-headline\">Gestion des cicatrices et mobilit\u00e9 articulaire <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Scar Management and ROM\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=9\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Scar Management and ROM\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=9\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>\u00ab L&rsquo;intervalle ant\u00e9rieur du genou est l&rsquo;espace situ\u00e9 entre le tendon patellaire et le coussinet adipeux infrapatellaire \u00e0 l&rsquo;avant, et le bord ant\u00e9rieur du tibia et le ligament interm\u00e9niscal ant\u00e9rieur \u00e0 l&rsquo;arri\u00e8re. \u00bb <sup id=\"cite_ref-:7_49-0\" class=\"reference\"><a href=\"#cite_note-:7-49\">(49)<\/a><\/sup> La bourse suprapatellaire se trouve entre le f\u00e9mur et le tendon quadricipital. Ces espaces permettent \u00e0 l&rsquo;articulation du genou de bouger librement sur toute l&rsquo;amplitude articulaire. Pendant la phase de prolif\u00e9ration (jusqu&rsquo;\u00e0 6 semaines apr\u00e8s l&rsquo;op\u00e9ration), un tissu cicatriciel rigide peut se former dans ces espaces. Les cicatrices dans ces zones peuvent limiter l&rsquo;amplitude articulaire du genou et entra\u00eener une perte d&rsquo;extension du genou.<sup id=\"cite_ref-:7_49-1\" class=\"reference\"><a href=\"#cite_note-:7-49\">(49)<\/a><\/sup> Elles peuvent \u00e9galement augmenter les pressions de contact dans l&rsquo;articulation du genou, ce qui contribue \u00e0 la douleur \u00e0 la face ant\u00e9rieure du genou et au d\u00e9veloppement de l&rsquo;arthrose.<sup id=\"cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\">(50)<\/a><\/sup><\/p>\n<p>La cicatrisation diminue \u00e9galement le bras de levier du m\u00e9canisme extenseur, r\u00e9duisant ainsi la force d&rsquo;extension produite par le quadriceps. Cela peut expliquer pourquoi certains athl\u00e8tes ne parviennent pas \u00e0 retrouver la pleine performance du quadriceps m\u00eame apr\u00e8s 9 mois de r\u00e9\u00e9ducation. <i><b>L&rsquo;objectif est donc de favoriser une prolif\u00e9ration organis\u00e9e de la cicatrice qui n\u2019aura pas d\u2019impact n\u00e9gatif sur la mobilit\u00e9.<\/b><\/i><\/p>\n<h4><span id=\"Early_ROM_Strategies\" class=\"mw-headline\">Strat\u00e9gies pr\u00e9coces de mobilit\u00e9 articulaire <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Strat\u00e9gies ROM pr\u00e9coces\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=10\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Strat\u00e9gies ROM pr\u00e9coces\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=10\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Les exercices d&rsquo;amplitude articulaire doivent commencer d\u00e8s le premier jour apr\u00e8s la chirurgie. Ces exercices cr\u00e9ent des gradients de pression dans le genou, ce qui contribue \u00e0 \u00e9vacuer le sang et les cellules inflammatoires de l&rsquo;articulation. La mobilit\u00e9 obtenue au cours des quatre premi\u00e8res semaines est \u00e9troitement li\u00e9e aux r\u00e9sultats obtenus \u00e0 12 semaines, ce qui rend les progr\u00e8s initiaux extr\u00eamement importants.<sup id=\"cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\">(51)<\/a><\/sup><\/p>\n<p>Les exercices de mobilit\u00e9 passive comprennent : la flexion assist\u00e9e par un th\u00e9rapeute au bout du lit pour obtenir une flexion compl\u00e8te du genou ; les \u00ab wall-slides \u00bb, o\u00f9 le patient est allong\u00e9 sur le dos devant un mur avec le pied au mur, le laissant glisser vers le bas en fl\u00e9chissant le genou et en utilisant la jambe oppos\u00e9e pour obtenir un plus grand mouvement (cette position avec la jambe sur\u00e9lev\u00e9e comporte l\u2019avantage d\u2019aider \u00e0 r\u00e9duire l\u2019\u00e9panchement) ; et la flexion \u00e0 l&rsquo;aide d&rsquo;un ballon suisse. Pour la flexion avec le ballon suisse, le patient est allong\u00e9 sur le lit de traitement, la jambe non atteinte est tendue, et la jambe op\u00e9r\u00e9e est pos\u00e9e sur le ballon suisse. Le th\u00e9rapeute fl\u00e9chit le genou jusqu&rsquo;\u00e0 ce que le patient signale une g\u00eane ou une douleur, ou qu&rsquo;il ressente une tension tissulaire. De petites oscillations en fin de course permettent d&rsquo;augmenter l&rsquo;amplitude de mouvement au fil du temps.<\/p>\n<p>Le v\u00e9lo d\u2019int\u00e9rieur, qui est une activit\u00e9 \u00e0 faible impact, est un excellent outil dans la gestion de la phase aigu\u00eb. Des mouvements r\u00e9p\u00e9t\u00e9s de flexion et d\u2019extension favorisent la mobilit\u00e9 et la souplesse de la cicatrice.<\/p>\n<div class=\"row\">\n<div class=\"col-md-6\">\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Passive_knee_flexion.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/1\/1c\/Passive_knee_flexion.gif\/300px-Passive_knee_flexion.gif\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/1\/1c\/Passive_knee_flexion.gif\/450px-Passive_knee_flexion.gif 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/1\/1c\/Passive_knee_flexion.gif\/600px-Passive_knee_flexion.gif 2x\" alt=\"Passive knee flexion.gif\" width=\"300\" height=\"309\" data-file-width=\"619\" data-file-height=\"638\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"col-md-6\">\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Knee_flexion_on_swiss_ball.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/f\/f0\/Knee_flexion_on_swiss_ball.gif\/300px-Knee_flexion_on_swiss_ball.gif\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/f\/f0\/Knee_flexion_on_swiss_ball.gif\/450px-Knee_flexion_on_swiss_ball.gif 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/f\/f0\/Knee_flexion_on_swiss_ball.gif\/600px-Knee_flexion_on_swiss_ball.gif 2x\" alt=\"Knee flexion on swiss ball.gif\" width=\"300\" height=\"300\" data-file-width=\"616\" data-file-height=\"616\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h5><span id=\"Loss_of_Extension\" class=\"mw-headline\">Perte de l&rsquo;extension<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Perte d'extension\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=11\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Perte d'extension\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=11\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>La perte d&rsquo;extension est l&rsquo;une des complications les plus courantes apr\u00e8s une chirurgie de reconstruction du LCA. L&rsquo;extension compl\u00e8te est n\u00e9cessaire pour une contraction efficace du quadriceps et une sollicitation optimale de l&rsquo;articulation. M\u00eame un petit degr\u00e9 de flexum du genou limitera la capacit\u00e9 du quadriceps \u00e0 retrouver toute sa force, ce qui est important pour optimiser les r\u00e9sultats fonctionnels. Sans extension compl\u00e8te, une concentration des charges se produit, ce qui augmente les pressions de contact au niveau des articulations, acc\u00e9l\u00e8re le d\u00e9veloppement de l&rsquo;arthrose et augmente le risque de douleur \u00e0 la face ant\u00e9rieure du genou.<sup id=\"cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\">(52)<\/a><\/sup><\/p>\n<p><b>M\u00e9thodes de restauration de l&rsquo;extension<\/b>:<\/p>\n<ul>\n<li>Th\u00e9rapie manuelle\/mobilisations (glissements post\u00e9rieurs du f\u00e9mur, mouvements de rotation interne automatique)<\/li>\n<li>Mobilisations articulaires passives utilisant des dispositifs externes<\/li>\n<li><a title=\"Massage\" href=\"\/Massage\">Massage<\/a> des tissus mous<\/li>\n<li>Auto-mobilisation<\/li>\n<li>Mobilisation f\u00e9moro-patellaire<\/li>\n<\/ul>\n<div class=\"row\">\n<div class=\"col-md-4\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/b00UCkvYgzE?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\">(53)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-4\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/Vb_FRyydYyI?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\">(54)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-4\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/OLvJwe5GAfg?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\">(55)<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<div class=\"row\">\n<div class=\"col-md-4\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/kcYDCDbsh3s?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\">(56)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-4\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/uNWkHPcpDfY?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\">(57)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-4\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/sGVbR1EiJzs?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\">(58)<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Restoring_Quadriceps_Strength\" class=\"mw-headline\">Restauration de la force du quadriceps<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : R\u00e9tablir la force des quadriceps\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=12\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : R\u00e9tablir la force des quadriceps\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=12\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Isometric_quadriceps.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/05\/Isometric_quadriceps.gif\/300px-Isometric_quadriceps.gif\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/05\/Isometric_quadriceps.gif\/450px-Isometric_quadriceps.gif 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/0\/05\/Isometric_quadriceps.gif\/600px-Isometric_quadriceps.gif 2x\" alt=\"Isometric quadriceps.gif\" width=\"300\" height=\"298\" data-file-width=\"622\" data-file-height=\"618\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>La perturbation de l\u2019activation du quadriceps est fr\u00e9quente \u00e0 la suite d\u2019une reconstruction du LCA et est souvent rapport\u00e9e comme \u00e9tant bilat\u00e9rale. La perte de l&rsquo;hom\u00e9ostasie articulaire entra\u00eene des changements dans le contr\u00f4le neural. En outre, la perte des m\u00e9canor\u00e9cepteurs du LCA perturbe le r\u00e9flexe ligamentaire-musculaire entre le ligament et le quadriceps, r\u00e9duisant ainsi la capacit\u00e9 \u00e0 recruter des unit\u00e9s motrices \u00e0 haut seuil. Ce ph\u00e9nom\u00e8ne, appel\u00e9 inhibition musculaire arthrog\u00e8ne (IMA), se produit lorsqu&rsquo;un muscle ne peut pas se contracter bien qu&rsquo;il n&rsquo;y ait aucune pathologie sous-jacente au niveau du muscle ou du nerf. Il r\u00e9sulte plut\u00f4t d&rsquo;une l\u00e9sion de l&rsquo;articulation qu&rsquo;il entoure.<sup id=\"cite_ref-:3_5-10\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup> <sup id=\"cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\">(59)<\/a><\/sup> L&rsquo;IMA constitue un obstacle clinique \u00e0 la r\u00e9\u00e9ducation.<\/p>\n<p>Les techniques de th\u00e9rapie manuelle, telles que <a class=\"external text\" href=\"https:\/\/www.physio-pedia.com\/Cryotherapy\" rel=\"nofollow\">la cryoth\u00e9rapie,<\/a>,  <a class=\"external text\" href=\"https:\/\/www.physio-pedia.com\/Transcutaneous_Electrical_Nerve_Stimulation_(TENS)\" rel=\"nofollow\">la stimulation \u00e9lectrique transcutan\u00e9e (\u00ab TENS \u00bb)<\/a> et la stimulation neuromusculaire \u00e9lectrique \u00ab NMES \u00bb peuvent aider \u00e0 diminuer l\u2019inhibition des quadriceps.<sup id=\"cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\">(60)<\/a><\/sup><sup id=\"cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\">(61)<\/a><\/sup><sup id=\"cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\">(62)<\/a><\/sup><sup id=\"cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\">(63)<\/a><\/sup><sup id=\"cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\">(64)<\/a><\/sup><\/p>\n<p>Les strat\u00e9gies visant \u00e0 r\u00e9duire l&rsquo;IMA consistent notamment \u00e0 faciliter la contraction isol\u00e9e du quadriceps en apprenant aux patients \u00e0 solliciter ce muscle de mani\u00e8re ind\u00e9pendante, afin d&rsquo;\u00e9viter les compensations par d&rsquo;autres muscles. Une technique consiste \u00e0 demander au patient de faire glisser la rotule vers le haut. M\u00eame si ce simple indice ne produit qu&rsquo;une contraction fr\u00e9missante, il d\u00e9clenche une contraction isol\u00e9e du quadriceps. On progresse \u00e0 partir de ce point pour atteindre l&rsquo;extension terminale du genou. La perte de l&rsquo;extension terminale du genou se manifeste souvent par une d\u00e9marche en flexum. L&rsquo;extension terminale du genou peut \u00eatre facilit\u00e9e en demandant au patient de \u00ab\u00a0soulever son talon de la table\u00a0\u00bb.<\/p>\n<p>D&rsquo;autres techniques pour traiter l&rsquo;IMA peuvent \u00eatre envisag\u00e9es en fonction du tableau clinique et de l&rsquo;expertise du praticien. Il s&rsquo;agit notamment du refroidissement focal des articulations, de la TENS combin\u00e9e \u00e0 l&rsquo;exercice, des techniques de fatigue des ischiojambiers, de l&rsquo;entra\u00eenement \u00e0 la restriction du flux sanguin (BFR) et de l&rsquo;apprentissage par l&rsquo;entra\u00eenement controlat\u00e9ral (\u00ab\u00a0cross-education training\u00a0\u00bb).<sup id=\"cite_ref-:3_5-11\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup> Pour en savoir plus sur ces techniques, voir : <a class=\"external text\" href=\"https:\/\/tripp.co.za\/wp-content\/uploads\/Optimising-the-Early-Stage-Rehabilitation-Process-Post-ACL-Reconstruction.pdf\" rel=\"nofollow\">Optimiser le processus de r\u00e9\u00e9ducation pr\u00e9coce apr\u00e8s une reconstruction du ligament crois\u00e9 ant\u00e9rieur.<\/a> <sup id=\"cite_ref-:3_5-12\" class=\"reference\"><a href=\"#cite_note-:3-5\">(5)<\/a><\/sup><\/p>\n<h3><span id=\"Rehabilitation_Planning\" class=\"mw-headline\">Planification de la r\u00e9\u00e9ducation<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Planification de la r\u00e9adaptation\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=13\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Planification de la r\u00e9adaptation\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=13\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Un plan de r\u00e9\u00e9ducation du LCA multiphasique comporte neuf phases essentielles. Chacune phase n\u00e9cessite une p\u00e9riode de temps qui doit \u00eatre individualis\u00e9 en fonction des besoins de l\u2019athl\u00e8te :<\/p>\n<ol>\n<li>Protection et restauration de la mobilit\u00e9 articulaire<\/li>\n<li>Tol\u00e9rance \u00e0 la mise en charge<\/li>\n<li>Endurance<\/li>\n<li>Force<\/li>\n<li>puissance;<\/li>\n<li>Course<\/li>\n<li>Vitesse et agilit\u00e9<\/li>\n<li>Retour \u00e0 l&rsquo;entra\u00eenement<\/li>\n<li>Retour au jeu<\/li>\n<\/ol>\n<p><b>N&rsquo;oubliez pas : Ne pr\u00e9cipitez pas la r\u00e9adaptation. Prenez votre temps.<\/b><\/p>\n<h4><span id=\"Progression_to_the_Next_Phase\" class=\"mw-headline\">Passage \u00e0 la phase suivante<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifier la section : Passage \u00e0 la phase suivante\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=14\">\u00e9diter<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifier la section : Passage \u00e0 la phase suivante\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=14\">\u00e9diter la source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Une fois l&rsquo;hom\u00e9ostasie articulaire assur\u00e9e, l&rsquo;amplitude articulaire du genou r\u00e9tablie et la tol\u00e9rance \u00e0 la mise en charge acquise, les patients peuvent passer \u00e0 la phase suivante de leur r\u00e9\u00e9ducation. Cette phase se concentre sur la composante endurance du d\u00e9veloppement p\u00e9riodis\u00e9 de la force. Le patient est pr\u00eat \u00e0 passer \u00e0 l\u2019\u00e9tape suivante de la r\u00e9\u00e9ducation lorsque nous retrouvons les \u00e9l\u00e9ments suivants<sup id=\"cite_ref-:0_45-4\" class=\"reference\"><a href=\"#cite_note-:0-45\">(45)<\/a><\/sup>:<\/p>\n<ul>\n<li>Extension terminale active compl\u00e8te du genou (0\u00b0)<\/li>\n<li>Flexion du genou avec une diff\u00e9rence de moins de 10\u00b0 par rapport au c\u00f4t\u00e9 controlat\u00e9ral.<\/li>\n<li>\u00c9panchement du genou r\u00e9solu (diff\u00e9rence de moins de 0,5 cm par rapport au genou controlat\u00e9ral)<\/li>\n<li>Capable de marcher sans appareil fonctionnel.<\/li>\n<\/ul>\n<p>Pour en savoir plus sur les neuf phases du plan de r\u00e9adaptation, cliquez <a title=\"R\u00e9\u00e9ducation apr\u00e8s une reconstruction du LCA : La planification\" href=\"\/ACL_Rehabilitation:_Rehabilitation_Planning#Creating_a_Plan\">ici<\/a>.<\/p>\n<h2><span id=\"References\" class=\"mw-headline\">R\u00e9f\u00e9rences<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;veaction=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=ACL_Rehabilitation:_Acute_Management_after_Surgery&amp;action=edit&amp;section=15\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-1\">\u2191<\/a><\/span> <span class=\"reference-text\">Waldron K, Brown M, Calderon A, Feldman M. <a class=\"external text\" href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2666061X21002315\" rel=\"nofollow\">Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast?<\/a>. Arthroscopy, sports medicine, and rehabilitation. 2022 Jan 1;4(1):e175-9.<\/span><\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-2\">\u2191<\/a><\/span> <span class=\"reference-text\">Beard DJ, Davies L, Cook JA, Stokes J, Leal J, Fletcher H, Abram S, Chegwin K, Greshon A, Jackson W, Bottomley N. <a class=\"external text\" href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(22)01424-6\/fulltext\" rel=\"nofollow\">Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial<\/a>. 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British Journal of Sports Medicine. 2020 May 1;54(9):546-55.<\/span><\/li>\n<li id=\"cite_note-:1-15\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_15-0\">15.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_15-1\">15.1<\/a><\/sup> <sup><a href=\"#cite_ref-:1_15-2\">15.2<\/a><\/sup><\/span> <span class=\"reference-text\">Adams D, Logerstedt D, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. <a class=\"external text\" href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3576892\/\" rel=\"nofollow\">Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression.<\/a> journal of orthopaedic &amp; sports physical therapy. 2012 Jul;42(7):601-14.<\/span><\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-16\">\u2191<\/a><\/span> <span class=\"reference-text\">Shelbourne KD, Klotz C. <a class=\"external text\" href=\"https:\/\/link.springer.com\/article\/10.1007\/s00776-006-1007-z\" rel=\"nofollow\">What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction.<\/a> Journal of Orthopaedic Science. 2006 May 1;11(3):318.<\/span><\/li>\n<li id=\"cite_note-:5-17\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:5_17-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. <a class=\"external text\" href=\"https:\/\/bjsm.bmj.com\/content\/49\/22\/1425.short\" rel=\"nofollow\">Nonsurgical or surgical treatment of ACL injuries: knee function, sports participation, and knee reinjury: the Delaware-Oslo ACL Cohort Study.<\/a> The Journal of bone and joint surgery. 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