**2. Study aim**

In the case discussed in the study, patient's knee dislocation led to breaking the anterior and posterior cruciate ligament and fibular and tibial collateral ligaments with grade 1 injury to the medial meniscus (X-ray, MRI). For this complex injury, followed by multiple-stage treatment, an individual rehabilitation program was developed, with consideration for the type of injury, time between injury and the first and another reconstruction, method to perform reconstruction and available orthopedic aids. The aim of the study is to analyze the possibilities of using a comprehensive rehabilitation program and to evaluate its effectiveness after a two-stage reconstruction of knee ligaments.

**35**

arthrofibrosis.

*Knee Dislocation: Comprehensive Rehabilitation Program after Two-Stage Ligament…*

The patient was female, aged 28 years, with body height of 170 cm and body mass of 55 kg (BMI 18.69). The injury occurred during a sport climbing activity due to the insufficiently protected landing surface. The training experience was 10 years of climbing, the trainings were usually completed three times a week with endurance components (running, swimming). Based on the information collected during the interview, the patient was a physically and professionally active person, which had a significant effect on the level of determination in activities leading to full recovery. The patient was qualified by the case physician for operative intervention. The entire process of diagnosis and surgical treatment was supervised by the same orthopedic surgeon and the surgery was performed in the same medical center.

After diagnostic examinations (knee joint X-ray examination) and excluding the damage of the popliteal artery and the peroneal nerve (ultrasound diagnosis of the popliteal fossa), the knee was reset into the proper position and immobilized by means of a knee joint immobilization bar (Sporlastic Genustabil 0°). A week later, the MRI examination revealed ruptured anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and fibular and tibial collateral ligaments (MCL) with grade 1 injury to the medial meniscus. The operating intervention involved two separate reconstruction procedures. The first one concerned the posterior cruciate ligament, whereas the second was used to reconstruct the anterior and fibular ligaments. An additional procedure used before the reconstruction was arthroscopy

The individual program of rehabilitation developed for the purposes of the discussed case took into consideration the damages to all structures formed during the injury, guidelines of the case physician, and the basic principles of rehabilitation [9]. The complete rehabilitation procedure was divided into four stages. The first stage directly after the injury lasted 10 weeks. The most important elements of the rehabilitation procedure together with the marked moment of their

Due to the damaged falciform cartilage, the first stage focused on creation of the conditions for the cartilage growth: immobilization of the joint for 4 weeks, complete absence of the load to the limb. At this stage, the activities also involved stimulation of creation of the scar in the location of the tibial collateral ligament through transverse massage (this ligament is fused with the joint capsule and the correctly formed scar can successfully overtake the function of the ligament). An additional recommendation in the period of immobilization was to use a Medi PTS orthosis, which ensured complete extension of the leg and, through the special pad fixed under the knee, it pushed the lower leg to the front, thus preventing the joint capsule contraction. Preparation of the joint for posterior cruciate ligament reconstruction was started after 4 weeks from immobilization and consisted mainly in reaching 100–110° of relaxed flexion movement in the knee joint (the range required for reconstruction). After around 2 weeks and reaching 90°, the meniscal block was observed. After consultation with the doctor, the meniscus was excluded as a cause of mobility limitation and, since the range of motion needed for the reconstruction was not achieved, the arthroscopy was performed to remove

After the arthroscopy which was performed to remove the resulting arthrofibrosis (ROM 0–80), the second stage of rehabilitation was started for 6 weeks and focused on the preparation of the joint and limb for reconstruction (**Table 2**).

*DOI: http://dx.doi.org/10.5772/intechopen.89649*

**3.1 Medical procedure and rehabilitation**

in order to remove arthrofibrosis.

implementation are presented below (**Table 1**).

**3. Material and methods**

*Knee Dislocation: Comprehensive Rehabilitation Program after Two-Stage Ligament… DOI: http://dx.doi.org/10.5772/intechopen.89649*
