**4. Results**

*Sports, Health and Exercise Medicine*

the isometric contractions with co-contraction of the hamstring muscles performed in full extension and in flexion of ca. 15°. Light flexion also allowed for proprioception exercises without load. Early introduction of the components of proprioceptive training (preferably already in the acute phase) accelerates regaining muscular control, which, with the knee extension, minimizes the risk of patellofemoral pain syndrome, and allows for maintaining the proper gait pattern [15]. Joint mobilization was started in the week 6. The large part of time was devoted to the improved proprioception: initially more in the sitting position and lying supine using balls and next in standing on the unstable ground (sensorimotor pads, mattresses with various softness, or platform for balance exercises) with both feet and then standing on one leg. Gait exercises were started after reaching the range of motion of 70° (ca. 2 weeks after mobilization started). Similar to the procedure following the PCL reconstruction, the focus was on gait symmetry and balance elements were added. Exercises of muscle force in closed kinematic chains were performed in the range of 0–60° excluding co-contraction of the hamstring muscles (half-squats with body forward inclination). In the 12th week, range of motion was 120°. After 12th week, new ligaments showed greater mechanical resistance [16], which allowed for introduction of muscle strength

exercises with greater intensity: squats with load, mini-squats on one leg, and exercises with a stair stepper. Range of motion for the exercises in closed kinematic chain was 0–90°. In the open kinematic chain, the flexion movements were initially performed at 20–60°, whereas extension was 90–70° (the range was increased to 90–30° after ca. 4 months). No extension exercises were used in the range of motion of 30–0°, which leads to excessive tension of the graft [17]. Endurance training was also introduced (stair stepper, cycle ergometer) and components of proprioception

**3.2 Subjective assessment of the effects of rehabilitation (Lysholm i IKDC** 

The patient was asked to evaluate the functioning of the knee joint twice: immediately after the completion of the fourth stage of rehabilitation (study 1) and then after 18 months (study 2). Two scales were used for the assessment: the knee joint assessment scale according to Lysholm and the IKDC 2000 knee assessment questionnaire (The International Knee Documentation Committee 2000). Both contain information about knee joint ailments and their impact on the functioning

The Lysholm scale contains eight points concerning pain and activity. In each point, the examined person is supposed to choose and check one of the statements which matches his or her pain or functions, each answer is a specific number of points. Maximal total score is 100 points, which means the highest subjective functional status possible (perfect level–over 90 points). The following functional levels are good: 84–90 points, satisfactory: 65–83 points and insufficient: below 65 points) [18].

The IKDC 2000 subjective knee evaluation form is composed of three blocks, which concern: pain, physical activity, and function during activity of daily living (ADL). Similar to filling the Lysholm form, the patient is expected to choose and check one of the statements that matches his or her complaints and abilities. For each answer, a certain number of points is assigned according to the principle that

training were extended by the components of various sports.

**2000 questionnaires)**

of the patient in daily life.

*3.2.1 Lysholm knee scoring scale*

*3.2.2 IKDC 2000 questionnaire*

**40**

The results of the questionnaires are presented in **Table 5**.

In the power tests, differences in peak power of quadriceps femoris muscle were found between the operated and nonoperated limbs. With the increasing load, the differences in power in knee extension were 32, 17, and 61% (**Table 6**). Examination of the power in the hamstrings also revealed smaller differences at lower levels of load between the legs. The use of maximal tolerable load of 30 kg confirmed greater difference in power at the level of 15% (**Table 6**). **Tables 6** and **7** include better result of the two attempts performed during the test.


**Table 5.** *The results of the questionnaires.*


#### **Table 6.**

*Quadriceps femoris power (knee extension).*


#### **Table 7.**

*Hamstring power (knee flexion).*

Analysis of the jump height using the right (operated) limb and the nonoperated limb revealed differences in rate of power development achieved in consecutive tests. The highest power was recorded for the operated limb during the first jump (19.5 cm; 70.6 W/s/kg), with power reducing for consecutive tests to 18.7 cm, (67.9 W/s/kg) and 16.3 cm (59 W/s/kg), respectively. During the examination of the healthy limb, the values obtained in the first and second tests were lower compared to the operated limb, with 16.5 (62.7 W/s/kg) and 17 cm (64 W/s/kg), respectively. The power similar to that of the operated limb was obtained only for the third attempt, with its value reaching 19.5 cm (74 W/s/kg).
