**3. Material and methods**

*Sports, Health and Exercise Medicine*

stabilization observed at the extended knee.

(proprioception).

**2. Study aim**

reconstruction of knee ligaments.

Crucial ligaments protect the knee joint from excessive anterior-posterior translation. The posterior cruciate ligament (PCL) ensures the major force that resists the posterior drawer effect (95% of the force), whereas the anterior cruciate ligament (ACL) prevents the anterior drawer displacements and overextension of the leg in the knee joint [4]. The ligaments interweave with each other, thus limiting internal rotation of the knee. Another function of cruciate ligaments is also initiation of the correct sliding of the joint surfaces in the direction opposite to the rolling motion. Two collateral ligaments control joint displacements in the frontal plane: tibial collateral ligament, which prevents from the valgus movement, and fibular collateral ligament, preventing from the varus movement, with the most effective

Structural deformation and the related functional failure of the ligament typically lead to the development of joint instability, termed disturbed joint movement control. In the case of tearing an individual ligament, the instability pattern is simple (e.g. tibial collateral ligament rupture: medial instability) or rotational (ACL rupture: anterior-medial-anterior-lateral instability). Knee dislocation with damage to all the stabilizing elements represents a complex instability: in addition to all the above types of instability, additional anterior-lateral-posterior-lateral instability

Conservative therapies and surgical interventions have been used in the treatment of cruciate ligament injuries. The conservative treatment is used in the case of partial ligament damage, without substantial symptoms of joint instability in people with low physical activity aged over 40 years of age, leading little active lifestyles [6]. In the case of acute injuries, conservative treatment is aimed to eliminate edema, joint hydrarthrosis, and pain syndromes, ensuring proper and painless joint mobility and adequate muscular tension and neuromuscular control

The surgical interventions are used in patients with positive results of functional

An integral part of the patient treatment process is preoperative and postoperative rehabilitation. The procedures before the surgery are mainly aimed to obtain the range of joint motion needed for the reconstruction, prevent muscle atrophy, increase muscle strength, and improve proprioception. Early postoperative rehabilitation accelerates recovery and is usually started a day after the surgery. This procedure impacts significantly on reducing the time of patient's regaining full health [7, 8].

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

tests for evaluation of anterior cruciate ligament, such as the Lachman test, the anterior drawer test, and the pivot-shift test with coexistence of subjective symptoms of instability reported by patients during the interview, such as knee giving way. In young patients, especially those who are involved in sports, the sufficient indication for the surgery is ligament rupture diagnosed during a diagnostic exami-

nation using magnetic resonance (MR) or ultrasonography examinations.

and anterior-medial-posterior-medial instability are also observed [5].

**34**

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.
