Rehabilitation following a minimally invasive procedure for the repair of a combined anterior cruciate and posterior cruciate ligament partial rupture in a 15-year-old athlete.
METHODS
Case report.


BACKGROUND
The healing response procedure is a minimally invasive arthroscopic surgical technique used to stimulate healing in the treatment of partial cruciate ligament tears. The purpose of this report is to provide information on the surgical procedure, the postoperative rehabilitation, and the overall functional results in a patient who underwent such a procedure.


METHODS
A 15-year-old male, who sustained a partial tear of both the anterior cruciate and posterior cruciate ligament while playing football, underwent arthroscopic surgical management utilizing a healing response technique. Precautions concerning range of motion and resisted activities were followed postoperatively to protect the healing cruciate ligaments. The postoperative protocol consisted of 3 phases, culminating in return-to-sport training. Treatment incorporated cardiovascular, proprioceptive, strength, power, plyometric, and sport-specific activities. Treatment was progressed based on specific criteria emphasizing proper movement patterns and eccentric control during functional activities.


RESULTS
The patient attended 31 physical therapy sessions over 17 weeks. Strength improved from 3/5 to 5/5, knee range of motion returned to normal, Lower Extremity Functional Scale scores improved from 21/80 to 80/80, and successful outcomes on functional return-to-sport testing allowed the patient to return to competitive athletics.


CONCLUSIONS
Primary repair of cruciate ligament tears has yielded poor results, and partial cruciate ligament tears may not require complete surgical reconstruction. The healing response technique offers a possible solution for the treatment of partial cruciate ligament tears. A criterion-based postoperative protocol was derived based on current evidence regarding rehabilitation following cruciate ligament reconstruction and evidence regarding lower extremity rehabilitation principles and injury prevention.


METHODS
Therapy, level 4.
Beecher
Michael
M
Sports Physical Therapist, Performance Physical Therapy, Cos Cob, CT,USA. m-beecher@alumni.sacredheart.edu.
Garrison
J Craig
JC
Wyland
Douglas
D
D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D005081:Exercise Therapy; D005538:Football / Q000293:injuries*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000534:rehabilitation*; D010147:Pain Measurement; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D016059:Range of Motion, Articular; D012421:Rupture / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing