{"id":1436,"date":"2025-01-02T22:56:27","date_gmt":"2025-01-02T21:56:27","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=1436"},"modified":"2025-03-02T19:45:09","modified_gmt":"2025-03-02T18:45:09","slug":"ligament-croise-anterieur-lca","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=1436","title":{"rendered":"Ligament crois\u00e9 ant\u00e9rieur (LCA)"},"content":{"rendered":"\n<p>Les tests<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Tests de Lachman<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Test de Lachman [Genou \/ Ligament crois\u00e9 ant\u00e9rieur]\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/zJAhvxP7XOc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Pivot shift test<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Pivot shift test knee\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/zu9GggiSHgQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Test de Lelli<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"The Lever Sign or Lelli&#039;s Test | Anterior Cruciate Ligament Rupture\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/T9ujIYIctdw?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Test du tiroir ant\u00e9rieur<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Anterior Drawer Test | Anterior Cruciate Ligament Rupture\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/IdnBKv38EEQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h2 id=\"quantification-de-la-laxite-du-ligament-en-cas-de-rupture-patielle-gnrb-le-plus-fiable-ou-telos\" class=\"wp-block-heading\">Quantification de la laxit\u00e9 du ligament en cas de rupture patielle : GNRB (le plus fiable) ou Telos<\/h2>\n\n\n\n<p>Diagnostic LCA<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ATCD, sexe, sport<\/li>\n\n\n\n<li>M\u00e9canismes sp\u00e9cifiques au sport, sensation de craquement, instabilit\u00e9, gonflement, douleur r\u00e9cente<\/li>\n\n\n\n<li>Lachman, Pivot shift, tiroir ant, IRM, tests fonctionnels&nbsp;?<\/li>\n\n\n\n<li>Arthrom\u00e9trie, IRM fonctionnelle, chirurgie<\/li>\n<\/ul>\n\n\n\n<p>Traitement conservateur vs traitement chirurgical&nbsp;: pas de diff\u00e9rence<\/p>\n\n\n\n<p>R\u00e9\u00e9ducation pr\u00e9 op\u00e9ratoire&nbsp;: programme de 5 semaines d\u2019entrainement<\/p>\n\n\n\n<p>D\u00e9faut de force quadri, d\u2019extension&nbsp;: facteurs pr\u00e9dictifs de mauvaise r\u00e9cup\u00e9ration<\/p>\n\n\n\n<p>R\u00e9\u00e9ducation&nbsp;: les grandes lignes<\/p>\n\n\n\n<p>Programme de 19s (pareil que 32 s)<\/p>\n\n\n\n<p>Avoir un programme et un suivi<\/p>\n\n\n\n<p>Phase 1&nbsp;: limiter gonflement, extension 0\u00b0, contraction volontaire quadriceps, pattern de mouvement dynamique<br>Phase 1 post op&nbsp;: flexion 120-130\u00b0, extension 0\u00b0, gain de force, travail neuromusculaire (planche destabilisation), activit\u00e9 fonctionnelle (marche, v\u00e9lo)<\/p>\n\n\n\n<p>AMI<\/p>\n\n\n\n<p>L\u00e9sion du ligament&nbsp;: inflammation (flexion r\u00e9flexe), gonflement (augmentation de l\u2019inhibition), laxit\u00e9, l\u00e9sion des r\u00e9cepteurs (dysfonction boucle gamma qui change la longueur du muscle pour une r\u00e9ponse appropri\u00e9e) -&gt; diminution de l\u2019excitabilit\u00e9 du quadriceps -&gt; AMI<\/p>\n\n\n\n<p>Etude pilote&nbsp;: fatiguer les IJ pour mieux recruter le quadriceps<\/p>\n\n\n\n<p>Post op imm\u00e9diat<br>&#8211; Mise en charge d\u00e8s les premiers jours<br>&#8211; Recrutement isom\u00e9trique quadriceps d\u00e8s s1<\/p>\n\n\n\n<p>Crit\u00e8res de validation&nbsp;: plaie ferm\u00e9e, pas de douleur au genou avec exo phase 1, gonflement miinimum, mobilit\u00e9 normale f\u00e9moro-pat, 0\u00b0 extension et 120\u00b0 flexion, contr\u00f4le volontaire quadriceps, marche sans boiterie et sans b\u00e9quille, qualit\u00e9 de mouvement bonne sur les exos<\/p>\n\n\n\n<p>R\u00e9orientation<\/p>\n\n\n\n<p>Si dans les jours qui suivent l\u2019op\u00e9ration&nbsp;: laxit\u00e9 anormale, signe de phl\u00e9bite, infection<\/p>\n\n\n\n<p>Vers 6-8s&nbsp;si progr\u00e8s insuffisants&nbsp;: d\u00e9faut d\u2019extension (syndrome du cyclope), d\u00e9faut mobilit\u00e9 patella&nbsp;: syndrome de Hoffa (contracture infra patellaire, retard sur les autres points de la r\u00e9\u00e9ducation<\/p>\n\n\n\n<p>Syndrome du cyclope&nbsp;: nodule fibreux sur l\u2019insertion tibial du crois\u00e9 ant -&gt; perte d\u2019extension -&gt; n\u00e9cessite chirurgie<\/p>\n\n\n\n<p>Syndrome de Hoffa&nbsp;: hyperplasie fibreuse au niveau du tendon infra patellaire -&gt; perte de flexion, perte d\u2019extension et abaissement de la patella irr\u00e9ductible. FDR&nbsp;: chirurgie pr\u00e9coce avec \u00e9panchement de genou et perte d\u2019amplitude pr\u00e9-op, mauvaise r\u00e9cup\u00e9ration des amplitudes en post-op imm\u00e9diat.<\/p>\n\n\n\n<p>Phase 2&nbsp;: accomplir des t\u00e2ches sportives sp\u00e9cifiques, r\u00e9ussir diff\u00e9rentes t\u00e2ches physiques sans compensation<\/p>\n\n\n\n<p>Mobilit\u00e9 compl\u00e8te, force (augmentation charge, difficult\u00e9), neuromusculaire (pliom\u00e9trie, plusieurs axe, impr\u00e9visibillit\u00e9), fonctionnelle (a\u00e9robie, course), sport sp\u00e9cifique<\/p>\n\n\n\n<p>Force quadriceps&nbsp;: une priorit\u00e9<\/p>\n\n\n\n<p>Obj&nbsp;: d\u00e9ficit inf\u00e9rieur \u00e0 20% sur LSI (Limb symetry Index)<\/p>\n\n\n\n<p>Evolution d\u2019exercice<br>Attention au squat&nbsp;: \u00e9viter l\u2019hyperflexion de hanche qui diminue l\u2019engagement du quadriceps<\/p>\n\n\n\n<p>Renforcement IJ<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit de force&nbsp;: facteur de r\u00e9cidive de LCA<\/li>\n\n\n\n<li>Risque de LMA surtout si greffe IJ<\/li>\n\n\n\n<li>R\u00e9g\u00e9n\u00e9ration du ST&nbsp;: 18m ou voire jamais<\/li>\n\n\n\n<li>Compensation importante du BF<\/li>\n<\/ul>\n\n\n\n<p>Autres groupes musculaires<br>&#8211; TS&nbsp;: limite la translation ant\u00e9rieure<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit \u00e0 8% \u00e0 6 mois chez le patient op\u00e9r\u00e9 du genou<\/li>\n\n\n\n<li>D\u00e9ficit de force dans les fessiers augmente risque de r\u00e9cidive (moment de force en abd genou augment\u00e9&nbsp;: + de contraintes sur les genoux)<\/li>\n<\/ul>\n\n\n\n<p>Les limites du LSI<\/p>\n\n\n\n<p>Attention \u00e0 la surestimation de capacit\u00e9 possible via le LSI<\/p>\n\n\n\n<p>Pour limiter ce biais&nbsp;: entrainement crois\u00e9, entrainer le membre CL de mani\u00e8re plus importante, comparaison avec les valeurs pr\u00e9-op (la jambe peut \u00eatre affaiblie en post-op)<\/p>\n\n\n\n<p>\u2022 LSI &gt; 90%: Certains se blesseront avec un score &gt; 90% , d\u2019autres ne se blesseront pas avec un score<\/p>\n\n\n\n<p>Pliom\u00e9trie<\/p>\n\n\n\n<p>D\u00e9ficit de force musculaire &gt;20%&nbsp;: retentissement sur les capacit\u00e9s pliom\u00e9triques<\/p>\n\n\n\n<p>Exos \u00e9volutifs&nbsp;: petite pliom\u00e9trie, r\u00e9ception longue, de plus en plus courte, peu d\u2019amplitude, s\u00e9rie courte, etc<\/p>\n\n\n\n<p>Reprise course \u00e0 pied<\/p>\n\n\n\n<p>Crit\u00e8re clinique, de force, de performance<\/p>\n\n\n\n<p>Monitoring&nbsp;: douleur, gonflement (p\u00e9rim\u00e8tre patella)<\/p>\n\n\n\n<p>Crit\u00e8res de validation 2<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Qualit\u00e9 de mouvement bonne sur les exercices<\/li>\n\n\n\n<li>LSI &gt; 80% quadri et IJ<\/li>\n\n\n\n<li>LSI &gt; 80% hop test<\/li>\n\n\n\n<li>Score global KOOS ou IKDC, questionnaire psychologique (ACL-RSI)<\/li>\n<\/ul>\n\n\n\n<p>Phase 3<\/p>\n\n\n\n<p>Mobilit\u00e9 compl\u00e8te, force (entra\u00eenement normal) pliom\u00e9trie, sollicitation interne et externe, fonctionnelle haute intensit\u00e9, t\u00e2che sp\u00e9cifique (travail sur situation)<\/p>\n\n\n\n<p>Prise en compte de la fatigue&nbsp;: quantifier la fatigue au temps d\u2019activit\u00e9 + mode de vie, facteurs cognitifs -&gt; Augmenter la r\u00e9sistance \u00e0 la fatigue<\/p>\n\n\n\n<p>Analyse biom\u00e9canique<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Se baser sur les r\u00e9ponses de l\u2019individu<\/li>\n\n\n\n<li>Aider l\u2019individu \u00e0 trouver et am\u00e9liorer ses propres strat\u00e9gies motrices<\/li>\n<\/ul>\n\n\n\n<p>Laisser l\u2019individu r\u00e9aliser une t\u00e2che sans consigne particuli\u00e8re, interpr\u00e9ter apr\u00e8s plusieurs r\u00e9p\u00e9titions.<\/p>\n\n\n\n<p>Adapter et varier l\u2019environnement, faire des tests de mouvements contr\u00f4l\u00e9s et impos\u00e9s<\/p>\n\n\n\n<p>Apprentissage moteur&nbsp;: focus interne et externe<\/p>\n\n\n\n<p>Focus externe&nbsp;:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Plus efficace que le focus interne pour le d\u00e9veloppement de la pr\u00e9cision technique du mouvement Benjaminse2015<\/li>\n\n\n\n<li>Plus efficace sur le d\u00e9veloppement des performances cardio vasculaire et le d\u00e9veloppement de la force Wulf2013<\/li>\n<\/ul>\n\n\n\n<p>Focus interne<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Concentration sur la contraction volontaire d\u2019un muscle<\/li>\n\n\n\n<li>Apprentissage implicite&nbsp;: analogie plut\u00f4t qu\u2019instructions explicites<\/li>\n\n\n\n<li>Apprentissage diff\u00e9renci\u00e9&nbsp;: varier les mvt intentionnellement (plus efficace que les gestes r\u00e9p\u00e9titifs)<\/li>\n<\/ul>\n\n\n\n<p>Retour au sport r\u00e9ussi<br>&#8211; Retour au niveau ant\u00e9rieur<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pas de r\u00e9cidive<\/li>\n<\/ul>\n\n\n\n<p>Autres crit\u00e8res<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>le temps<\/li>\n\n\n\n<li>psychologique<\/li>\n\n\n\n<li>stabilit\u00e9<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Les tests Tests de Lachman Pivot shift test Test de Lelli Test du tiroir ant\u00e9rieur Quantification de la laxit\u00e9 du ligament en cas de rupture patielle : GNRB (le plus fiable) ou Telos Diagnostic LCA&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=1436\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Ligament crois\u00e9 ant\u00e9rieur (LCA)\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[357],"tags":[],"class_list":["post-1436","post","type-post","status-publish","format-standard","hentry","category-pathologie-genou"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/1436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1436"}],"version-history":[{"count":10,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/1436\/revisions"}],"predecessor-version":[{"id":3814,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/1436\/revisions\/3814"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1436"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1436"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}