The document outlines a case study on the rehabilitation of a 25-year-old professional female basketball player following ACL reconstruction using a patellar tendon graft. It details functional assessment tests, rehabilitation exercises, and a timeline for recovery focusing on restoring strength and preventing performance deficits. The rehabilitation incorporates various methods including hydrokinesis, dynamic exercises, and progressive difficulty levels to enhance movement and address specific muscle issues.

1. Movement Therapy in
Orthopaedic Rehabilitation
2nd year Internship
Rome

2. Exam Case Study
Woman, 25 years of age, professional basketball player: height 180 cm,
weight: 70 kg, 2 months after ACL reconstruction from patellar tendon;
proposing functional assessment tests and rehabilitation exercises for
movement.

3. Anthropometrics (general informations)
• Female
• 25 Years old
• BMI = 70 / 1.8 * 1.8 = 19
• professional basketball player
• ACL Reconstruction from patellar tendon

4. ACL Reconstruction: Patellar vs Harmstring
Surgery
• The patients with HT graft had
• lower hamstring muscle power
• lower hamstring to quadriceps ratio in their injured leg
than the patients with PT graft. (Eva Ageberg Æ Harald P. Roos et Al.)
• The hamstring muscles play a major role in preventing or decreasing
anterior and rotatory displacement of the tibia relative to the femur

5. Return to Performance
Purpose: To prevent quadriceps femoris weakness. Deficit in QF > 15%
negetively affects performance.
Factors influencing RTP (Sue D. Barber-Westin et Al.)
• Muscle strength
• General knee examination
• Dynamic function
• Stability

6. Time-line in Orthopaedic Rehabilitation
Preoperative: injuried leg strenghtening in QF
Post operative - Early (2 up to 4 weeks)
 -Intermediate (4 up to 10 weeks) 
-Late (2-3 months)

7. Functional Assessment Tests in 2nd month after
surgery
• ACL laxity:Arthometers (GNRB) More than 6mm indicates laxity.
• ROM: Goniometer
• Function and Performance: Strenght Testing MIVC (Maximal
Isometric Voluntary Contraction)
-Vertical Jump
-Pivot Shift Test
-H/Q Ratio (2:1 ?)
-Hop Test and 3Hop Test

8. The Re-Education pattern
• The exercises performed by the subjects are organized with gradual
difficulty: the first aim is to enhance body’s perception, especially in
the operated limb. At the very begin, we train just the operated leg,
to avoid compensation patterns.
• The re-education starts form the walk-and-run analysis. If necessary,
electrical stimulation is useful too.
• Starting walk or run onwards and backwards. After lateral and
direction’s changes, accelerations and pliometry.

9. The Ball
Generally, during the protocol the subjects use a ball as facilitator. The
purpose of the ball usage during the re-athletization period is to
motivate more the subjects, providing them with aims during the
training. Moreover, the usage of the ball is useful to define a difference
in pain’s intensity: in fact, if subjects report light complaint - maybe
due to psychological causes - using the ball their attention get focused
on some other sensations.

10. Rehabilitation Exercises for Movement
• hydrokinesis were implemented. Exercises in water involved cycling,
walking, and stepping movements.
• Open and Closed Kinetic Chain exercises. Sets3x10 reps
• Step ups and down
• Calf raises
• Lunges with weight
• Squat in device

11. Rehabilitation Exercises for Movement
• Medium running squatting-stop and lateral shift, adding forwards and
backwards changes in directions.
• Shooting the ball suddenly after receiving
• Zig-zag leading the ball
• Pliometric exercises and trampoline
• Core stability (Plank 3x40 sec, rec. 10sec)
• To enforce the Harmstring in static stances (Z 3x15 sec, rec.10 sec; H curl)
• Open Kinetic Chain Exerciese (Leg extension:15kg, 3x60 sec, 15sec rec.)
• Overall stretching

12. References
• Objective evaluation of anterior knee laxity; comparison of the KT-1000 and GNRBarthrometers, Michel Collette • Julie Courville • Marc
Forton • Bertrand Gagnie`re, Knee surg Sport Traumatol Arthrosc, 2011.
• Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons
graft: a cross-sectional comparison 3 years post surgery, Eva Ageberg Æ Harald P. Roos Æ Karin Gra¨vare Silbernagel Æ Roland Thomee´ Æ
Ewa M. Roos, Knee Surg Sports Traumatol Arthrosc (2009) 17:162–169
• Proprioception of the Knee Before and After Anterior Cruciate Ligament Reconstruction; Bruce Reider, M.D., Michel A. Arcand
• A Comprehensive Rehabilitation Program With Quadriceps Strengthening in Closed Versus Open Kinetic Chain Exercise in Patients With
Anterior Cruciate Ligament Deficiency; Sofi Tagesson,*† RPT, Birgitta Öberg,† RPT, PhD, Lars Good,‡ MD, PhD, and Joanna Kvist,† RPT, PhD;
AJSM PreView, published on October 16, 2007.