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{"id":240,"date":"2018-06-29T05:48:25","date_gmt":"2018-06-29T05:48:25","guid":{"rendered":"https:\/\/www.dr-antoinecombes.com\/?page_id=240"},"modified":"2018-07-02T21:29:29","modified_gmt":"2018-07-02T21:29:29","slug":"reeducation-apres-une-chirurgie-stabilisatrice-de-la-rotule","status":"publish","type":"page","link":"https:\/\/www.dr-antoinecombes.com\/reeducation\/reeducation-apres-une-chirurgie-stabilisatrice-de-la-rotule\/","title":{"rendered":"R\u00e9\u00e9ducation apr\u00e8s une chirurgie stabilisatrice de la rotule"},"content":{"rendered":"
\n\t<\/h1>\n
\t\t\t\t<\/p>\n
Voici les recommandations habituelles pour votre r\u00e9\u00e9ducation.<\/p>\n
Elles peuvent changer en fonction de la chirurgie r\u00e9alis\u00e9e, et doivent \u00eatre confirm\u00e9es par le chirurgien. <\/p>\n
Votre kin\u00e9sith\u00e9rapeute saura vous guider, mais il est important que vous consacriez du temps \u00e0 votre r\u00e9\u00e9ducation entre vos s\u00e9ances avec lui, afin d\u2019optimiser le r\u00e9sultat de la chirurgie.<\/p>\n
\t\t\t\t<\/p>\n
\n\t\tPrincipe g\u00e9n\u00e9ral \n\t<\/h2>\n
La chirurgie stabilisatrice de rotule inclus g\u00e9n\u00e9ralement un geste osseux d\u2019ost\u00e9otomie de l\u2019insertion du tendon rotulien sur le tibia et un geste de reconstruction ligamentaire.<\/p>\n
La r\u00e9\u00e9ducation comprend 2 temps\u00a0: une phase de 6 semaines ou la flexion est limit\u00e9e \u00e0 90\u00b0, l\u2019appui est prot\u00e9g\u00e9 par 2 cannes et le port d\u2019une attelle est obligatoire \u00e0 la marche afin de ne pas d\u00e9placer la zone d\u2019ost\u00e9otomie. <\/p>\n
Une deuxi\u00e8me phase ou l\u2019attelle et les cannes sont retir\u00e9es et la flexion n\u2019est plus limit\u00e9e.<\/p>\n
\n\t\tMOBILISATION DU GENOU \n\t<\/h2>\n
Habituellement, la r\u00e9cup\u00e9ration des mobilit\u00e9s est facile. Cependant il ne faut pas oublier de mobiliser le genou afin d\u2019\u00e9viter l\u2019installation d\u2019une raideur, qui est toujours difficile \u00e0 r\u00e9cup\u00e9rer par la suite.<\/p>\n
Les 6 premi\u00e8res semaines, elle se fait uniquement en passif (pas de contraction musculaire autour du genou). Le travail passif n\u00e9cessite un rel\u00e2chement musculaire complet. <\/p>\n
Cela n\u00e9cessite l\u2019aide du kin\u00e9sith\u00e9rapeute. Il convient de remettre l\u2019attelle de chaque\u00a0 lever.<\/p>\n
\n\t\tEXTENSION \n\t<\/h2>\n
Au lit<\/strong><\/p>\n
Passif\u00a0: laissez l\u2019arri\u00e8re du genou toucher le plan du lit. Le gros orteil regarde vers le ciel. Attention \u00e0 la position genou fl\u00e9chi sur le cot\u00e9 qui permet au genou de toucher le plan du lit sans travailler l\u2019extension. <\/p>\n
Actif\u00a0: contraction flash pour \u00e9craser votre main sous votre genou.<\/p>\n
Sur une chaise\u00a0:<\/strong> posez votre pied sur un tabouret ou une autre chaise.<\/p>\n
\n\t\tLA FLEXION \n\t<\/h2>\n
Elle ne devra pas d\u00e9passer 90\u00b0 les 6 premi\u00e8res semaines\u00a0: <\/h4>\n
Au bord du lit,<\/strong> assis de mani\u00e8re sym\u00e9trique, laissez tomber votre jambe \u00e0 la verticale, le pied restant libre.<\/p>\n
Sur une chaise,<\/strong> les fesses bien pos\u00e9es, la jambe non op\u00e9r\u00e9e poussera sur la jambe op\u00e9r\u00e9e afin d\u2019augmenter la flexion.<\/p>\n
Sur un lit,<\/strong> une tierce personne pourra mobiliser doucement votre genou en flexion<\/p>\n
<\/p>\n
A partir de 6 semaines<\/h4>\n
Flexion autoris\u00e9e au del\u00e0 de 90\u00b0<\/p>\n
Le gain de flexion maximale (\u00e9tirement des ischiojambiers) est possible vers 3 mois.<\/p>\n
Debout en ramenant la jambe sur la cuisse.<\/p>\n
Allong\u00e9 sur le ventre, en ramenant la jambe sur la cuisse.<\/p>\n
\n\t\tLE RODAGE ARTICULAIRE \n\t<\/h2>\n
Sur une chaise,<\/strong> \u00e0 l\u2019aide d\u2019une planche \u00e0 roulette, faites des mouvements de va et vient.<\/p>\n
Apr\u00e8s 6 semaines, sur un v\u00e9lo,<\/strong> au d\u00e9but moulinage sans r\u00e9sistance. Puis augmentation progressive.<\/p>\n
\n\t\tLA MARCHE \n\t<\/h2>\n
La marche est autoris\u00e9e avec un appui doux \u00e0 l\u2019aide de cannes et d\u2019une attelle pendant 6 semaines, puis sans canne et sans attelle.<\/p>\n
\n\t\tLES ESCALIERS \n\t<\/h2>\n
Retrouver une marche fluide dans les escaliers n\u2019est pas toujours \u00e9vident. Aidez-vous de la balustrade, le travail d\u2019\u00e9tirement au 3\u00e8me mois sera d\u2019une grande importance.<\/p>\n
\n\t\tLE RENFORCEMENT MUSCULAIRE \n\t<\/h2>\n
Les exercices de renforcement doivent \u00eatre peu douloureux.<\/p>\n
Voici quelques exercices<\/h3>\n
Verrouillage\u00a0 de la cuisse\u00a0:<\/strong> Sur le lit et sur le dos,\u00a0 levez la jambe, r\u00e9p\u00e9tez l\u2019effort une dizaine de fois. C\u2019est le seul exercice musculaire autoris\u00e9 les 6 premi\u00e8res semaines.<\/p>\n
Rodage articulaire sur un v\u00e9lo<\/strong> en augmentant la puissance \u00e0 partir de la 6\u00e8me semaine.<\/p>\n