[Pain after anterior cruciate ligament reconstruction: detail and treatment]
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L Savalli1, M I Hernandez-Sendin, P L Puig
1Centre européen de rééducation du sportif, 83, avenue du Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France. laurent.savalli@wanadoo.fr
Objective:
Several factors can influence the occurrence of pain after anterior cruciate ligament (ACL) ligamentoplasty, namely, factors linked to the selection of graft, the surgical technique and rehabilitation program. The aim of this research was to review the literature for different types of pain experienced after ACL reconstruction to illuminate better prevention and treatment.
Method:
We reviewed reports by searching the PUBMED* research engine using the key words pain, complication, and anterior cruciate ligament.
Results:
We found an increasing incidence of anterior pain after use of the patellar tendon for ACL reconstruction. Some anterior pain can be mistakenly interpreted as donor site morbidity or patello-femoral problems, but it is in fact linked to graft impingement caused by bad placement of tunnels and/or proliferation of a fibrovascular nodule on the ACL graft ("cyclops syndrome"). Some posterior-external pain, sometimes associated, can occur under the same circumstances. Cartilage, ligament or meniscal lesions or saphenous nerve injuries can explain some occurrences of pain. Pain linked to loco-regional factors such as reflex sympathetic dystrophy appear to be rare with rehabilitation and surgery.
Conclusion:
The treatment of pain after ACL reconstruction lies first in the establishment of an etiologic diagnosis. Prevention, by controlling tendon-muscular and joint stress during rehabilitation, is essential and requires sound knowledge of biomechanical data.
