N001 – PRM follow up after ACL reconstruction

Accredited in September 2010


Dr Georges de Korvin
Centre Hospitalier Privé Saint-Grégoire
Board certification: 2007

Full description (pdf file)


The knee cruciate ligament reconstruction is discussed and performed in the perspective a functional goal: restoring a stable knee, which is necessary to let the patient resuming a series of daily, professional and sports activities. But the ligament replacement is not sufficient to reach this goal. The overall success of the procedure is also based on a safe and steady functional progression of the patient.

Since 1998, two similar PRM programmes of care have been run in Nantes and in Rennes, in order to follow up outpatients after ACL reconstruction. Their general goal is to optimize the post-surgical recovery in community conditions, for all patients after ACL reconstruction. This means:

  • To detect and to manage, as early as possible, any complication or mismanagement of the operated knee.
  • To supervise the rehabilitation process, i.e. to give advices to the physiotherapist and to coach the patient’s self training.
  • To assess the patient’s functional progress in terms of pain and swelling decrease, passive stability, range of motion and muscle strength, until we decide that he/she has met the conditions for resuming pivot activities with reasonable safety.

The rehabilitation procedure has been divided into three main phase:

  • Rehabilitation to daily activities, from D8 to D60.
  • Progressive effort training, from D60 to D 120
  • Training to sports resumption, D120 to D360.

For main PRM assessments are scheduled during this process, 3 weeks, 2 months, 3-4 months and 6-8 months after surgery. An isokinetic dynamometer assessment is usually performed within the third and the fourth assessment and a joint examination with the surgeon is commonly organized at M3 or M4.

This programme has obviously been appreciated by patients and surgeon partners, whose number has increased from one to four. Complications, such as regional pain have dramatically decreased and the physiotherapists’ habits have been harmonized and improved in our area.

Isokinetic dynamometric assessment has proved to be a powerful mean to improve the level of muscle strengthening and the commitment of patients to their self training. Outdoor cycling has appeared to be the most efficient exercise to reach the basic functional level required to resume easy running and sports activities with pivot strains.

Our programme in Rennes, together with Dr Bertrand Rousseau’s similar programme in Nantes, has obtained a National recognition, becoming the basis for funding negotiations between the French PRM Union (SYFMER) and the National Health Insurance and for professional practice recommendations issued by the French PRM Society (SOFMER)

The programme fits the European accreditation standards.
The author is invited to update references and assessment in the future.