Jordan Amavi

Thinman wrote:

Villa_Dan wrote:

Thinman wrote:Can't see him playing again for us, certainly not in the PL. will take him ages to get back his pace, if ever.

He may be ok in the Championship if we go down.

What an absolutely ridiculous statement! How do you know this?

Of course I don't KNOW this, it's just an opinion based on many years of observing players who have returned after similar serious knee injuries. Remember Stephen Froggatt?

What are Amavi's strengths? Pace and the ability to put in a decent cross once in a while. Take away the pace and you are left with a very average player. I certainly hope I'm wrong for the lads sake, but it doesn't look good for him, or us.

I'll counter your argument with the following players who've all badly injured their ACLs:

Walcott
Shearer
Owen
Van Nistlrooy
Pires (at Arsenal)
Arteta 

Cruciate injuries can be very bad. But it's impossible to judge how he'd fair on his return. Absolutely impossible.

For those who are interested in the structured rehab for ACL repair.

POSTOPERATIVE REHABILITATION PROTOCOL FOLLOWING ACL RECONSTRUCTION
Leo Pinczewski, Justin Roe, Lucy Salmon & Emma Fitzgibbon, NSOSMC.
Mater Clinic, Suite G02, 3 Gillies Street Wollstonecraft NSW 2065. Australia. Tel 02 9437 5999.
www.leopinczewski.com.au
Updated September 2015
1
RATIONALE OF REHABILITATION
Based upon the following assumptions:
The ACL graft is merely a scaffold which the human body will use to remodel into a ligament in a biological process that takes in excess of 12 months.
Accompanying the “ligamentization” process are significant other deficiencies such as weakness, impaired proprioception, impaired muscular function,
impaired neuromuscular control.
Prehabilitation
 Only operate on pain-free mobile joints – minimizes complications
 May take weeks or months
 Prehabilitation advantages the patient but preparing a pain free joint with full ROM and optimal strength
 Patients are better able to manage postoperative exercises if they have learnt them before surgery
Stage 1 - Acute Post op - 0 -14 days
 ACL sees minimal force in ADL and closed chain exercises
 Surgery has placed the ACL graft in the functionally anatomic position
 Immediate weight bearing 1 RCT
 pf pain, VMO strength and does not laxity (Tyler Clin Orth, 1998)
 CPM offers no advantage 6 RCT
 Rehab must respect fixation choice
 Chosen fixation allows for immediate mobilisation
 Graft tissue is probably never stronger than the day it is implanted
Stage 2 - Muscular control - 2-6 weeks
 In a anatomically correct position the ACL graft will allow a full ROM without excessive loading
 EMG biofeedback is beneficial 1 RCT
 quads strength at 3 months, earlier full extension (Draper 1990)
 Bracing offers no advantage 11 RCT
 No difference injuries, pain, laxity, ROM at 6 wks
Stage 3 - Proprioception - 6 -12 weeks
 Laxity should not be assessed until full ROM
 The prime determinant of laxity is graft position
 Fixation improves with time
 HT graft ST to bone healing in 8-12 weeks
 Open Chain Exercises 5 RCT
 Early open chain =  laxity +  pf pain (Bynum, 1995)
 Closed chain 6 weeks then open chain =  quads, return to sport, = laxity (Mikkelsen, 2000)
 Start 40-900 progress to 10-900 over 6 weeks
 Beware highly increased pf forces, desist if patellofemoral symptoms develop
 Deficits in hip and postural control have been found to be strong predictors of further ACL graft rupture (Paterno AJSM 2010)
Stage 4 – Neuromuscular and Sport Specific - 3 - 5 months
 Graft maturation continuing
 Proprioceptive recovery vital and takes time and practice and practice and practice
 For jumpers practice good landing technique
  knee flexion, valgus rotation and toe land
 Neuromuscular training improves subjective function and hamstring strength compared to strength training alone (Risberg AJSM 2009)
Stage 5 –Prepare for return to sport - 6 -12 months
 Normal graft strength and stiffness 8 months, gross histology graft remodelled by 12 months but maturation of the ultra-structure continues >
than 3 years
 Compliance with a sport specific neuromuscular training (eg PEP) reduces primary ACL injuries and repeat ACL injuries (Gilchrist AJSM 2008)
 Warm up with strengthening, plyometrics, agility drills
 PEP program RCT 1435 female soccer (Gilchrist AJSM 2008)
  non contact ACL injury by 70% & if prior ACL injury -  non contact ACL injury by 5x
 Joint injury results in impaired muscle function for at least 18 months
 Slower muscle reaction times
 Altered muscle recruitment order patterns and spinal reflexes (Wojtys 2000) in 25 ACL rec vs 40 normal
Stage 6 – Return to Sports
 Knee normal = Which knee? Approx 18 months coincides with muscular function
 Rate of another ACL injury > 12 months is 1% per knee per year (equal graft and opposite ACL) (Salmon Arthroscopy, 2005, Bourke AJSM
2012)
 Neuromuscular programmes as warm before ball sports are beneficial in reducing odds of further ACL injuries (eg PEP, FIFA Mark 11)
POSTOPERATIVE REHABILITATION PROTOCOL FOLLOWING ACL RECONSTRUCTION
Leo Pinczewski, Justin Roe, Lucy Salmon & Emma Fitzgibbon, NSOSMC.
Mater Clinic, Suite G02, 3 Gillies Street Wollstonecraft NSW 2065. Australia. Tel 02 9437 5999.
www.leopinczewski.com.au
Updated September 2015
2
STAGE AIMS GOALS TREATMENT GUIDELINES
Prehabilitation  Prepare the
patient for
surgery
 Full ROM
 Painfree mobile joint
 Teach simple post
op exercises
 Operate on pain free mobile joints – minimizes complications and speeds recovery
 May take many months
 Do not be pressured by patient into early surgery.
 Preprogramming post operative rehabilitation is beneficial at every level
 Patients are better able to manage postoperative exercises if they have learnt them
before surgery
Stage I
Acute
Recovery
Day 1 to Day
10-14
 Postoperative
pain relief
and
management
of soft tissue
trauma.
 Progress off
crutches and
normal gait.
 Wound healing.
 Manage the graft
donor site morbidity,
i.e. pain and
swelling.
 Decrease joint
swelling.
 Restore full
extension (including
hyperextension)
 Establish muscle
control.
 Decrease swelling & pain with ice, elevation, co-contractions and pressure pump. No
use of tubigrip around the knee joint region.
 Full weight bearing as pain allows.
 Aim for a full range of motion using active and passive techniques.
 Patella mobilisations to maintain patella mobility.
 Gait retraining with full extension at heel strike.
 Return of co-ordinated muscle function encouraged with biofeedback. Active
quadriceps strengthening is begun as a static co-contraction with hamstrings
emphasising VMO control at various angles of knee flexion and progressed into
weight bearing positions.
 Commence use of an exercise bike after day 3 postop.
 Gentle hamstring stretching to minimise adhesions.
 Active hamstring strengthening begins with static weight bearing co-contractions and
progresses to active free hamstring contractions by day 14.
 Resisted hamstring strengthening should be avoided for at least 6-8 weeks.
Stage II
Hamstring And
Quadriceps
Control
2-6 Weeks
 To return
the patient
to normal
function.
 Prepare the
patient for
Stage III.
 Develop good
muscle control and
early proprioceptive
skills.
 If not done sooner,
restore a normal
gait.
 Reduce any
persistent or
recurrent effusion.
 Progress co-contractions for muscle control by increasing the repetitions, length of
contraction and more dynamic positions, e.g. two leg quarter squats, lunges,
stepping, elastic cords.
 Gym equipment can be introduced gradually such as stepper, leg press, mini
trampoline, cross trainer.
 If swelling is persistent, continue with pressure pump and ice
 Hamstring strengthening progresses with the increased complexity and repetitions of
co-contractions. Open chain hamstring exercises are commenced although often
they are painful.
 Care must be taken as hamstring straining may occur
 Low resistance, high repetition weights aim to increase hamstring endurance.
 Continue with intensive stretching exercises.
Week 6:
 Eccentric hamstring strengthening is progressed as pain allows. Hamstring curl
equipment can be introduced.
 Consider beyond the knee joint for any deficits, e.g. gluteal control, tight hamstrings,
ITB, gastrocs and soleus, etc.
Stage III
Proprioception
6-12 weeks
 Improve
neuromuscular
control and
proprioception
 Continue to improve
total leg strength.
 Improve endurance
capacity of muscles.
 Improve confidence.
 Progress co-contractions to more dynamic movements, e.g. step lunges, half squats.
 Proprioceptive work more dynamic, e.g. lateral stepping, slide board etc.
 Can begin jogging in straight lines on the flat.
 Progress resistance on gym equipment such as leg press and hamstring curls.
Hamstring strengthening programme aims for a progression in both power and
speed of contraction.
 Start cycling on normal bicycle.
 Consider pelvic and ankle control plus cardiovascular fitness.
 Solo sports such as cycling, jogging and swimming are usually permitted with little or
no restrictions during this stage.
 Open chain exercises commence (if no patellofemoral symptoms) 40-900 progressing
to 10-900 by 12 weeks
POSTOPERATIVE REHABILITATION PROTOCOL FOLLOWING ACL RECONSTRUCTION
Leo Pinczewski, Justin Roe, Lucy Salmon & Emma Fitzgibbon, NSOSMC.
Mater Clinic, Suite G02, 3 Gillies Street Wollstonecraft NSW 2065. Australia. Tel 02 9437 5999.
www.leopinczewski.com.au
Updated September 2015
3
STAGE AIMS GOALS TREATMENT GUIDELINES
Stage IV
Neuromuscular
12 Weeks To 5
Months
 Sport
Specific
perparation
 Incorporate more
sport specific
activities.
 Introduce agility and
reaction time into
proprioceptive work.
 Increase total leg
strength.
 Develop patient
confidence.
 Progressing of strength work, e.g. half squats with resistance, leg press & curls, wall
squats, step work on progressively higher steps, stepper & rowing machine.
 Proprioceptive work should include hopping and jumping activities and emphasise a
good landing technique. Incorporate lateral movements.
 Agility work may include shuttle runs, ball skills, sideways running, skipping, etc.
 Low impact and step aerobics classes help with proprioception and confidence.
 Pool work can include using flippers.
 Sport specific activities will vary for the individual, e.g. Tennis - lateral step lunges,
forward and backwards running drills: Skiing - slide board, lateral box stepping and
jumping, zigzag hopping; Volleyball or Basketball - vertical jumps.
 Commence PEP programme and progress as able (see Stage V for detail)
 For jumpers practice good landing technique
  knee flexion, valgus rotation and toe land
 Emphasize gluteal maximus strengthening which is strong hip extender and external
rotator while in a flexed hip posture
Stage V
Sport Specific
6-12 Months
Restoration of
strength and
neuromuscular
function
 Improve confidence
and skill level
 Return to training
 Continue progression of plyometrics and sport specific drills.
 Return to training and participating in skill exercises.
 Continue to improve power and endurance.
 Train in neuromuscular program for warm up to reduce further ACL injury
 Good examples are FIFA and PEP (shown below)
1.Warm-up (50 yards each):
 Jog line to line of soccer field (cone to cone)
 Shuttle run (side to side)
 Backward running
2. Stretching (30 s × 2 reps each):
 Calf stretch
 Quadriceps stretch
 Figure 4 hamstring stretch
 Inner thigh stretch
 Hip flexor stretch
3. Strengthening:
 Walking lunges (20 yards × 2 sets)
 Russian hamstring (3 sets × 10 reps)
 Single toe-raises (30 reps on each side)
4. Plyometrics (20 reps each):
 Lateral hops over 2 to 6 inch cone
 Forward/backward hops over 2 to 6 inch cone
 Single leg hops over 2 to 6 inch cone
 Vertical jumps with headers
 Scissors jump
5. Agilities:
 Shuttle run with forward/backward running (40 yards)
 Diagonal runs (40 yards)
 Bounding run (45–50 yards)
Ref: Gilchrist et al AJSM 2008
See you tube for excellent sample video of programme.
Stage VI
Return to
Sports
12+months
Safe return to
sports
 Minimise risk of
further injury
 By this stage should be adept at PEP program (or similar neuromuscular program).
 Neuromuscular warm up before training and playing
 Advice may be needed as to the need for modifications to be able to return to sport,
e.g. Football - start back training in running shoes or short sprigs. Will usually return
to lower grades initially; Skiing - stay on groomed slopes and avoid moguls and off
piste initially. Racers may initially lower their DIN setting on the bindings.
OUTLINE OF THE SURGICAL PROCEDURE
The knee joint is examined via the arthroscope. Meniscal surgery is performed as required and the ruptured ACL stumps are removed. Via a 2cm
incision on the anterior tibia the semitendinosus and gracilis hamstring tendons are harvested at about 20 cm up the medial thigh. The two tendons are
doubled over to create a 4 strand graft and sutured together at both ends. The tunnels for the graft are drilled through the tibia and femur and the
graft pulled into place in an anatomic position. The graft is secured with interference screws in both the femur and tibia. Full ROM is achieved prior to
final tibial fixation. The wounds are closed then closed. Braces are not used routinely postoperatively and patients may weight bear as tolerated
immediately after surgery. For the vast majority of patients this is a day surgery procedure.

Thought as much.
Amavi faces a tough battle to recover from this.

Good luck Jordan. I wish you nothing but the best

I hope his rehab isn't as long as Wendy's list :) x

Well! Just consider yourself better informed than you were before.

I'm flattered that you think I might be able to follow such an informed synopsis Wendy!

Has there been any news regarding how his surgery went?

Something's just occurred to me, for all his faults (probably from being constantly played out of position), Weimann worked his arse off for Villa and always looked like he gave a shit. It wound him up when he fucked up and he hated being subbed. Amavi is cut from the same mould and I can't think of anyone else who plays with any real passion. Kozak does, but I just don't see it from anyone else. Sure, we have a lot of new players but Amavi is also new but still managed to look like he wanted nothing else than to play for Villa as best he could.

I suspect this is down to a lot of factors, from lack of decent manager and results to an unhappy fan base and transient nature of footballers coming to the kind of feeder club we have to accept Villa has temporarily become. We need some passion and anger in our players. Remember how Stan looked like he wanted to punch himself when he fucked up.

I really think the loss of Amavi - and more importantly how we replace him - this season is going to be a huge factor in whether we stay up or not. In a season where we've struggled to score, in his 10 appearances he made two assists and he was a good defender, with potential to become an excellent one. We need to get in cover of some kind, whether it be Bennett coming back from loan or someone more permanent, because without someone a lot more defensive minded on the left side of a four-man midfield and Clark needing a strong LB to operate successfully, every opposition team is going to target our left side, especially with Richards and Hutton doing a good job on the right.

Damn right Foxy AV

Looking forward to seeing this young man realise his undoubted talent this year.

I hope your season is injury free Jordan, good luck.

If he's over his injury and if he stays with us then he'll absolutely tear this league to shreds.

Was back in training yesterday and Tweeted about it with #fightlikelions

Both Grealish and Gardner retweeted it. Nothing solid but hopefully signs that he might be hanging around

Love Amavi.

And im other news N'Zogbia is having a trial with Sunderland. Yes it's fine to laugh

I really like Amavi I hope he stays with us.

Joppe84 wrote:Love Amavi.

And im other news N'Zogbia is having a trial with Sunderland. Yes it's fine to laugh

There's an image doing the rounds of a Sunderland gym session. N'Zog is in the background doing fuck all.

ahahahahaha... That made my day. Awesome.

He's watching. Carefully. Someone has to do it in case something happens that needs to be seen.

I couldn't like Jordan Amavi anymore if I tried........

Some words from this legend   here

He sounds like a real decent guy reading that and so refreshing for him to pin his colours to the mast. Positive signs a plenty are emerging from the cinders!

Am liking first impressions of RDM too i have to say. I can see glimmers already of why Xia liked him. Judging by certain comments i've read regards his awareness of "details which matter" which under the Lerner years were obliviously ignored as nobody picked up on their importance, is refreshing and shows the intelligence level of the man.

I have hope back

I honestly think he is CL quality. Gonna wreck the Championship

JA seems like half the player he was since that injury, he appeared better in a worse team then he does now.

Somewhere in there is a World class LB and the addition of Taylor is a master stroke for me by Bruce, a solid pro who will put pressure on JA for that spot in the team.

I'd like Bruce to bring in an old mate solely to work with JA to help him be the player I'm sure he can be, so come on Brucie get on the blower to Dennis Irwin, bring him in for 3/6 months to help the defensive coaches work on that position alone.

If we're going to be playing 532, I find it strange that this guy isn't going to be first choice at left wing back, not sure if we could wish for a better option. But not only is he behind Taylor, a decent player but not renowned for his attacking abilities, but also behind Bjarnasson, who isn't even a full-back (or a wing-back).

Makes me wonder if there's perhaps already a deal in place to sell him in the summer, and he's not being used so as not to risk him getting injured.

deadbuzzardalive wrote:If we're going to be playing 532, I find it strange that this guy isn't going to be first choice at left wing back, not sure if we could wish for a better option. But not only is he behind Taylor, a decent player but not renowned for his attacking abilities, but also behind Bjarnasson, who isn't even a full-back (or a wing-back).

Makes me wonder if there's perhaps already a deal in place to sell him in the summer, and he's not being used so as not to risk him getting injured.

no mate i doubt it, he was dropped because his last few performances have been dreadful. it could be down to confidence, coming back from injury or just bad form either way he has been very poor.