Multiple knee ligament injuries represent a significant traumatic event with an important functional prejudice which involves the injury of at least two of the four major ligaments of the knee. Management of such injury requires a thorough assessment and an interdisciplinary approach.The rehabilitation program will be constructed in accordance to the severity of the lesion and the patients expectations. The higher the goals and a more pronounced injury will results in a higher degree of involvement from the rehabilitation team. In case of cruciate ligament injury associated with a collateral ligament injury the rehabilitation program is based mostly on the same principles as for a cruciate ligament intervention, with the first phase of the rehabilitation protocol being governed by an early protection phase due to the fact that early weight-bearing is considered a risk for later instability of the knee and influence over the healing tissue, while the second phase of protocol is characterised by gait restoration and maintaning balance and coordination. Multiple ligament injuries often necessitate longer rehabilitation periods, regaining full activity level being estimated at around 1 year post surgery. The purpose of the paper is to analyse the optimal modality of constructing a rehabilitation program for multiple ligament injuries and whether a consensus regarding protocol and procedures can be obtained.

Shockwaves can be defi ned as transient pressure oscillations which propagate in three dimensions and offer an increased pressure in a very short period of time. Biological effects of shockwave therapy have been proven to stimulate the release of angiogenic growth factors, and contribute to the improvement of blood supply which leads to the repair of bone and soft tissue. The role of ESWT in the treatment of chronic calcifying tendinitis of the rotator cuff has been evaluated in many studies. ESWT has been gaining attention as an alternative option to surgical excision of calcifi cation or when other conservative options have not proven effi cient. The main purpose for using ESWT in heel spur is to increase the local blood supply by inducing neovascularisation. This action influences the inflammatory process and furthermore stimulates the local metabolism. Also, shockwaves have been proposed as a possible treatment in early phases of femoral head necrosis in adults. In case of patellar tendinopathy in vitro studies have shown biological effects, while clinical effects remain unclear. Data suggests that ESWT associated with other physical modalities achieve realiable clinical importance of pain reduction in lateral epycondylitis. However there is still a lack of standardisation and a consensus is needed regarding frequency and intensity.

Anterior cruciate ligament lessions represent one of the most frequently met injuries of the knee, with an increasing incidence depending on the statistics, most of them occuring in athletes or young adults[1-5]. The re-construction of the anterior cruciate ligament can be obtained by using different surgical procedures and varies according to the graft material that is used. The outcomes after ACL reconstruction is depended on both surgical and rehabilitation factors[6,7]. [...]

Metabolic Syndrome (MetS) represents a group of clinical and biological criteria that when combined can become a potential threat for the development of severe pathologies -diabetes mellitus, cardiovascular disease, obesity. The International Diabetes Federation(IDF) defines the presence of MetS when 3 or more of the following criteria are detected: 1.raised triglycerides ?150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality
2.reduced HDL cholesterol <40 mg/dL (1.03 mmol/L) in males <50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality
3.raised blood pressure systolic BP ?130 or diastolic BP ?85 mm Hg or treatment of previously diagnosed hypertension
4.raised fasting plasma glucose, (FPG) ?100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes
5.central obesity (defined as waist circumference* with ethnicity specific values) (IDF guidelines)[1-3].