knee interventions Flashcards
PFPS
-LE muscle performance (hip ER and ABD) -these are commonly weak in this population, can help decrease pain!
-Stability (hypermob, coordination) vs Mobility (compressive syndromes) presentation -address related issues
PFPS Taping
-min. long term effects
-NM and proprio effect likely
~loose taping vs corrective taping-similar effects in pain mx
~biomechan theory: improved patellar tracking and alignment- redistributes patellofemoral stress
PFPS Bracing
-certain braces (protronics) may reduce pain
- exact mechanisms unclear (similar to taping)
PFPS surgical
Lateral release, debridement
-early concen. on ROM (guarding), inflammation mx, coordination/activation exercises
-progression (as tolerated) to w/b exercises, muscle performance exercises
-progress to exercises based on activity limitations (progress until remodeling phase)
PFPS 4 categories associated w/ functioning, disability and health
- Overuse/overload w/o other impairment (excessive microtrauma/loading in an area) (taping and activity mods recommended)
- Muscle performance deficits (weakness in hip/knee musculature) (strengthening)
- Movement coordination deficits (gait and movement retraining)
- Mobility impairments (tight retinaculum/ tight capsules, inflexibility) (treat hyper (foot orthosis, taping) /hypomobility(tissue mobs, stretching not great research))
Articular Cartilage deficits (lavage and debride)
-Full ext ROM by week 1
-Fill flex ROM by week 3 (progress loading AT once func/inflammation/pain permits)
Articular Cartilage (Microfx-drilling the holes)
-Full ext AAROM by ~week 1
-Full flex AAROM by ~week 3, progress w/b over ~weeks 6-12
AVOID loading at lesion site until ~6-12 weeks
AC grafts/chondrocyte implantation
-early PROM and AAROM
-should restore full ext by end of ~ week 1, flex by ~week 6 (AVOID loading lesion site initially w/ AAROM)
-CKC exercises once full WBAT
-full WB ~6weeks
-progressive loading ~6-12weeks (AVOID loading lesion site initially)
OA (6 things)
-pt education: pt empowerment, progress to I! and activity mods
-manual therapy
-LE strengthening/endurance exercises
-diet/ weight loss
-walking/gait training
-pain control modalities
Arthrofibrosis mx (acute and chronic stages)
-Exercise/ manual therapy
-Based on stages
Acute: self-mx, ROM/mobility, stretches, pain/inflamm control, muscle performance AT (adjacent joints and hip)
Chronic: aggressive joint mobs, stretching, strengthening, static stretch, devices (creep)
Arthrofibrosis surgical mx
MUA (ripping connective tissue, PT needs to see them right away so it doesn’t redevelop)
Arthroscopic capsular release
Meniscus Lesion -conservative (5 things)
-pt education
-pain mx
-guarding
-joint mobility
-muscle performance: hip, knee (especially rotational stability)
Meniscus lesion (post op mx- meniscectomy)
-early concen. on ROM (guarding), inflamm mx, coordination/activation exercises
-quicker progression to WB exercises (AT, tissue loading, coordination), LE strengthening exercises
-progress to exercises based on activity limits until remodeling phase
Meniscus lesion (post op mx- meniscus repair)
greater protection phase (~6wks)
gradual increase WB and ROM, address inflamm, hip strengthen/endurance, gait, limit progressive loading on posterior menisci (limit flex ROM, RT flex), coordination/activation exercises
~6-10wks: gradually increase loading on involved tissues (aerobic equipment), address ROM
>10wks: progress to exercises based on activity limits until remodeling
CPG Meniscal and AC lesions
-Early rehab strategies (progressive A/PROM)
-Early to late rehab strategies (progressive WB- FWB 6-8wks, RTA, supervised rehab, TE-ROM, strength, NM, NMES/biofeedback- increase quad strength, knee func)
ACL prevention
Exercise-based knee injury prevention programs to reduce risk of ACL injuries (PEP, Sportsmetrics, Harmoknee, Olsen and Petersen
ACL prevention
Prox control exercises, combo of strength and plyometrics
Balance should not be sole component
ACL lesion: sx mx
-Want to return func stability to knee
-Sx: debride, repair (rare), reconstruction (tissue: bone-patellar tendon-bone, hamstring tendon, synthetic, origin: allo vs autograft)
ACL lesion sx mx autograft
-Double bundle semitendinosus and gracilis autograft common
Improved rotation stability!
Decreased likelihood of revision, developing OA, and damage to meniscus!
Improved func, satisfaction, QOL!
ACL lesion post op mx (immediate and early)
vary by type of sx and surgeon
Immediate (week 1)- knee A/PROM 0-90, active quad contraction (S. displacement)
Early (week 2)- knee flex >110, ambulation w/o crutch, full knee ext, knee outcome survey >65%, no ext lag w/ SLR, reciprocal stair climbing, cycling
ACL lesion post op mx (intermediate and late and transitional)
Intermediate (3-5weeks)- knee flex ROM w/in 10 degrees of non affected side, quad strength >60% of NAS.
Late (weeks 6-8)- full knee ROM, quad strength >80% of NAS, normal gait, knee effusion trace or less
Transitional (weeks 9-12)-maintain/improve quad strength, hop test >85% of NAS, KOS >70%
CPG: knee lig sprain
Continuous passive motion to decrease pain (intermediate post op)
Early WBAT (within 1 week)
Functional knee bracing w/ ACL deficiency
Appropriate bracing for PCL, MCL, PLC injuries
Really good:
WB and nonWB concentric and eccentric exercises (4-6 weeks)
NMES 6-8 weeks
NM re-ed
Immediate mobilization within 1 week
cryotherapy immediately
supervised exercises and HEP
ACL lesion conservative mx
Prog factors: age, gender, occupation, sports particip, radiographic findings, KT-1000 measurement, knee func scores, presence of additional knee injuries
address inflam/pain early (protection, manual therapy, modalities)
muscle performance: coordination/endurance/strength (hamstrings and tibiofemoral rotators)
Patellar tendinopathy
-address impairments identified on exam
-eccentrics:
facilitate tendon remodeling
improved collagen fiber alignment
exercises: squats on declined slant board
Tendon rupture: patellar and quad (repair <3- 6wks)
<~3wks: protect, pain/inflamm mx
~3-6wks: light loading (resistance free cycling)
bracing
motion limited to 0-45 by surgeon, progressive increase
AROM knee flex (common 45)
gait w/ AD
min WB
modalities PRN
hip muscle performance
Tendon rupture (repair 7-12)
~7-12wks: progression of loading, FWB (hinge locked 0-60), knee extensor activation/coordination, progress CKC
~9-12wks: single leg CKC, increase tensile loading(max activation, knee ext exercises)
Patellar fx: non sx
acute: WBAT w/ AD and locked hinge brace initally
coordination/activation exercuses
stretching/mobility/mod CKC exercises at 3-4 weeks, patellofemoral mobs
6-12wks: pain free ranges, progress WB exercises
