Knee Treatments Flashcards
Patellar Tendinitis
Resolves with rest or modification of activity; adjust mm imbalances; patella strap may be helpful (it decreases the work load on tendon)
Fat Pad Syndrome; “Hoffa’s”
RICE
Modalities ???
Motor control exercises to limit and slow hyperextension
Knee Bursitis
Remove the irritation with activity modification
Acute: Ice, NSAIDs
Sub-acute: Isometrics, gentle ROM, improve muscle imbalances, protect area from further irritation
ITB Friction Syndrome
Improve LE Mechanics:
Hip - decrease TFL activity and improve glute med activity, improve glute max activity to assist with ITB stability; Foot - correct foot mechanics with stability and/or orthoses
Modify activity
Soft tissue mobilization to loosen ITB adhesions
Flexibility
Baker’s Cyst
Typically conservative; NSAIDs, ice, decreased WB’ing status
PT Intervention: ROM, pain, strength…
Excision rarely indicated; occasionally aspirated (frequent in athletics)
**TREAT the underlying cause!
Tibial Plateau Stress Fracture
Reduction in activity and in some cases casting; external bone stimulator
Chronic = intramuscular nailing of fracture
PFPS
Improve posterolateral hip muscles activation; bracing and taping may be beneficial; combination of orthotics and therapeutic exercise; feedback interventions during running; multimodal approach seems to be best; physical agents not helpful; no long term gains seen
PFJ Instability
First time or infrequent dislocators usually do well with conservative tx; chronic: usually require surgical intervention; Similar to PFPS (foot and hip interventions); patella bracing with lateral buttress (no adequate evidence to support or refute the use of bracing)
ACL Non surgical Treatment
Restore joint mobility
Increase strength around the knee
Quads and hamstrings: HS help promote dynamic posterior pull of the tibia supporting ACL deficiency
Bracing (sports/activities) to prevent anterior translation of the tibia
Treatment success more for sedentary individuals
“Copers” - higher level function without ACL via stabilization or bracing
ACL Reconstruction
*
PCL Non Operative
Brace immobilization x2-4 weeks
Focus on ROM, quad activation and limiting HS overactivity initially progressing to closed chain strengthening, proprioception, and quad strength
*slower progression compared to ACL because more unstable
PCL Postoperative
Weeks 1-3: NWB, crutches, long leg brace locked in full extension
Weeks 4-6: NWB c crutches until end of Post Op wk 6. Brace unlocked and progressive ROM begins
Weeks 7-10: Progressive WB c crutches at ~25% bw per week (full bw WB by week 10)
Weeks 11-24: Progressive ROM and strength training, avoiding resisted HS exercises
Weeks 25-52: Cont. strength and agility training; return to sports or heavy labor when strength ROM and proprioceptive skills are symmetric to the uninjured LE
Grade I/II MCL (non operative)
Rest/Ice, hinged brace, early ROM - strength/proprioception, early WB’ing, Avg. return to football 20 days (grade II), 74% return to pre injury activity level at 3 mo
Grade III MCL
Controversial; most treated non operatively same as I/II
Collateral Ligament
Managed conservatively; studies indicate no significant benefit from surgically management; Imperative to limit varus forces (LCL) or valgus forces (MCL) and rotational forces within 6-8 weeks post injury; Restore ROM and improve dynamic stability to take stress off collaterals
Non-Surgical management of meniscal injury
Leave alone, conservative care of impairments and functional limitations (control swelling, restore ROM and progressive stability)
Surgical options for Meniscal injury
Meniscus repair, partial meniscetomy, allograft transplantation
Partial Menisectomy Treatment
Little to no protection
Moderate last 3-4 weeks
Muscle setting, SLR, active ROM
WBAT
Full WB and 90 degrees flexion typically achieved by 10 days
Initiate closed chain exercise a few days post op
Caution* Pts can go too quickly, closely monitor signs
Meniscal Repair/Transplantation
Dependent on type/location of repair/transplant (Physician directed)
Generally:
Restricted WBing 2-4 weeks
Long leg brace x^ wks (typically immobilized in extension progressively allowing flex)
Flexion ROM restricted to 80 week 1, 120 week 4, 135 week 6
OC exercises progressive to CC exercises
Biking wk 7, straight running month 4, cutting month 5, return to sport month 5
Non Operative treatment of PLC injury
Phase 1: Edema mgmt; QS activation, ROM Return
Phase 2: Gait mechanics, increase strength - QS, HS, GS, Popliteus, Hip, Lumbopelvic
Phase 3: NMC, control of varus and tibial ER at increased angles of knee flexion
Phase 4: Sport specific training
Post Op PLC Injury
NWB x6 wks, immobilizer locked out for 1-2 weeks
ROM: 0-90 in 2 weeks, full in 6 weeks
Full body squats permitted by 12 weeks
until 4 months NO:
CKC therex at greater than 70 degree knee flexion
Tibial ER
Resisted or repetitive HS in knee flexion
Treatment options for Chondral defects
Conservative/Palliative (debridement/lavage)
Reparative (Subchondral drilling, microfracture)
Restorative (Osteochondral grafting “OATS”, Autologous Chondrocyte Implantation “ACI”)
Chondromalacia/OA
Muscle imbalances, hip strength, flexibilit, alignment issues, possible surgical, aerobics, lose wt, *EXERCISE reduces pain and improves function but no significant different between types (aerobic vs strengthening, or high vs low impact); manual therapy
PT Knee OA management
Education: Wt loss, activity modification, Exercise - incorporate multiple muscles, Manual Therapy, Bracing (medial unloader/Valgus), Heel wedge (lateral heel wedge to unload medial knee compartment), Aquatic therapy, modalities (?)
Medical management of Knee OA
Medication: NSAIDs Cox II inhibitors, injections, TKA
Patellar Tendinopathy/Tendinosis
Activity modification and eccentric loading to the tendon; single limb squat on a decline board, systematic review shows efficacy but mechanisms unknown
Management of Saphenous nerve injury
RICE, possibly surgical release of fascial bands
Medical Plica
Conservative treatment typically successful
Ensure pt’s activity level was appropriate
Implement stretching program for mm of LE: Quads, Gastrocs, HS
Instruct in knee extension exercises, especially Terminal knee extension
