Week 5- Knee Interventions Flashcards
PART 1: PFPS
PART 1: PFPS
What muscle strengthening is highly indicated for PFPS?
-Hip ER and ABD
“________” for hypomobility/coordination vs “__________” for compressive syndromes
- “Stability”
- “Mobility”
What 2 intervention strategies are not promising with PFPS?
- Taping
- Bracing
Taping is likely to have _________/_________ effect, but is unlikely to have __________ _________.
- neuromuscular/proprioceptive
- biomechanical correction
What is a common surgical intervention used for PFP?
-Lateral release and debridement (lateral retinaculum)
What are the 4 subcategories of individuals with PFP and what interventions can be used for each?
PFP Overuse/overload
- Taping (B)
- Activity modification/relative rest (F)
PFP With Movement Coordination Deficits
-Gait and movement retraining (C)
PFP With Muscle Performance Deficits
- Hip/gluteal muscle strengthening (A)
- Quad muscle strengthening (A)
PFP with Mobility Deficits
- Hypermobility
- Foot Orthosis (A)
- Taping (B)
- Hypomobility
- Patellar retinaculum/STM (F)
- Muscle stretching (F)
PART 2: ARTICULAR CARTILAGE DEFECTS
PART 2: ARTICULAR CARTILAGE DEFECTS
What are (3) common surgical interventions?
- Arthroscopic Lavage and Debridement
- Microfracture
- Grafts/Chondrocyte Implantation
Explain the recovery process of Arthroscopic Lavage and Debridement.
- Full extension ROM by week 1
- Full flexion ROM by week 3
Explain the recovery process of Microfracture.
- Full extension ROM by week 1
- Full flexion ROM by week 3, progress WB over weeks 6-12
- Avoid loading at lesion site until 6-12 weeks
Explain the recovery process of Grafts/Chondrocyte Implantation.
- Early PROM & AAROM
- Full extension ROM by week 1
- Full flexion ROM by week 6
- CKC exercises once WBAT
- Full WB week 6
- Progressive loading 6-12 weeks
PART 3: OA
PART 3: OA
What 7 physical, psychosocial, and mind-body approaches are strongly recommended?
- Exercise
- Self-Efficacy and Management Programs
- Weight Loss
- Tai Chi
- Cane
- 1st CMC Orthosis
- TF Knee Brace
What 3 pharmacological approaches are strongly recommended?
- Oral NSAIDs
- Topical NSAIDs
- I-A Steroids
What physical, psychosocial, and mind-body approach is strongly recommended against for the knee and hip?
-TENS
OA:
- What does pt education focus on?
- Manual Therapy
- LE Strengthening/Endurance
- Diet/Weight Loss
- Walking/Gait Training
- Pain Control Modalities
Pt education focuses on patient empowerment and progression to independence and activity modification.
PART 4: ARTHROFIBROSIS
PART 4: ARTHROFIBROSIS
What is recommended in the ACUTE stages of arthrfibrosis?
-Self-management, ROM/mobility exercises, stretches, pain/inflammation control interventions, muscle performance as tolerated
What is recommended in the CHRONIC stages of arthrofibrosis?
-Aggressive joint mobs, stretching, strengthening, static stretching devices (creep)
What are some surgical interventions for arthrofibrosis?
- MUA
- Arthroscopic capsular release
PART 5: MENISCUS LESION
PART 5: MENISCUS LESION
Meniscectomy post-op management.
- Early ROM
- Quicker WB exercises, strengthening exercises
- Progress to exercise based on activity limitations
Meniscus Repair post-op management.
- Greater protection phase (~6 weeks)
- 6-10 weeks: Gradually increase loading on involved tissues, address ROM
- > 10 weeks: Progress to exercises based on activity limitations
PART 6: ACL INJURY
PART 6: ACL INJURY
What interventions can be used for prevention of ACL injury?
-Exercise-based knee injury prevention programs
What is the primary goal of conservative and surgical intervention for ACL lesions?
-Return functional stability to the knee.
What are some surgeries performed for ACL lesions?
- Debridement
- Repair (rare)
- Reconstruction (tissue/origin)
What is the gold standard surgical management of ACL lesions?
-Double-bundle Semitendinosus & Gracilis Autograft
Double-bundle Semitendinosus & Gracilis Autograft:
- Improves _________ stability.
- Decreases likelihood of revision, development of knee ___, and damage to the _________.
- Improved function, satisfaction, and QOL as per patient self-report.
- rotational stability
- knee OA and damage to the meniscus
What are the phases of post-op management for ACL lesions?
- Immediate Post-op Phase (week 1)
- Early Post-op Phase (week 2)
- Intermediate Post-op Phase (weeks 3-5)
- Late Post-op Phase (weeks 6-8)
- Transitional Phase (weeks 9-12)
- Follow-up Testing (4, 5, 6, 12 months)
Immediate Post-op Phase (Week 1):
- Knee A/PROM __-__ degrees.
- Active _____ contraction.
- 0-90
- Active quad contraction
Early Post-op Phase (Week 2):
- Knee flexion >____ degrees
- Ambulation ________ crutch
- Full knee ________ with ambulation
- Knee outcome survey >___%
- No ____________ with SLR
- Reciprocal __________
- __________
- Knee flexion > 110 deg
- Ambulation without crutch
- Full knee extension with ambulation
- Knee outcome survey (ADL subscale) ->65%
- No extension lag with SLR
- Reciprocal stair climbing
- Cycling
Intermediate Post-op Phase (Week 3-5):
- Knee flexion ROM within ___ degrees of non-affected LE
- Quad strength >___% of non-affected LE
- 10 degrees
- >60%
Late Post-op Phase (Week 6-8):
- _____ knee ROM
- Quad strength >___% of non-affected LE
- ______ gait
- Knee effusion trace or less
- full knee ROM
- > 80%
- normal gait
Transitional Phase (Week 9-12):
- Maintain/improve _____ strength
- Hop test >___% of non-affected side (week 12)
- KOS >___%
- quad strength
- 85%
- 70%
What are the prognostic factors for conservative management of ACL lesion?
- Age/gender
- Occupation/sport participation level
- Radiographic findings
- KT-1000 arthrometric measurement
- Knee function scores
- Presence of additional knee injuries
When do we want to address pain and inflammation in ACL lesions?
-Early
PART 7: PATELLAR TENDINOPATHY
PART 7: PATELLAR TENDINOPATHY
What are the best exercises?
-Eccentrics
PART 8: TENDON RUPTURE (patellar/quad)
PART 8: TENDON RUPTURE (patellar/quad)
Describe the phases of repair with patellar/quad tendon rupture.
- <3 weeks: protection, pain/inflammatory management
- 3-6 weeks: light loading (resistance free cycle)
- 7-12 weeks: progression of loading (full WB
- 9-12 weeks: single leg CKC exercises, increase tensile loading
PART 8: PATELLAR FRACTURE (NON-SURGICAL)
PART 8: PATELLAR FRACTURE (NON-SURGICAL)
Acute:
- WBAT with AD & locked hinge brace initially
- Coordination/ activation exercises for knee, muscle performance of hip
- Stretching/ mobility/ modified CKC exercises at ~3-4 weeks
- Patellofemoral mobs
6-12 weeks
- Pain-free ranges
- Progress WB exercises
