Knee Interventions

Why do we need screw home mechanism

Makes iliofemoral ligament taught in hip causing decreased energy expenditure and increased stability

Best HS exercises

Nordic curl

Barbel dead lift

Hip thrust

OA/RA

Acute

- protection, education

- pain management

- maintain muscle setting exercises

Later

- Strengthen

- minimal increase in pain

- increase ROM w/ stability

- Aqautics?

Joint Degeneration

Articular cartilage lesions lead to further Soft tissue injury

- surgery depends on size, location

Repair = microfracture

Restore = osteochondral autograft transfer (OAT), Osteochondral allograft transplant, or autologous chrondrocyte inplantation (petri dish)

Interventions after articular cartilage repair

Early & controlled ROM

Progressive WBing

RTP/S/A

- Low impact = 6 months

High impact = 8-12 months

Higher impact = 12-18

Ligamentization

Between 9/12/18 to 24 months

How long after ALC injury is the incidence of another high

12-24 months post-op

ACL rehab

Protect healing graft (OPP not good for ACL)

Regain full extension ASAP

No excessive ACL staring during PROM

Need OKC & CKC

Cyclops Lesion

This is arthrofibrosis after ACL reconstruction

This causes DECREASED rom when extension and a palpable clunk

Seen around 16 weeks post op because there needs to be time for this scar to form

Autograft precautions/considerations

Patellar

- discomfort in patellar tendon not ok!

- taping may be helpful

Hamstring

- no OKC hamstring for 8-12 weeks

Phase 1 of ACL protocol criteria to progress

1-2 weeks

Knee ext to 0

Quad contraction and full active ext

Able to perform SLS w/o lag

Phase 2 of ACL protocol criteria to progress

3-5 weeks

SSwelling of 1+ or less

Flexion ROM within 10 degrees of uninvolved

Ext ROM = to other side

Phase 3 of ACL protocol criteria to progress

6-8 Weeks

No effusion after ex

Normal gait

ROM equal to other side

Phase 4 of ACL protocol criteria to progress

9-12 weeks

No instability

KOOS > 70%

Quads and HS > 80% of contralateral side

Phase 5/6 of ACL protocol criteria to progress

3+ months

Who cares

OKC with ACl

Can be done 4 weeks post-op in restricted ROM of 90-45

RTS considerations for ACL

30% reinjury rate in 2 years

Consider graft type

RTS considerations needed

> 90 % on quad stregnth, HHS strength

Hop tests

Full ROM

No pain/effusion

PCL Injuries

Emphasize RE: knee ext & hip

Avoid knee Flexion RE for 8-12 weeks

Slower progression of Flexion

PCL graft tension peaks at 70-90

MCL sprains

1&2 = immediate ROM and PT

3 = non-op, NWB initially, knee immobilized at 30 Flexion

- surgery = slocum procedure (this does not exist)

Partial meniscectomy

Avoid high impact activity initially

2-6 wk recovery

Repair of Meniscus

Immobilized at 0 for 4 was

WBAT

NO LE loading beyond 45 for 4 weeks, 90 for 8 weeks

Goals =

- 6-8 wk = full AROM

- 8-10 weeks = strength at 80 % of uninvolved

- 12-16 weeks = ploys, agility RTS

PFPS

Cause

- trauma

- overuse

- faulty tracking (laterally)

- joint degeneration

Classification categories

- overuse

- muscle performance deficit is

- movement coordination deficits

- mobility impairments

PFPS guidelines

Activity modifications —> avoid prolonged positioning

Correct poor pelvic/hip stability

Address DKV and foot support

Joint mobilizations

TKAs

Indications

- joint pain w/ WBing

- degenerative conditions

- marked deformity (genu valgum/varum)

- instability or motion limitation

- failure of conservative measures

Acute TKA rehab

Mobility within 24 hours

Joint camp before?

ROM

Strength

Transfers

Gait training

Incision management

CPM short term active knee extension ROM

Higher !

Outpatient TKA Rehab Goals

ROM = LLPS very effective

0-90 Flexion by 2 weeks

0-115 Flexion by 6 weeks

SLR w/o lag by 3-4 weeks

- OVERlOAD

Gait = discontinue AD by 6 weeks