1. Title of the article: The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures.
2. Explain the purpose(s) of this article:
- This article can be considered to be multi-purposeful. The ultimate purpose of the article is to offer a comparison of timing, in terms of return to normal/sport activity, strength, and load-bearing status, associated with different rehabilitation programs post-meniscus injury. The different rehabilitation programs described refer to treatment post-surgery, and are largely dependent the specific surgical intervention employed, several of which are also briefly outlined in the article. In addition to describing the differing rehabilitation programs, this article also serves the
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By offering a review of the basic structure of the menisci, it is easier to understand the different types of meniscal tears and why some are more significant than others (for example, tears in the lateral regions have greater potential for healing due to greater vascularization). Understanding the type of tear that a patient has is important when determining treatment options, conservative or surgical, for the tear and this article does a good job at including indications within the description for each option. Even if you are not the clinician who decides the initial treatment option, if you are treating a post-surgical patient, the knowledge of the procedure and why it was indicated is important for being able to fully understand and communicate with the patient about his/her case, as well as to guide the rehabilitation program. Perhaps the most important clinical implication this article offers for physical therapists is the empirical evidence in terms of rehabilitation protocols following the various surgical treatments. Having this evidence allows the clinician to better understand the basis for rehabilitation and progression guidelines set forth by the referring surgeon and can guide the development of an individualized treatment plan. General guidelines that can be taken away from the various programs outlined include the progression of progressive loading, return to normal gait, restoration of range of motion, quadriceps strengthening, proprioception, balance, and return to full physical activity. In terms of creating goals and patient education, while each case may be a little different, it is also important to consider, on average, how long each stage of the rehabilitation process is and when to expect return to normal activity. For example, return to full activity may be possible within two months after a partial meniscectomy, while return to activities
Many factors like patients age, symptoms, size of the tear, and nature of onset (traumatic or degenerative) are responsible for determining the prognosis of the physical therapy treatment 9. Since it’s a partial thickness tear of the rotator cuff, the non-operative treatment is reasonable unlike, a full thickness tear where surgery will be required to treat the patient 9. The patient shows symptoms of moderate irritability without significant functional deficit which makes him a good candidate for conservative treatment 10. The pain reported by the patient is 6/10 so the patient participates well in physical therapy exercise to increase shoulder strength, and flexibility. There was a study done from Finland which asserted that physical therapy alone can produce results which are equal to those produced by arthroscopic surgery and open surgical repair in cases of rotator cuff tears 11. In this case, with three weeks of physical therapy the patient has showed a decrease in pain and reported it as 4/10 on pain rating scale and showed improvements in abduction (140̊) and external rotation (65̊). The MMT for shoulder abduction was 4-/5 and external rotation is still same as
Tearing the ACL is now considered an epidemic in the United States over 100,000 recorded incidences are reported each year (Moeller). While such a finding may be good for orthopedic doctors and surgeons, this is not good for millions of athletes’ competing these days in high intensity sports. This is especially a problem for female athletes who are two to four times more likely to tear their ACL than men (Moeller). This is one of the biggest mysteries about ACL tears is the difference between the number of injuries seen in women and men. Women tend to tear there ACL far more frequently then men. While not everyone agrees that gender itself is the source of the problem, evidence is growing that females are learning too late that participating in sports can also become the first step to ruining an active lifestyle.
Return to play time frame depends on a few factors, such as the severity of the tear, where the tear occurred, and how good the repair was. The more severe the tear the longer the time frame becomes. If surgery is needed the time frame is normally ten to twelve weeks to re strength the shoulder.
When comparing rotator cuff tears from the common people and athletes, they are much more common when a person is physically active in sports. An injury in the rotator ...
Anterior cruciate ligament rehabilitation has undergone a considerable amount of change within the past decade. With thorough research into the biomechanics of the injury itself and on the operated knee have both helped with the movement away from the techniques of the early 1980's.
In November of 2010, I was playing basketball in the fifth game of my senior season. It was just like any other game. However, I would soon find out otherwise. It was late in the game; I drove into the lane and got fouled hard. I was knocked so off-balance that I speared the floor with my knee. As soon as my knee hit the floor I heard a “snap” that I will never forget for the rest of my life. Little did I know at the time, that would be the last shot of my high school basketball career. Not long after my injury, I consulted a doctor. After getting an x-ray and an MRI, the doctor informed me that I had completely torn my ACL and would need to have surgery. An ACL tear can be a very devastating injury. The anterior cruciate ligament (ACL) is one of the four major ligaments within the knee. The ACL is one of the most commonly injured ligaments, injured by an estimated 200,000 patients each year. Of the 200,000 annual ACL injuries, surgery is performed in approximately 100,000 cases. There are many types of reconstructive surgery on the ACL. However, there is an alternative to surgery in the form of physical therapy.
Since ACL damage frequently occurs, and can cause numerous complications even after receiving surgical treatment, many studies have been conducted on ACL damage related surgery and the most efficient rehabilitation exercises. Unfortunately, ACL tears rarely heal by themselves (10). The loss of this ligament causes the knee to be highly unstable, and drastically increases the chance of the knee slipping out of place. Usually, this will occur while attempting sudden changes in direction or lateral pivoting motions. As the incidence rates continue to grow, both surgical and therapeutic measures must be taken in order to improve the lives of this population. Post-operative rehabilitation is the most important determinant for a successful outcome of ACL reconstruction, one of the most common procedures used to date (3,6). Patients with an ACL deficiency, whom are not suitable for reconstructive surgery, should focus on regaining full range of motion (ROM) and strength; this will reduce the chance of encountering post-operative issues, while using an accelerated rehabilitation physical therapy program. Ultimately, this study will be very significant; the contribution of the proposed research is expected to be favorably beneficial for populations aged 15-45 years, who are recovering from reconstructive surgery of the anterior
...cient knee during activities of daily living, as they have yet to be determined ⁷². In understanding the factors contributing to the mechanism of non-contact ACL injury, investigators should consider whether the kinematics, kinetics and muscle activation strategies observed are the cause of increased ACL strain or compensation for other kinetic chain insufficiencies ²⁹. Further knowledge on how movement patterns and other kinetic chain structures affect ACL loads prove critical in enhancing future prevention strategies ²⁹ ³⁴. As with reconstruction, rehabilitation should aim to aid the knee in attaining its near-normal function ⁵⁵. Through producing rehabilitation programmes built around existing knowledge on the biological and mechanical properties of the ACL, objectives such as reduced pain, greater ROM and improved muscle function can be achieved ⁵⁵.
Amanda was in her sophomore year of soccer season when she heard the pop of her knee that cut her season short. The next thing she knew she was at the doctor’s who told her she had an ACL tear, and wasn’t sure if she could play again. From there it was boiled down to two options. One to re-strengthen her knee through rehabilitation, physical therapy and bracing, or to undergo an ACL reconstruction surgery. Although it is costly and some may consider it frivolous, those who have encountered ACL tears should receive the reconstruction surgery instead of attending rehabilitation for the damage to their knee, because it dramatically lessens the chances of meniscal injuries and osteoarthritis occurring later and allows the patient to return back to their sport or physical activity with better knee mobility and less pain in a timely manner.
The meniscus is one of the most commonly injured structures in the knee. Meniscal injuries can occur in any age group, but causes are somewhat different for each age group. In younger people, the meniscus is fairly tough and rubbery, and tears usually occur as a result of a fairly forceful twisting injury. In the younger age group, meniscal tears are more likely to be caused by athletic activity (Sutton, 1999).
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
In today’s sports world, athletes are pushing themselves to the limits to accomplish a sound victory for themselves or their team. But sometimes they succumb to pushing themselves too hard and get injured. They put them in a position where the only option they have is getting an injury. Lots of injuries happen to the leg of the athlete, but the knee is where the most damage is. Although it does not happen often, a knee dislocation is a serious injury. Being different than a patellar dislocation which is where the patella relocates to another spot of the knee, a knee dislocation is where the tibia and femur are forcibly separated. Not only can one dislocate their knee, they also can also tear their anterior cruciate ligament, posterior cruciate ligament, and sometimes tear the medial collateral ligament or the lateral collateral ligament. As well with the ligaments be torn, blood supply and nerve blockage could happen making a dislocated knee very dangerous to the athlete who dislocates their knee. A dislocation is a medical emergency that usually ends up in surgery to fix not only the placement of the bones, but the ligaments as well. This injury can keep an athlete out for weeks or months depending on the severity of the dislocation making a long and painful rehab. Once back into play, unfortunately, the chances of them dislocating again increase making the management and rehab of the athlete even more important.
The primary outcome measurement of this study will be the overall Knee injury and Osteoarthritis Outcome Score (KOOS), including all 5 subscales: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life (Appendix B). The KOOS is a 42-question, self-assessed Likert Scale questionnaire. Each subscale of the KOOS is scored on a scale from 0 to 100, indicating extreme symptoms to no symptoms, respectively. All 5 subscales of the KOOS test have been validated for knee OA and knee injuries that can lead to posttraumatic OA, including meniscal injuries, for both short-term and long-term outcomes.31,32 However, the KOOS test as a total score has not been validated, and thus the KOOS User Guide recommends averaging subscale scores to use as a primary outcome measure for RCTs. As such, the overall KOOS score will be calculated in this manner. All KOOS subscales will also be used individually as primary outcomes.
If you walk into any high school at any time of year, you will most likely see several students on crutches and or wearing knee braces. Most often these injuries are a result of a torn anterior cruciate ligament, better known as ACL. This injury is very common and current research reports it “has steadily increased among 6- to 18-year-olds in the United States, rising more than 2 percent a year over the last two decades” (Reinberg). ACL dramatic rise among high school students injuries in the past twenty years is alarming, which should motivate parents, coaches, schools, and doctors need to re-examine adolescent athletic programs.
Once I could bend my knee again, I started playing sports again. I took a break from basketball, but I kept up with softball and volleyball. My knee didn’t feel quite the same, but I thought that would pass. During my volleyball camp at Olivet Nazarene University, I was jumping up to block and when I landed my knee buckled and I knocked over my friend Christie. I could not believe this happened again! After I couldn’t get up, once again, the coach insisted that I go and see Ozzy, the trainer. He checked out my knee and thought I had torn my meniscus(the cartilage in the knee joint) and possibly had a small tear in my MCL(the inside tendon of the knee). He insisted that I go to O.A.K. Orthopedics (a health care office that includes 8 orthopedic surgeons) to see Dr. Ellis.