Knee Interventions Flashcards
(43 cards)
1
Q
Patellofemoral Pain Interventions
A
- Taping
- Bracing
- Surgical
- Strengthening
2
Q
Patellofemoral Pain classifications
A
- Overuse/Overload without other impairment
- PFP with movement coordination deficits
- PFP with muscle performance deficits
- PFP with mobility impairments
3
Q
describe taping for PFP
A
- minimal long-term effects
- neuromuscular and proprioceptive effect likely; biomechical correction unlikely
- loose taping vs corrective taping → similar effects in pain management
- biomechanical theory → improved patellar tracking/alignment leads to redistributed patellofemoral stress
- imaging studies have not supported repositioning of patellar with taping
4
Q
describe bracing for PFP
A
- certain braces (e.g Protronics) may be effective in pain reduction
- exact mechanisms unclear (similar to taping)
5
Q
describe a surgical approach for PFP
A
- Lateral Release, debridement
- early concentration on ROM, inflammation management, coordination/activation exercises
- progression to w/b exercises, muscle performance exercise
- progress to exercise based on activity limitations (progressing appropriately until remodeling phase)
6
Q
describe the subtype: PFP overuse/overload without other impairments
A
- pain primarily due to overuse/overload
- pt presents with a history suggesting an increase in magnitude and/or frequency of PFJ loading at rate that surpasses the ability of his/her PFJ tissues to recover
7
Q
describe the subtype: PFP muscle performance deficits
A
- may respond favorably to hip and knee resistance exercises.
- pt presents with LE muscle performance deficits in the hip and quads
8
Q
describe the subtype: PFP with movement coordination deficits
A
- may respond favorably to gait retraining and movement re-education interventions leading to improvements in LE kinematics and pain
- assess dynamic knee valgus during movement
- pt presents with excessive or poorly controlled knee valgus during dyanamic task, but not necessarily due to weakness of LE muscles
9
Q
describe the subtype: PFP with mobility impairments
A
- may have impairments related to either hyper/hypomobile structures
- pt presents with higher than normal foot mobility and/or flexibility deficits of 1 or more of the following structures:
- hamstrings
- quads
- gastroc
- soleus
- lateral retinaculum
- ITB
10
Q
Intervention strategies for PFP Overuse/overload without other impairment
A
- taping (B)
- activity modification/relative rest (F)
11
Q
intervention strategies for PFP with movement coordination deficits
A
- gait and movement retraining (C)
12
Q
intervention strategies for PFP with muscle performance deficits
A
- hip/gluteal muscle strengthening (A)
- quad strengthening (A)
13
Q
Intervention strategies for PFP with mobility impairments
A
- Hypermobility
- foot orthosis (A)
- taping (B)
- Hypomobility
- patellar retinaculum/soft tissue mobilization (F)
- muscle stretching (F)
- hamstrings
- quads
- gastroc
- soleus
- ITB
14
Q
surgical options for articular deficits at the knee
A
- arthroscopic lavage and debridement
- microfracture
- grafts/chondrocyte implantation
15
Q
arthroscopic lavage and debridement PT implications
A
- full extension ROM by week 1
- full flexion ROM by week 3
- progress loading as tolerated once motion functional and inflammatory/pain permits
16
Q
microfracture PT implications
A
- full extension (active assisted) ROM by ~week 1
- full flexion (active assisted) ROM by ~week 3
- progress w/b over ~week 6-12
- avoid loading at lesion site until ~6-12 weeks
17
Q
grafts/chondrocyte implantation PT implications
A
- Early PROM and active assisted ROM
- should restore:
- full extension by end of ~week 1
- flexion by ~week 6
- avoid loading lesion site intially with AA ROM
- CKC exercises once full WBAT
- Full WB ~6 weeks
- Progressive loading ~6-12 weeks
- avoid loading lesion site initially
18
Q
osteoarthropathy intervention suggestions
A
- Pt edu → focus on pt empowerment/progression to independence and activity modification
- Manual therapy
- sustained hold
- +/- oscillation mobs
- LE strengthening/endurance exercise (hip and knee)
- Diet/weight loss
- Walking/gait training
- Pain control modalities +/-
19
Q
Management of Arthrofibrosis
A
- exercise, MT
- based on stage of progression
- Acute stage → self management, ROM/mobility exercises, stretches, pain/inflammation control interventions, muscles performance as tolerated (adjacent joints and hip)
- Chronic stage → aggressive joint mobs, stretching, strengthening, static stretching devices (crep)
20
Q
surgical managment of Arthrofibrosis
A
- MUA
- Arthroscopic capsular release
21
Q
conservative management of meniscus lesions
A
- address impairments per ICF model
- pt edu
- pain management
- guarding
- joint mobility
- muscle performance: hip, knee (especially rotational stability)
22
Q
post-op management of meniscetomy
A
- early concentration on ROM (guarding), inflammation management, coordination/activation exercise
- quicker (as tolerated after acute healing phase) progression to:
- w/b exercise (tissue loading, coordination, etc)
- strengthening exercises (LE)
- Progress to exercises based on activity limitiations
- progressing appropriately until remodeling phase
23
Q
post-op management of meniscus repair (6 weeks)
A
- greater protection phase (~6 weeks)
- gradual increase in w/b and ROM
- address inflammation
- hip strengthening/endurance
- Gait (AD as needed)
- limit compressive loading on posterior menisci
- limit flexion ROM accordingly
- limit resisted knee flexion
- coordination/activation exercises
24
Q
post-op management of meniscus repair (6-10 weeks)
A
- gradually increase loading on involved tissues
- aerobic equipment, etc
- address ROM
25
post-op management of meniscus repair (\>10 weeks)
1. progress to exercise based on acitivty limitations
* progressing appropriately until remodeling phase
26
primary goal of conservative and surgical management of ACL tears
return functional stability to the knee
27
Surgical management of ACL tears
1. debridement
2. repair (rare; scaffold placed)
3. reconstruction
* tissue → bone-patellar, tendon-bone, hamstring tendon, or synthetic
* origin → allograft vs. autograft
28
gold standard for ACL lesion surgical management
1. double-bundle semitendinosus and gracilis autograft common
* improved rotation stability
* decreased likelihood of revision, development of knee OA, damage to the meniscus
* improved function, satisfaction, and QOL as per pt self-report
29
post-op phases for ACL reconstruction (via Adams)
1. Immediate post-op phase (week 1)
2. Early post-op phase (week 2)
3. Intermediate post-op phase (weeks 3-5)
4. Late post-op phase (weeks 6-8)
5. Transitional phase (weeks 9-12)
6. Follow-up testing (4, 5, 6, 12 months)
30
immediate post-op phase
week 1
1. Knee A/PROM 0-90 degrees
2. active quad contraction (superior displacement of patella)
31
ACLR early post-op phase
week 2
1. knee flexion \>110 degrees
2. ambulation w/o crutch
3. full knee extension w/ambulation
4. knee outcome survey (ADL subscale) \>65%
5. no extension lag with SLR
6. reciprocal stair climbing
7. cycling
32
ACLR intermediate post-op phase
weeks 3-5
1. knee flexion ROM within 10 degree of non-affected LE
2. quad strength \>60% of non-affected LE
33
ACLR late post-op phase
weeks 6-8
1. full knee ROM
2. quad strength \>80% of non-affected LE
3. normal gait
4. knee effusion trace or less
34
ACLR transitional phase
weeks 9-12
1. maintaining/improving quad strength
2. hop test \>85% of non-affected side (week 12)
3. KOS (sports subscale) \>70%
35
prognositic factors for conservative management of ACLR
1. age
2. gender
3. occupation
4. sports participation level
5. radiographic findings
6. KT-1000 arthrometric measurement
7. knee function scores
8. presence of additional knee injuries
36
patellar tendinopathy management
1. address impairments ID on exam
2. Eccentrics
* facilitating tendon remodeling
* improved collagen fiber alignment
* common exercise: squats on declined slant board
37
tendon rupture repair \<3 weeks
protection, pain/inflammatory management
38
tendon rupture repair 3-6 weeks
light loading (resisted - free cycle)
1. bracing (motion limited with hinge brace)
2. motion commonly limited by surgeon (0-~45), progressive increase during this period
3. active knee flexion
* within limited range, common 45 degrees
4. gait with AD
5. minimal w/b exercises
6. modalities PRN
7. hip muscle performances
39
tendon rupture repair 7-12 weeks
progression of loading
1. progress to full w/b:
* hinge locked 0-60 commonly
2. knee extensor activation/coordination (sub-max)
3. progress CKC exercises
40
tendon rupture repair 9-12 weeks
1. single leg CKC exercises
2. increase tensile loading
* max activation, knee extension exercises, etc.
41
patellar fracture: non-surgical management in acute phase
1. WBAT with AD and locked hinge brace initially
2. coordination/activation exercises for knee, muscle performance of hip
3. stretching/mobility/modified CKC exercises at ~3-4 weeks
4. patellofemoral mobs
42
patellar fracture: non-surgical management 6-12 weeks
1. pain-free ranges (motion limitations)
2. progress w/b exercises
43
Joint mobilizations at the knee
1. Tibiofemoral Joint
* Posterior glide (M/L comparment)
* Anterior glide (M//L compartment)
* Traction
2. Patellofemoral Joint
* medial glide
* lateral glide
* caudal glide
