Post Op Rehab for sporting injuries

Question 1

Describe the basic procedure for ACL reconstruction

Answer 1

1. spinal or general anesthesia
2. incision around the knee to insert instruments and camera
3. excision of remaining torn ACL portions
4. autograft taken from patella tendon
5. tunnel made through tibia and femur
6. graft placed into tibia and pulled thorugh the femur
7. small screws put in to hold it in place; bone growth will fill in the tunnels and stabilize the graft

2-2.5 hr long surgery
recovery room 2-3 hrs

Question 2

Describe the basic procedure for tommy john surgery

Answer 2

• ligament is exposed on medial side
• allograft or autograft is obtained for UCL replacement
• various methods of attaching the graft to the medial side (figure 8, docking, graftlink method etc)

Question 3

What are the goals of rehab post UCL surgery?

Answer 3

Phase 1 (0-4):

• reduce pain/inflammation/swelling
• ROM in 30-90 range (brace locks this)
• wear brace at all time
• no PROM (think about the mm’s that insert around medial epicondyle - you don’t want to work these mm’s too hard initially!)

Phase 2 (4-6 weeks)

• ROM 15º-115º (brace locks this)
• still avoid PROM/wear brace all times

Phase 3 (6-12 weeks):

• full ROM
• strength 5/5
• restore UE endurance
• still avoid valgus stress/avoid pain with ex

Phase 4 (12-16 weeks):

• full strength/flexibility
• neuromuscular control
• prepare for RTS/RTA/RTW
• be able to complete plyometrics without symptoms

Phase 5 (4-9 months)

• RTA
• prevent re-injury

Question 4

What are the S/Sx of a fracture and how does your management differ depending on which phase of healing the fracture is in?

Answer 4

SSx:
- TTP, deformity, swelling, pain, crepitus, history of trauma

Inflammatory phase mgm’t:
- immob/prevent 2º problems

Remodelling phase mgm’t:
- treat pain/swelling/regain ROM+strength+motor control/function

Question 5

Describe the phases of post op scaphoid # repair

Answer 5

Phase 1 (0-4 weeks):

• minimize edema/pain + full ROM of uninvolved joints
• remove dressing in 2-4 weeks
• keep wrist in forearm thumb spica splint - 0-20º extension to prevent active insufficiency

Phase 2 (4-16 weeks)

• AROM to wrist/thumb; AAROM and PROM start 1 week after AROM
• graded strengthening 3-4 weeks later
• remove splint throughout the day to perform ROM ex’s

Phase 3 (8-21 weeks):

• gentle mobs
• work on pinch grip since this is heavily affected