knee injuries & surgical inteventions
DESCRIPTION
MedRisk August Webinar from John Knecht.TRANSCRIPT
MedRisk Learning CenterKnee Injuries & Surgical Interventions August 4, 2011
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» Your instructor: John Knecht MA, PT, ATC Select Medical Center Manager
Manchester, CT East Hartford, CT
Performs FCEs & Biodex testing
» Please submit written questions by clicking the Q&A tab at top of screen, John will answer at end of presentation
Work Related Knee Injuries and Surgical Interventions
John F. Knecht MA, PT, ATC, SCS
Basic Anatomy of Knee
Largest and most complex joint in the body.
3 joints within a single synovial cavity. Medial Tibiofemoral Lateral Tibiofemoral Patellofemoral
Synovial Joint: Syn = together The bones forming the
joint have a synovial cavity and are united by dense irregular connective tissue of an articular capsule, and often accessory ligaments.
Diarthrosis- free moving joint.
Bone/Synovial Anatomy
Ligament/ Muscle Anatomy
Cruciates Anterior Posterior
Collaterals Medial Lateral
Anatomy:Anterior and Posterior Cruciates
MCL/LCL Anatomy
Common Injuries in Work Setting
TraumaSlip/Trip/Falls (STF)
All Slip, Trip & Fall incidents are preventable through proper awareness and housekeeping practices.
Direct Blow Hyperextension Overuse/Repetitive Motion
Trauma
Slip/Trip/Falls (STF)Cords, Cables, and Tubes – Safely and
appropriately secure all cords, cables, and tubes
from items such as: computers, printers, telephones, extension cords, call buttons, and medical equipment. Where appropriate, use cord ties, cable wraps/clips, hook and loop fasteners, or duct tape to keep these hazards out of the path of travel.
STF continue
Clutter and Debris – Keep floors and stairs free of clutter and debris. A slip on something as small as a needle cap/grape can cause a severe STF injury.
Direct Blow
Landing on bent knee
Object hitting knee Contusion/bruise
Hyperextension Injuries
Knee moves backward, feels like it “gives out” or “buckles”.
Overuse/Repetitive Injuries
Squatting Lunging Kneeling
ACL Surgeries
Approximately 100,000/yr in U.S. B-PT-B Quadruple Hamstring Allograft Quad tendon Primary (partial tears–with bone marrow stimulation)
Gobbi et al, Am J Sports Med 2009 Milan, Italy
Beecher et al, JOSPT May 2010 South Carolina, USA
ACL Reconstruction:Tensile Load
Intact 2160 +/- 157 N Tensile Load
BPTB autograph 2376 +/- 151
Quadruple semi/gracilis 4108 +/- 200
Quad tendon autograph 2352 +/- 495
ACL reconstruction cont
Non-Surgical Intervention
NSAIDS X-ray MRI Physical Therapy
Rehabilitation: Pre, Post and Non-operative Overlapping Stages of Healing
Inflammation
Primary
Obligatory
Individual Adaptation
Inflammation Stage of Healing
Maximum ProtectionCritical to healingWant to control itLimit it to the 1st 24-48 hoursSets up healing process
Primary Stage of Healing
Moderate protectionKitting together of the tissues2 days to 6 weeksDefect is healed, but tissue is not strongNot ready to be tested
Obligatory Maturation Stage of Healing Minimal protection
6 weeks to 1 yearMaturing of the tissues in response to the
stressEverybody’s injured site needs to go through
this phaseDo the stresses that caused the problem
Individual Adaptation Stage of Healing Return to activity
Program adapted to individual
Design treatment programs to stress tissue so it becomes strong
Need to stress in a controlled and gradual way
S.A.I.D.- Specific Adaptations to Imposed Demands
Recuperation time for injuries
Bone 6-8 weeks
Soft tissue healing 8-12 weeks
Criteria to Return to Work
Full ROM Quad strength 85% of
contra-lateral side No pain No effusion No other symptoms
Hamstring strength 85% of contra-lateral side
Ham to quad ratio 70% or greater
Functional testing 85% or greater vs. contra-lateral side
Work Related testing
Lift/CarryWaist to shoulderFloor to waistFloor to shoulder
Push/PullCartsCablesPatients
Conclusion
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