scholarly journals The Conformity of Rehabilitation Protocols Used for Different Cartilage Repairs of the Knee Joint—A Review on Rehabilitation Standards in German Speaking Countries

2021 ◽  
Vol 11 (19) ◽  
pp. 8873
Author(s):  
Clemens Memmel ◽  
Werner Krutsch ◽  
Matthias Koch ◽  
Moritz Riedl ◽  
Leopold Henssler ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cartilage Repair ◽  
Weight Bearing ◽  
Joint Space ◽  
Early Rehabilitation ◽  
Full Weight Bearing ◽  
Defect Zone ◽  
Rehabilitation Protocols ◽  
Osteochondral Autograft Transfer ◽  
Rehabilitation Needs

The present study analysed current rehabilitation protocols to investigate whether there is a standard for early rehabilitation after microfracturing (MFX), matrix-assisted cartilage transplantation (MACT), and osteochondral autograft transfer (OATS) of the knee joint in clinical routine, and if rehabilitation protocols differ in the repair technique used or the localization of the cartilage defect. The evaluation included rehabilitation criteria such as weight-bearing, range of motion, use of an orthosis, motion therapy, and rehabilitation training during the early rehabilitation phase after MFX, MACT, and OATS of the femorotibial and retropatellar joint space. We analysed 153 rehabilitation protocols after cartilage repair of the knee joint, including 137 protocols for after repair of the main weight-bearing (femorotibial) area and 16 for after retropatellar cartilage repair. Most of the protocols differed significantly according to the location of the repair and the procedure performed. Our findings indicate that full weight-bearing can be achieved significantly faster after MFX (5.6 weeks) and OATS (5.3 weeks) than after MACT of the main weight-bearing zone (6.6 weeks, p < 0.001). In addition, after retropatellar cartilage repair, patients are allowed full weight-bearing after 2.1 weeks compared to the main weight-bearing zone (5.3–6.6 weeks; p < 0.001). No standardized rehabilitation recommendations have been established. The present study shows that rehabilitation needs to be adjusted to the surgical technique and the location of the defect zone, and further investigation is warranted to establish standardized rehabilitation protocols after cartilage repair of the knee joint.

scholarly journals Quantitative Three-dimensional Assessment of Knee Joint Space Width from Weight-bearing CT

Radiology ◽  
2021 ◽  
pp. 203928
Author(s):  
Tom D. Turmezei ◽  
Samantha B. Low ◽  
Simon Rupret ◽  
Graham M. Treece ◽  
Andrew H. Gee ◽  
...  
Keyword(s):  
Knee Joint ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Joint Space Width ◽  
Joint Space ◽  
Dimensional Assessment ◽  
Space Width

Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

2020 ◽  
Vol 13 ◽  
pp. 152-159 ◽  
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Megan Bechtold ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Return To Sport ◽  
Full Weight Bearing ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Operative Care ◽  
Ankle Ligament ◽  
Rehabilitation Protocols ◽  
Lateral Ankle Ligament ◽  
Suture Tape

Introduction. Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study was to analyze and assess the variability across different rehabilitation protocols for patients undergoing either lateral ankle ligament repair, reconstruction, and suture tape augmentation. Methods. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria were protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weight-bearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. Results. Twenty-six protocols were analyzed. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. All (12/12) repair, internal brace, and unspecified protocols and 86% (12/14) of reconstruction protocols recommended no ROM immediately postoperatively. Eighty-six percent (6/7) of repair and 78% (11/14) of reconstruction protocols recommended no weight-bearing immediately after surgery, making post-operative ROM and weight-bearing status the most consistent aspects across protocols. Five protocols allowed post-operative weight-bearing in a cast to keep ROM restricted. Sixty-six percent (2/3) of suture tape augmentation protocols allowed full weight-bearing immediately post-operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker time-line with full weight-bearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3) protocols. RTS was consistent in repair protocols (100% at week 12-16) but varied more in reconstruction. Conclusion. There is significant variability in the post-operative protocols after surgery for ankle instability. ROM was highly variable across protocols and did not always match-up with supporting literature for early mobilization of the ankle. Return to sport was most likely to correlate between protocols and the literature. Weight-bearing was consistent between most protocols but requires further research to determine the best practice. Overall, the variability between programs demonstrated the need for standardization of rehabilitation protocols.

The association between external-ground-reaction force and knee-joint kinetics during partial- and full-weight-bearing gait

2010 ◽  
Vol 25 (4) ◽  
pp. 359-364 ◽  
Author(s):  
Jay R. Ebert ◽  
David G. Lloyd ◽  
Anne Smith ◽  
Timothy Ackland ◽  
David J. Wood
Keyword(s):  
Knee Joint ◽  
Ground Reaction Force ◽  
Weight Bearing ◽  
Reaction Force ◽  
Full Weight Bearing ◽  
Joint Kinetics

scholarly journals Proximal fibular osteotomy for pain relief and functional improvement in patients of osteoarthritis of knee

2019 ◽  
Vol 6 (7) ◽  
pp. 2368 ◽  
Author(s):  
Anil Kumar Rai ◽  
Anand Saurabh ◽  
Shubhanshu Shekhar ◽  
Abhijeet Kunwar ◽  
Vishal Verma
Keyword(s):  
Pain Relief ◽  
Knee Joint ◽  
Lower Extremity ◽  
Weight Bearing ◽  
Lateral Compartment ◽  
Joint Space ◽  
Functional Improvement ◽  
Fibular Osteotomy ◽  
Short Term Study ◽  
Almost All

Background: The aim of this study was to evaluate the effect of proximal fibular osteotomy in relieving pain and functional improvement in patients of osteoarthritis knee.Methods: We selected 38 patients with KOA, out of which 30 patients gave written informed consent and underwent proximal fibular osteotomy. The median time of follow-up was 13.3 months. Preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained to analyse the alignment of the lower extremity (tibio-femoral angle) and ratio of the knee joint space (medial/lateral compartment). Assessment of knee pain was done using a visual analogue scale, and knee functional activities were evaluated using the American Knee Society score (KSS 1 and 2) preoperatively and postoperatively.Results: Pain relief was observed in almost all patients after proximal fibular osteotomy. Weight-bearing lower extremity radiographs showed significant change in tibio-femoral angle an average increase in the postoperative medial knee joint space. Additionally, obvious change in alignment was observed in the whole lower extremity radiographs in 24 out of 30 patients. In three patients tibio-femoral angle showed progressive more varus alignment after proximal fibulectomy.Conclusions: In short-term study, proximal fibular osteotomy provides pain relief and functional wellbeing to the patients of KOA.

Assessing Foot Loads in Continuous Passive Motion (CPM) and Active Knee Joint Motion Devices

2019 ◽  
Author(s):  
Benedikt Stolz ◽  
Casper Grim ◽  
Christoph Lutter ◽  
Kolja Gelse ◽  
Monika Schell ◽  
...  
Keyword(s):  
Knee Joint ◽  
Weight Bearing ◽  
Continuous Passive Motion ◽  
Full Weight Bearing ◽  
Joint Motion ◽  
Active Motion ◽  
Passive Motion ◽  
Normal Gait ◽  
Knee Joint Motion ◽  
Joint Load

Abstract Background Continuous passive motion (CPM) and active knee joint motion devices are commonly applied after various surgical procedures. Despite the growing use of active motion devices, there is a paucity of data comparing plantar loads between the different mobilization techniques. The aim of this study was to investigate foot loads during knee joint mobilization in continuous passive and active knee joint motion devices and to compare this data to the physiological load of full weight-bearing. Patients/Material and Methods Fifteen healthy participants (7 women and 8 men, 25 ± 3 years, 66 ± 6 kg, 175 ± 10 cm, BMI 21.9 ± 2) were recruited. Plantar loads were measured via dynamic pedobarography using a continuous passive motion device (ARTROMOT-K1, ORMED GmbH, Freiburg, Germany) and an active motion device (CAMOped, OPED AG, Cham, Switzerland), each with a restricted range of motion of 0-0-90° (ex/flex) and free ROM for the knee joint. For the active motion device, cycles were performed at four different resistance levels (0-III). Data were assessed using the pedar® X system (Novel Inc., Munich, Germany), which monitors loads from the foot-sole interface. Force values were compared between motion devices and normal gait, which served as the reference for conditions of full weight-bearing. P-values of < 0.05 were considered statistically significant. Results Normal gait revealed peak forces of 694 ± 96 N, defined as 100 %. The CPM device produced plantar forces of less than 1.5 N. Using the active motion device in the setting of 0-0-90° produced foot loads of < 1.5 N (resistance 0-II) and 3.4 ± 9.3 N with a resistance of III (p < 0.001). Conditions of free ROM resulted in foot loads of 4.5 ± 4.5 N (resistance 0), 7.7 ± 10.7 N (resistance I), 6.7 ± 10.4 (resistance II) and 6.7 ± 6.9 N with a resistance of III (p < 0.001), corresponding to 0.6 %, 1.1 %, 1.0 % and 1.0 % of full weight-bearing, respectively. Conclusion Motion exercises of the knee joint can be performed both with passive and active devices in accordance with strict weight-bearing restrictions, which are often recommended by surgeons. Also, active motion devices can be used when the ankle joint or foot have to be offloaded. Further studies assessing intraarticular joint load conditions have to be performed to confirm the findings obtained in this study.

scholarly journals CLINICAL AND FUNCTIONAL OUTCOME OF PROXIMAL FIBULAR OSTEOTOMY AND ARTHROSCOPIC DEBRIDEMENT FOR MEDIAL COMPARTMENT OSTEOARTHRITIS OF KNEE

2020 ◽  
pp. 1-3
Author(s):  
Abhishek Chaturvedi ◽  
Amar Kamat ◽  
Abhishek Shinde ◽  
Abhishek Kulkarni ◽  
Vishwas Gawte
Keyword(s):  
Pain Relief ◽  
Knee Joint ◽  
Lower Extremity ◽  
Weight Bearing ◽  
Common Peroneal Nerve ◽  
Joint Space ◽  
Medial Compartment ◽  
Arthroscopic Debridement ◽  
Medial Compartment Osteoarthritis ◽  
Fibular Osteotomy

OBJECTIVE: To explore the effects of proximal fibular osteotomy and Arthroscopic debridement for pain relief and improvement of medial joint space and function in patients with knee osteoarthritis. METHODS: From January 2018 to December 2019, 22 patients who underwent proximal fibular osteotomy and arthroscopic debridement for medial compartment osteoarthritis were retrospectively followed up. To analyse the alignment of the lower extremity and ratio of the knee joint space (medial/lateral compartment preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained. Preoperatively and postoperatively at 6wks, 3 months, 6 months and 1 yr using a visual analogue scale,knee pain was assessed and knee ambulation activities were evaluated using the American Knee Society score RESULTS: Medial pain relief was observed in 20/22 patients after this procedure. Most patients exhibited improved walking postoperatively. An average increase in the postoperative medial knee joint space was seen in weight-bearing lower extremity radiographs. Additionally, obvious correction of alignment was observed in the whole lower extremity radiographs in 2 of 22 patients. But 25 % of patients had common peroneal nerve neuro-praxia which got improved over the period of average 6 months.
 CONCLUSIONS This study demonstrates that proximal fibular osteotomy and arthroscopic debridement in patients with medial compartment osteoarthritis effectively relieves pain and improves joint function at a mean of 15 months postoperative.

FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

2015 ◽  
Vol 21 (4.1) ◽  
pp. 638-642
Author(s):  
Andrius Brazaitis ◽  
Algirdas Tamosiunas ◽  
Janina Tutkuviene
Keyword(s):  
Patellar Instability ◽  
Weight Bearing ◽  
Patellofemoral Pain ◽  
Full Weight Bearing ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Full Extension ◽  
Low Degrees ◽  
Mri Study ◽  
Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

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