DOCSLIB.ORG

Knee Joint Distraction Compared with Total Knee Arthroplasty a RANDOMISED CONTROLLED TRIAL

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Knee Joint Distraction Compared with Total Knee Arthroplasty a RANDOMISED CONTROLLED TRIAL KNEE Knee joint distraction compared with total knee arthroplasty A RANDOMISED CONTROLLED TRIAL J. A. D. van der Woude, Aims K. Wiegant, Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the R. J. van Heerwaarden, goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We S. Spruijt, present a randomised controlled trial comparing the two. P. J. E m ans , Patients and Methods S. C. Mastbergen, The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either F. P. J. G. Lafeber KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, From UMC Utrecht, representing a surrogate marker of cartilage thickness. Utrecht, The Netherlands Results In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. J. A. D. van der Woude, MD, At one year, the TKA group showed a greater improvement in only one of the 16 patient- PhD, Resident in Orthopaedic Surgery, Limb and Knee related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology- Reconstruction Unit, Department of Orthopaedic Osteoarthritis Research Society International clinical response was 83% after TKA and 80% Surgery after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the R. J. van Heerwaarden, MD, PhD, Orthopaedic Surgeon, KJD group both mean minimum (0.9 mm, standard deviation (SD) 1.1) and mean JSW (1.2 mm, Limb and Knee Reconstruction Unit, Department of SD 1.1) increased significantly (p = 0.004 and p = 0.0003). Orthopaedic Surgery S. Spruijt, MD, Orthopaedic Conclusion Surgeon, Limb and Knee Reconstruction Unit, In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate Department of Orthopaedic inferiority of outcomes at one year when compared with TKA. However, there is a high Surgery Maartenskliniek Woerden, incidence of pin track infection associated with KJD. Woerden, The Netherlands. K. Wiegant, MD, PhD, Cite this article: Bone Joint J 2017;99-B:51–8. Resident in Orthopaedic Surgery, Rheumatology and In end-stage osteoarthritis (OA) of the knee a TKAs performed in patients aged under 65 Clinical Immunology total knee arthroplasty (TKA) is generally indi- years, a burden of revision arthroplasty may S. C. Mastbergen, PhD, 1 9-10 Associate Professor, cated. This intervention for OA was first per- well be generated. Rheumatology and Clinical Immunology formed in the 1970s and is now generally On this basis, joint-preserving surgery is an F. P. J. G. Lafeber, PhD, regarded as standard treatment.1,2 However, attractive option, but arthroscopic debride- Professor of Experimental Rheumatology, Rheumatology joint arthroplasty is not without drawbacks, ment, one of the most popular forms, is and Clinical Immunology, UMC Utrecht, Utrecht, The with up to 20% of patients dissatisfied with becoming less supported by modern evi- Netherlands. their TKA and up to 44% reporting continuing dence.11,12 Osteotomies have a place in uni- P. J. Emans, MD, PhD, pain, a third of whom reported extreme persis- compartmental disease and the KineSpring Orthopaedic Surgeon, 3-6 Department of Orthopaedics tent pain in one study. Patients younger than (Moximed Inc., Hayward, California) has MUMC Maastricht, Maastricht, The Netherlands. 55 years have an almost fivefold increase in the recently been introduced for medial compart- lifetime risk of revision surgery compared with ment disease, although long-term evidence of Correspondence should be sent 7 13,14 to F. P. J. G. Lafeber; email: those aged 75 years or older. One of the main its efficacy is yet to become available. [email protected] reasons for this is aseptic loosening, a charac- Knee joint distraction (KJD) has been pro- ©2017 The British Editorial teristic of implant wear, which is responsible posed as a temporising technique for sympto- Society of Bone & Joint 7,8 Surgery for more than 30% of revisions. Since wear matic, arthritic knees in younger patients and doi:10.1302/0301-620X.99B1. increases with both time and activity, a young comprises a six- to eight-week period of dis- BJJ-2016-0099.R3 $2.00 patient with relatively higher functional traction of the knee by means of an external Bone Joint J demands of the implant can experience signifi- fixator. A prospective, uncontrolled study of 2017;99-B:51–8. Received 17 March 2016; cantly more wear than their older, more seden- 20 patients aged below 60 years at five-year Accepted after revision 13 September 2016 tary counterparts. In addition, with 40% of follow-up reported clinical improvement and VOL. 99-B, No. 1, JANUARY 2017 51 52 J. A. D. VAN DER WOUDE, K. WIEGANT, R. J. VAN HEERWAARDEN, S. SPRUIJT, P. J. EMANS, S. C. MASTBERGEN, F. P. J. G. LAFEBER All surgery was performed by one of three surgeons (RJvH, SS or PJE). Knee arthroplasty was performed using the Genesis II posterior stabilised system (Smith & Nephew, Warsaw, Indiana) with fixation using GentaPala- cos cement (Heraeus, Hanau, Germany). Routine post- operative rehabilitation and venous thrombo-embolism prophylaxis was provided. Distraction surgery was per- formed using the Triax proof-of-concept external distrac- tion device (Stryker, Kalamazoo, Michigan), based around two tubes with internal 45 kg springs (Fig. 1). Eight fixa- tion pins were used to provide two points of fixation for each tube, each side of the knee. The knee was distracted by 2 mm intra-operatively and distracted a further 1 mm during the following three days, achieving total distraction of 5 mm. This was verified radiologically on post-operative Fig. 1 day four and patients were then discharged on crutches. Ini- tially patients were permitted to transmit up to 20% body Example of the bilateral external fixation frame used for knee joint dis- traction treatment (left) and an example of a radiograph (right) during weight through the operated limb, which increased to full distraction treatment with 5 mm of distraction. weight bearing within six weeks. Radiological evaluation of the distraction and clinical assessment of the pin sites evidence of cartilage repair. If these results were to be gen- was made at three weeks post-operatively in the outpatient erally applicable, the possibility arises of delaying the clinic. The fixator was removed at six weeks. Patients were requirement of TKA in young patients.15-18 prescribed low molecular weight heparin for the duration This study is a randomised controlled trial comparing of fixation and for three weeks thereafter. outcomes of KJD with TKA at one year. A total of 60 patients were recruited to the study, with four withdrawing consent once randomised to TKA, leav- Patients and Methods ing a population of 56 patients (Fig. 2). The demographic This study was conducted in two centres between 2011 and characteristics of the participants are given in Table I.22 2014. Randomisation was conducted in a 2:1 ratio in favour Initial baseline scores were taken at randomisation, and of TKA in blocks of six by a sealed envelope method. The again the day before surgery. Questionnaires were further ratio was a condition of the institutional review board’s completed at three, six, nine and 12 months post- favourable opinion. Group size calculation was based on a operatively. non-inferiority hypothesis. The sample size was based on The WOMAC and knee injury and osteoarthritis out- non-inferiority in the primary outcome measure, the Western come score (KOOS)23 were used to score clinical improve- Ontario and McMaster Universities Osteoarthritis Index ment, normalised to a 100-point scale with 100 being the (WOMAC),19 with a 5% type I error, and with a power of best condition possible. The intermittent and constant 80%.20 A 15% margin was allowed for loss to follow-up. A osteoarthritis pain score (ICOAP)24 for the knee was the difference in WOMAC score of more than 15 points (stand- secondary clinical outcome parameter (0 to 100, 0 repre- ard deviation (SD) 16.7) compared with the TKA group was senting no pain). A visual analogue scale for pain (VAS- considered clinically relevant.21 This resulted in group sizes pain; 0 mm to 100 mm, 0 representing no pain and 100 of 40 patients for TKA and 20 for KJD. Neither patient nor severe pain) was the tertiary clinical outcome parameter. surgeon was blinded to treatment. The EuroQol (EQ)-5D-3L25 was used to assess improve- Inclusion criteria were OA of the knee and eligibility for ment of quality of life. The obtained questionnaire was TKA according to routine standard of care, age ≤ 65 years, transformed to an EQ-5D index score (0 to 1, 1 being best). functionally intact knee ligaments, ≥ 120° flexion at the The Short Form (SF)-36 health survey26 was used to meas- knee and body mass index (BMI) < 35 kg/m2. Patients with ure the health status of the patients. The SF-36 items were primary patellofemoral OA were excluded, as were those converted to physical (PCS) and mental (MCS) component with a history of inflammatory or septic arthritis, inability summary scores. At baseline, three, six, nine and 12 months to tolerate external fixation, an already ankylosed knee, the KOOS/WOMAC, ICOAP, EQ-5D-3L and VAS-pain post-traumatic fibrosis due to a fracture of the tibial pla- were recorded. At baseline, six, and 12 months the SF-36 teau, previous surgery on the same knee within the past six was recorded. months, or previous joint arthroplasties. The study was Radiographs of the KJD group were obtained at baseline granted ethical approval (No 10/359/E) and was registered and 12 months post-operatively.
Load more

Recommended publications
  • Knee Flow Chart Acute
    Symptom chart for acute knee pain START HERE Did the knee pain begin Does the knee joint You may have a fracture or Stop what you are doing immediately and go to a hospital emergency room YES YES suddenly, with an injury, appear deformed, or dislocated patella. or an orthopedic surgeon specializing in knee problems. slip, fall, or collision? out of position? If possible, splint the leg to limit the movement of the knee until you reach NO the doctor. Do not put any weight on the knee. Use a wheelchair, a cane, or NO crutch to prevent putting any weight on the leg, which might cause further damage to the joint. GO TO FLOW CHART #2 Go to an orthopedic surgeon Stop what you are doing. Continuing activity despite the feeling that the knee ON CHRONIC KNEE Did you hear a “pop” YES immediately, you may have is unstable can cause additional damage to other ligaments, meniscus , and PROBLEMS THAT DEVELOP and does your knee feel torn your anterior cruciate, or cartilage. Try ice on the knee to control swelling. Take anti-in ammatories OR WORSEN OVER TIME. unstable or wobbly? other ligaments in the knee. like Advil or Nuprin until your doctor’s appointment. About a third of ligament tears get better with exercises, a third may need a brace, and a third may need sur gery. NO Use R•I•C•E for sore knees Does your knee hurt YES You may have damaged the articular Try anti-in ammatories, as directed on the bottle, for two days to reduce R: Rest as you bend it? cartilage on the bottom of the the chronic in ammation.
    [Show full text]
  • Medical Terminology Abbreviations Medical Terminology Abbreviations
    34 MEDICAL TERMINOLOGY ABBREVIATIONS MEDICAL TERMINOLOGY ABBREVIATIONS The following list contains some of the most common abbreviations found in medical records. Please note that in medical terminology, the capitalization of letters bears significance as to the meaning of certain terms, and is often used to distinguish terms with similar acronyms. @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial blood gas a.c.—before meals ac & cl—acetest and clinitest ACLS—advanced cardiac life support AD—right ear ADL—activities of daily living ad lib—as desired adm—admission afeb—afebrile, no fever AFB—acid-fast bacillus AKA—above the knee alb—albumin alt dieb—alternate days (every other day) am—morning AMA—against medical advice amal—amalgam amb—ambulate, walk AMI—acute myocardial infarction amt—amount ANS—automatic nervous system ant—anterior AOx3—alert and oriented to person, time, and place Ap—apical AP—apical pulse approx—approximately aq—aqueous ARDS—acute respiratory distress syndrome AS—left ear ASA—aspirin asap (ASAP)—as soon as possible as tol—as tolerated ATD—admission, transfer, discharge AU—both ears Ax—axillary BE—barium enema bid—twice a day bil, bilateral—both sides BK—below knee BKA—below the knee amputation bl—blood bl wk—blood work BLS—basic life support BM—bowel movement BOW—bag of waters B/P—blood pressure bpm—beats per minute BR—bed rest MEDICAL TERMINOLOGY ABBREVIATIONS 35 BRP—bathroom privileges BS—breath sounds BSI—body substance isolation BSO—bilateral salpingo-oophorectomy BUN—blood, urea, nitrogen
    [Show full text]
  • About Your Knee
    OrthoInfo Basics About Your Knee What are the parts of the knee? Your knee is Your knee is made up of four main things: bones, cartilage, ligaments, the largest joint and tendons. in your body Bones. Three bones meet to form your knee joint: your thighbone and one of the (femur), shinbone (tibia), and kneecap (patella). Your patella sits in most complex. front of the joint and provides some protection. It is also vital Articular cartilage. The ends of your thighbone and shinbone are covered with articular cartilage. This slippery substance to movement. helps your knee bones glide smoothly across each other as you bend or straighten your leg. Because you use it so Two wedge-shaped pieces of meniscal cartilage act as much, it is vulnerable to Meniscus. “shock absorbers” between your thighbone and shinbone. Different injury. Because it is made from articular cartilage, the meniscus is tough and rubbery to help up of so many parts, cushion and stabilize the joint. When people talk about torn cartilage many different things in the knee, they are usually referring to torn meniscus. can go wrong. Knee pain or injury Femur is one of the most (thighbone) common reasons people Patella (kneecap) see their doctors. Most knee problems can be prevented or treated with simple measures, such as exercise or Articular cartilage training programs. Other problems require surgery Meniscus to correct. Tibia (shinbone) 1 OrthoInfo Basics — About Your Knee What are ligaments and tendons? Ligaments and tendons connect your thighbone Collateral ligaments. These are found on to the bones in your lower leg.
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • ANTERIOR KNEE PAIN Home Exercises
    ANTERIOR KNEE PAIN Home Exercises Anterior knee pain is pain that occurs at the front and center of the knee. It can be caused by many different problems, including: • Weak or overused muscles • Chondromalacia of the patella (softening and breakdown of the cartilage on the underside of the kneecap) • Inflammations and tendon injury (bursitis, tendonitis) • Loose ligaments with instability of the kneecap • Articular cartilage damage (chondromalacia patella) • Swelling due to fluid buildup in the knee joint • An overload of the extensor mechanism of the knee with or without malalignment of the patella You may feel pain after exercising or when you sit too long. The pain may be a nagging ache or an occasional sharp twinge. Because the pain is around the front of your knee, treatment has traditionally focused on the knee itself and may include taping or bracing the kneecap, or patel- la, and/ or strengthening the thigh muscle—the quadriceps—that helps control your kneecap to improve the contact area between the kneecap and the thigh bone, or femur, beneath it. Howev- er, recent evidence suggests that strengthening your hip and core muscles can also help. The control of your knee from side to side comes from the glutes and core control; that is why those areas are so important in management of anterior knee pain. The exercises below will work on a combination of flexibility and strength of your knee, hip, and core. Although some soreness with exercise is expected, we do not want any sharp pain–pain that gets worse with each rep of an exercise or any increased soreness for more than 24 hours.
    [Show full text]
  • Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction
    UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction The knee joint is comprised of an A B articulation of three bones: the femur Medial (thigh bone), tibia (shin bone), Collateral Ligament Lateral and patella (knee cap). The femur (MCL) Collateral has a medial (inside) and a lateral Ligament (outside) condyle that forms a radial (LCL) or rounded bottom that comes together, forming a trochlear groove for the patella to move. The medial and lateral condyle sit on top of the Fat LM Fat Pad tibia, which has a flat surface called Pad MM the tibial plateau. The knee also is comprised of two Fibula menisci, which are fibro-cartilaginous structures and each meniscus Figure 1 a: Medial or inner view of the knee showing the medial collateral ligament, is thinner towards the center of b: Lateral or outer view of the knee showing the lateral collateral ligament. the knee and thicker toward the Image property of Primal Pictures, Ltd., primalpictures.com. Use of this image without authorization from Primal Pictures, Ltd. is prohibited. periphery of the knee, giving it a wedge-shaped appearance. The Femur medial meniscus forms a “c” shape and is located between the medial ACL femoral condyle and the medial ACL LCL aspect of the tibia. The lateral meniscus forms an oval shape and is PCL located between the lateral femoral condyle and the lateral aspect of the MM LM tibia. The menisci act to improve stability between the tibia and the Menisci MCL Tibia femur secondary to its wedge shape that acts to limit translation.
    [Show full text]
  • Patellar Tendon Tear - Orthoinfo - AAOS 6/14/19, 11:18 AM
    Patellar Tendon Tear - OrthoInfo - AAOS 6/14/19, 11:18 AM DISEASES & CONDITIONS Patellar Tendon Tear Tendons are strong cords of fibrous tissue that attach muscles to bones. The patellar tendon works with the muscles in the front of your thigh to straighten your leg. Small tears of the tendon can make it difficult to walk and participate in other daily activities. A large tear of the patellar tendon is a disabling injury. It usually requires surgery and physical therapy to regain full knee function. Anatomy The tendons of the knee. Muscles are connected to bones by tendons. The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia). It is actually a ligament that connects to two different bones, the patella and the tibia. The patella is attached to the quadriceps muscles by the quadriceps tendon. Working together, the quadriceps muscles, quadriceps tendon and patellar tendon straighten the knee. https://orthoinfo.aaos.org/en/diseases--conditions/patellar-tendon-tear/ Page 1 of 9 Patellar Tendon Tear - OrthoInfo - AAOS 6/14/19, 11:18 AM Description Patellar tendon tears can be either partial or complete. Partial tears. Many tears do not completely disrupt the soft tissue. This is similar to a rope stretched so far that some of the fibers are frayed, but the rope is still in one piece. Complete tears. A complete tear will disrupt the soft tissue into two pieces. When the patellar tendon is completely torn, the tendon is separated from the kneecap. Without this attachment, you cannot straighten your knee.
    [Show full text]
  • Knee History
    Knee History Name:___________________________________ Age:__________ Occupation:_______________________________ Which Knee is involved: Right Left Both When did the symptoms first appear: Date:_________ How did symptoms occur: (Check One) No apparent injury (started slow) Sports injury: Type of sport:_____________________ Motor vehicle accident Date:___________________ Fall Unknown If injured, how did injury occur: (Check all that apply) Twist Direct Trauma to the knee Forced bend to the knee Force straightening to the knee Quick stop when leg is in motion In injured, at time of trauma did you: (Check all that apply) Hear a pop at the time of the injury Have immediate swelling within six hours Develop swelling after six hours What treatment have you had: (Check all that apply) X-rays MRI or CAT scan ER Visit Other physicians, Please list:___________________________________ Medications for knees:________________________________________ Physical Therapy: Dates:______________________________________ Surgeries (List date and type i.e. arthroscopy, reconstruction, etc.) Date:______________ Type:__________________________ Date:______________ Type:__________________________ Date:______________ Type:__________________________ Past Knee History - Any previous injury to injured knee or knees: Date of injury____________________ Type of Injury____________________ Type of Treatment_________________ Page 2 Knee History CURRENT SYMPTOMS What is the level of your pain: (Check one in each column) Mild Dull No Ache Moderate Sharp (knife like) Intermittent
    [Show full text]
  • Medial Meniscus Anatomy
    Quantitative and Qualitative Assessment of the Posterior Medial Meniscus Anatomy Defining Meniscal Ramp Lesions Nicholas N. DePhillipo,*y MS, ATC, OTC, Gilbert Moatshe,yz§ MD, PhD, Jorge Chahla,z MD, PhD, Zach S. Aman,z BA, Hunter W. Storaci,z MSc, Elizabeth R. Morris,z BA, Colin M. Robbins,z BA, Lars Engebretsen,§ MD, PhD, and Robert F. LaPrade,*k MD, PhD Investigation performed at Steadman Philippon Research Institute, Vail, Colorado, USA Background: Meniscal ramp lesions have been defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus (PHMM) at the meniscocapsular junction or an injury to the meniscotibial attachment. Precise anatomic descriptions of these structures are limited in the current literature. Purpose: To quantitatively and qualitatively describe the PHMM and posteromedial capsule anatomy pertaining to the location of a meniscal ramp lesion with reference to surgically relevant landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen male nonpaired fresh-frozen cadavers were used. The locations of the posteromedial meniscocapsular and meniscotibial attachments were identified. Measurements to surgically relevant landmarks were performed with a coordinate measuring system. To further analyze the posteromedial meniscocapsular and meniscotibial attachments, hematoxylin and eosin and alcian blue staining were conducted on a separate sample of 10 nonpaired specimens. Results: The posterior meniscocapsular attachment had a mean 6 SD length of 20.2 6 6.0 mm and attached posteroinferiorly to the PHMM at a mean depth of 36.4% of the total posterior meniscal height. The posterior meniscotibial ligament attached on the PHMM 16.5 mm posterior and 7.7 mm medial to the center of the posterior medial meniscal root attachment.
    [Show full text]
  • Guidebook for Hips and Knees Personal Health Care Contact Information
    Guidebook for Hips and Knees Personal Health Care Contact Information Name: Date of Surgery: Surgeon: Primary Care Physician (PCP): Phone #: Phone# Pharmacy: Emergency Contact: Address: Relationship: Phone #: Phone #: 2 • piedmont.org/orthopedics Guidebook for Hips and Knees Welcome Welcome to Piedmont Healthcare. We are delighted you have chosen Piedmont for your joint replacement surgery. We are dedicated to making your healthcare experience the best it can be, returning you to independent living and to an improved quality of life. Congratulations on taking a great next step toward getting back on track to an active and healthy life. It is our pleasure to serve and guide you on this journey. Our goal at Piedmont is to provide you with the best experience possible. We pride ourselves on the high quality care that our skilled care teams and talented physicians provide to thousands of people per year across the southeast. We believe the more information you have on what to expect before, during, and after your joint replacement surgery, the more empowered you will be to actively partner with us in making your surgery and recovery a success. We hope that you take advantage of everything that we have to offer and become an expert about your health and care in preparation for your surgery. • In-person Joint School o Available in your community at most Piedmont hospitals • Orthopedic Nurse Navigators o RNs who are your advocate. They teach Joint School, assist with pre-operative preparation, provide support throughout treatment, answer questions
    [Show full text]
  • Anatomy and Physiology of the Human Knee Joint
    Curriculum Units by Fellows of the Yale-New Haven Teachers Institute 1985 Volume VII: Skeletal Materials- Biomineralization Anatomy and Physiology of the Human Knee Joint Curriculum Unit 85.07.06 by Mara A. Dunleavy Introduction This unit takes an indepth look at a very complex part of the human anatomy, the knee joint. There are numerous structures that are found in this joint, classified as a diarthrodial or synovial joint. Study of this area must include a review of the skeletal and muscular systems in order to see how they interact under normal use. Some knee injuries and the pathologies will be considered. The objectives of this unit are: 1. to introduce the student to the skeletal system with emphasis on the lower extremity; 2. to explain the chemical make-up of bone and the process of ossification; 3. to differentiate between the types of joints in the human body; 4. to introduce the student to the muscular system, with emphasis on those muscle groups of the leg; 5. to describe other structures that are essential for normal movement of this diarthrodial joint, including ligaments, tendons, cartilage and bursa; 6. to explain, demonstrate, and illustrate the coordination of the different systems and each of their specializations; 7. to describe some knee injuries and the pathologies. The outline of the unit is divided into the following five parts: I. Bone, as a tissue Curriculum Unit 85.07.06 1 of 15 a. Histology of bone b. Other tissues related to bones as organs II. Skeleton, bones as organs or structures a.
    [Show full text]
  • Posterior Cruciate Ligament Tears: Functional and Postoperative Rehabilitation
    Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-012-1970-1 KNEE Posterior cruciate ligament tears: functional and postoperative rehabilitation Casey M. Pierce • Luke O’Brien • Laurie Wohlt Griffin • Robert F. LaPrade Received: 8 November 2011 / Accepted: 12 March 2012 Ó Springer-Verlag 2012 Abstract whether nonoperative or postoperative, should include early Purpose Historically, the results of posterior cruciate immobilization (when necessary), prone passive range of ligament (PCL) reconstructions are not as favourable as motion to prevent placing undue stress on grafts or healing anterior cruciate ligament (ACL) reconstructions, and it is tissue, and progression of rehabilitation based on biome- well recognized that nonoperative treatment and postop- chanical, clinical, and basic science research. erative rehabilitation for PCL injuries must be altered Conclusions An optimal set of guidelines for the non- compared to those for ACL injuries. The purpose of this operative or postoperative management of PCL injuries has article was to review current peer-reviewed PCL rehabili- not yet been defined or agreed upon. Based on the current tation programmes and to recommend a nonoperative and review study, suggested guidelines are proposed. postoperative programme based on basic science and Level of evidence IV. published outcomes studies. Methods To discover the current practices being used to Keywords PCL Á Treatment Á Nonoperative rehabilitation Á rehabilitate PCL injuries, we conducted a search of Pub- Postoperative rehabilitation Á Guidelines Med with the terms ‘‘posterior cruciate ligament’’ and ‘‘rehabilitation’’ from 1983 to 2011. All articles within the reference lists of these articles were also examined to Introduction determine their rehabilitation programmes. Results A review of peer-reviewed PCL rehabilitation Unlike the anterior cruciate ligament (ACL), the posterior protocols revealed that the treatment of PCL injuries depends cruciate ligament (PCL) has an intrinsic ability to heal and on the timing and degree of the injury.
    [Show full text]