Overview of Multiple Cartilage Sparing Techniques and Rehab Principles For The Knee
|
|
- Kristian Thornton
- 5 years ago
- Views:
Transcription
1 Overview of Multiple Cartilage Sparing Techniques and Rehab Principles For The Knee Owner & Founder of the Fischer Institute Trent Rincon, PT, MPT, CSCS Brett Fischer PT, ATC, CSCS,CertDN
2 The Knee Joint 2 types of The Knee Joint 2 types of Cartilage Cartilage (A) Meniscus: Cushion between the femur & tibia Made up of fibrocartilage ( Type I & II Collagen) (FIG I) (B) Articular: hyaline cartilage Smooth layer that covers the articular bones Has a fractional coefficient 1/5 of ice on ice Large portion is fluid which helps with compressive forces Poor ability to heal itself Has only a single type of cell for renewal the chondrocyte (FIG 2)
3 Osteoarthritis Of The Knee FIG 1 FIG 2 Credit: Dr. Greg Portland
4 Osteoarthritis Of The Knee FIG 3 FIG 4 Credit: Dr. Greg Portland
5 Overview of Surgical Options For: Articular Cartilage Restoration 1. Palliative Procedure 2. Intrinsic Repair Enhancement 3. Whole Tissue Transplantation of Hyaline Cartilage Autograft Allograft 4. Cell Based Repairs 5. Cell Based Repairs with Scaffold 6. Scaffold Based Repair 7. Minced Cartilage Repair
6 1. Palliative Procedure Clean Out Basically removed of loose fragments of cartilage or meniscus Short term relief Doesn t address the true problem
7 2. Intrinsic Repair Enhancement / Marrow Stimulation Procedure aka Microfracture Drilling of subchondral bone causing the release of mesenchymal stem cells from the bone marrow. This creates a fibrous tissue formation (not hyaline cartilage) The effectiveness depends on age, size & location of the defect and post op strategies Made popular by Vail, Co physician Dr. Richard Steadman
8 Intrinsic Repair Enhancement / Marrow Stimulation Procedure Positives Simple, inexpensive Negative The fibrous / clot formation is not as mechanically sound as hyaline cartilage Need 6-8 weeks of NWB in some cases with 8 hours of CPM Muscle atrophy, compliance issues Research has shown only a 44% returns to sport (Mithoefer, et al. Am I Sports Med 2006, Sep)
9 3. Whole Tissue Transplantation of Hyaline Cartilage (A) Autograft Mosaicplasty / OATS (B) Allograft - AOT
10 Whole Tissue Transplantation of Hyaline Cartilage (Autograft) Mosaicplasty AOCG (Autologous Osteochondral Grafting) OATS -similar to Mosaicplasty but bigger plugs and less in number Osteochondral plugs are taken from non-weight bearing areas on both femoral condyles with insertion of these plugs into defect area. Usually 3-6 weeks NWB followed by 3 to 6 more weeks PWB
11 Autograft Positives Defect is filled with mature hyaline cartilage Better results than microfx ( Krych, Harnly, Williams, J Bone Joint Surg AM, 2012) Negatives Only suitable for small defects Technically difficult Limited donor tissue available Donor site morbidly Non-impact activities until after 12 weeks Returns to sport 10 months & on
12 Whole Tissue Transplanation of Hyaline Cartilage Allograft (AOT) Similar procedure to mosaicplasty / OATS procedure except the cartilage is obtained from another donor Usually used for larger type chondral defects Cryopreserved Chondral grafts such as BioCartilage or Cartiform very popular brands used by Orthopods
13 Whole Tissue Transplantation of Hyaline Cartilage Allograft (AOT) Positives Well documented success Viable, fresh cells & sustainable matrix 88% return to sports ( Krych, Robertson, Williams, AM Journal of Sports Medicine 2012) Negatives Limited availability High Cost Disease Risk? Fresh allografts obtained hours earlier provide higher chondrocyte availability but carry a higher risk for disease transmission versus cryopreserved frozen allograft have reduced disease transmission but low chondrocyte availability.
14 4. Cell Based Repair Procedures ACI (carticel) PRP Stem Cell Orthokine / Regenokine
15 Autologous Chondrocyte Implantation (ACI) (Carticel) Procedure performed in 3 major phases Phase I Diagnostic arthroscopy with cartilage harvest Phase II Chondrocyte Cultivation in lab for 6 weeks Phase III Implantation surgery which consists of debridement of the defect, harvesting of the periosteal flap from the proximal tibia to help create a patch followed by injection of harvested and cultured chondrocytes under the patch.
16 Autologous Chondrocyte Implantation (ACI) (Carticel) Positives Somewhat favorable outcomes (vol. 4 Genzyme tissue repair, Cambridge, MA,1998) (891 Transplants 86% good to excellent results) Negatives Hypertrophy of the patch leads to another surgery Unreliable potential of re-implanted cartilage cells Less favorable at patellofemoral joint
17 PRP PRP - Platelet-Rich Plasma Basically infuses the joint via injection with high concretion of growth factors that promote healing and remolding. (In 2009, Drengk, et all in Cell Tissue Organ) reported that PRP creates proliferation of autologous chondrocytes + mesenchymal cells. This also increases hyaluronic acid secretion. These chondrocytes demonstrate less interleukin - 1B induced inhibition of Collagen II
18 PRP Positives Easy Non surgical Good outcomes for early osteoarthritis Negatives Limited lasting effect No Change on MRI Relatively, new treatment frequency still being debated
19 Stem Cell Procedures for Osteoarthritis Use of stem cell found in humans to promote healing within the joint by creating more chondrocyte cell Allogeneic mesochymal stem cells ( adult cells, not fetal, or embryonic, usually harvested from bone marrow or adipose tissue) Embryonic Stem Cells (Medical News Today, 3/4/2015) Univ of Manchester, U.K. promising new results
20 Stem Cell Procedures for Osteoarthritis Positives Less Invasive Easier Recovery Outpatient Basis Negative Science in still not there yet Costly
21 Orthokine / Regenukine Orthokine / Regenokine Experimental medical procedure in which the patients own blood is extracted, manipulated and then re-introduced to the body as an anti-inflammatory drug. Around 60 ML of blood is removed from the patient Developed in Germany by Dr. Reinecke and Dr.Wehling Focuses on treating the inflammation as opposed to the mechanical problem in the joint Different than PRP in that PRP, platelets are targeted whereas the interleukin 1 (an arthritic agent in one s blood) is targeted
22 Orthokine / Regenokine Positives Non Surgical Easy to administer Early results are good (accordantly to German studies 75% success rate) Negatives Costly (around $10,000 cost per joint) Not FDA Approved
23 5. Cell Based Repairs With Scaffold (Neocart) Similar to ACI in that patients own cells are harvested but these cells are then embedded into Type I collagen matrix and incubated in an unique processor that stimulates the cells to produce protein then implanted over the defect
24 Cell Based Repairs With Scaffold (Neocart) Positives Results are promising (Crawford, et all,j Bone Joint Surg 2012) Negatives Takes up to 9 weeks for final implantation Costly Long term studies not available
25 MACI Matrix-Introduced Autologous Chondrocyte Implantation Much like ACI procedure but collagen patch with cultured harvested cells is secured with fibrin glue Positives Early studies are processing (mostly in Europe) Negatives Not FDA Approved Costly Long Rehab time
26 6. Scaffold Based Repairs ( Trufit :by Smith & Nephew) Synthetic osteochondral graft by use of polymers, ceramics and fibers. The material is designed to be a highly porous scaffold to support issue incorporation and remodeling by absorbing biological fluids and nutrients, the material is biologically friendly. Positives Easily done arthroscopically Negatives Not available in US yet Mixed results so far Not FDA Approved
27 7. Minced Cartilage Repair DeNovo NT (Natural Tissue) Made out of minced cartilage from organ donors under the age of 13 Uses fibrin to stick minced carriage onto defect area Positives Not harvesting of own cells 1 step procedure immediate implantation Negatives Costly Limited availability, donors No long term studies / follow up
28 Goals of Evaluation Identify & treat the tissue and / or the cause Such as identity & treat ROM imbalances Restore / improve / facilitate proper Movement via manual therapy, Neuromuscular re-education, etc Establish rapport/trust with patient!
29 Overall Goal of Evaluation Basic understanding of the biomechanics of the lower chain, then functionally isolate to find specific deficits.( not symptom based treatment )
30 3 Planes Of Motion Gary Gray
31 3 Planes Of Motion Sagittal Plane Motion Gary Gray
32 3 Planes Of Motion Frontal Plane Motion Gary Gray
33 Gary Gray 3 Planes Of Motion Transverse Plane Motion
34 Gary Gray Kinetic Chain The body works synergistically with muscles, joints, and proprioceptors, all working together. There is a cause effect relationship in movement between force reduction and force production.
35 Definitions Pronation the collapsing or eccentric loading phase Supination the propulsion or concentric loading phase
36 Gait The basis for understanding the biomechanics of the Lower Extremity
37 Gait Evaluation Tips Movement Analysis You will only see what you are looking for be unbiased Gather data before you analyze, be systematic View each motion at 90 degrees to the plane observed Video when possible and freeze key motions & phases Mark calcaneal bisector, tibial tuberosity, lumbo-pelvic markers Choose appropriate speeds to cover all training speeds & over speed ( From Matthew Walsh, BSc., PT, Level III)
38 Gait Evaluation Tips Movement Analysis Mimic movements in your head, try to assemble all the factors together Allow speed changes, inclination & fatigue to be part of your evaluation Get a second opinion (often from a non PT!) Change as many variables as possible & analyze the effects (arms, vision, strike, shoes, speed, surface, camber) ( From Matthew Walsh, BSc.,PT, Level III )
39 Gait Evaluation - Checklist Foot/Ankle/Knee Metatarsal Phalangeal Extension deg terminal stance Forefoot Abduction/Adduction sign of the toes early midstance Longitudinal Arch navicular drop, early midstance Subtalar/Calcaneal Position deg total ROM Heel Rise 10 deg ROM during gait, view from side different timing in Running Pivoting (Terminal St.) in-toe or out toe, is it associated with foot or hip motion Knee Control (Initial Contact) is there excessive trunk flexion also, has the quad absorbed initial load Knee Alignment (Medial-Lateral) marker on the knee, view anterior Knee Flexion & swing line, Stance & swing Knee Extension (Initial Contact) Knee Extension (Single Limb Support or Initial Swing In Running) (From Mathew Walsh, BSc., PT, Level III )
40 Gait Evaluation - Checklist Hip/Pelvis/Lumbar Spine Pelvic Tilt (Trendelenburg) place markers or tape on iliac crest Pelvic Rotation that is, Lumbar spine rotation Hip Extension & Lumbar Extension best viewed side-on and from both sides Hip Flexion especially in the swing phase, 45 deg to the ground Femoral Rotation view anterior Hip abd/add 5-7 deg acceptable as normal Lumbar Side Flexion mark the skin or use tape, should be symmetrical to the hip abd/add ( From Matthew Walsh, BSc.,PT,Level III )
41 Gait Evaluation - Checklist Trunk & Arms Thoracic Flexion / Extension Scapular Posture Arm Swing compare the swing to the thoracic rotation, forearm position Breathing Pattern Head Movement Vertical look for the timing of the rise, should be midstance Lateral may indicate Trendelenburg or poor counter rotation (e.g. instability or structural scoliosis) Rotation usually indicates cervical or upper thoracic dysfunction, possibly scoliosis Center of Mass should follow a smooth curve of motion Cranial-Vertebral Posture - eyes level? (From Matthew Walsh, BSc., PT, Level III)
42 Ankle Dorsiflexion Passive / Standing
43 Standing MP Extension
44 Standing Calcaneal Eversion
45 Knee Flexion Single Leg Squat
46 Hip Rom IR/ER Supine
47 Hip Rom IR/ER Prone
48 Thomas Test Hip Flexor Psoas
49 Quad Bias Strength Test
50 Hamstring Bias Strength Test
51 Hip Abduction Bias Strength Test
52 Hip Rotation Strength Test
53 A Objective Evaluation - Posture Poor posture results in Altered Length-Tension Relationships Altered Force-Couple Relationships Altered joint Arthrokinetics From Dr. Michael Clark, MS,PT,PES,CSCS
54 From Dr. Michael A. Clark, MS,PT,PES,CSCS A Objective Evaluation - Posture Standard Posture Side View
55 From Dr. Michael A. Clark, MS,PT,PES,CSCS A Objective Evaluation - Posture Standard Posture Back View
56 Posture Objective Evaluation Posture Anterior View Head Rotated? Ear to shoulder height Shoulder ANT or POST rotated? Chest ANT or POST Hand Position Count knuckles Hip/Pelvis Lateral Shift? Knee Varus/Valgus? Extended/Flexed? Ankle Navicular Height
57 References Clark, Michael A., MS, PT, PES, CSCS. Integrated Kinetic Chain Assessment. National Academy of Sports Medicine: Integrated Training for the New Millenium, Gambetta, V., & Gray, G., PT. (n.d). Following the Functional Path. Gray, Gary. (1996). Chain Reaction Festival, 8,10. Walsh, Matthew, BSc, PT, Level III. (May 2003) The Running Course: Biomechanical Analysis and Rehabilitation. North American Seminars, Webster s Dictionary Online.
58 Special Acknowledgement Dr. Riley J Williams, HSS, NYC
59 Thank You!
Knee Preservation and Articular Cartilage Restoration
Knee Preservation and Articular Cartilage Restoration With Special Thanks to Aaron Krych, MD and Riley Willims, MD Zak Knutson, MD Articular Cartilage Layer of tissue covering the bone which are part of
More informationRehabilitation Protocol:
Rehabilitation Protocol: Patellofemoral resurfacing: Osteochondral Autograft Transplantation (OATS), Autologous Chondrocyte Implantation (ACI) and Microfracture Department of Orthopaedic Surgery Lahey
More informationBasics of Cartilage Restoration Introduction of TruFit
Basics of Cartilage Restoration Introduction of TruFit Philip A. Davidson, MD Heiden Orthopaedics Park City, Utah USA Smith & Nephew Seminar London, UK October 2008 Cartilage Restoration A wide realm between..
More informationTREATMENT OF CARTILAGE LESIONS
TREATMENT OF CARTILAGE LESIONS Angelo J. Colosimo, MD -Head Orthopaedic Surgeon University of Cincinnati Athletics -Director of Sports Medicine University of Cincinnati Medical Center -Associate Professor
More informationOSTEOCHONDRAL ALLOGRAFT RECONSTRUCTION FOR MASSIVE BONE DEFECT
OSTEOCHONDRAL ALLOGRAFT RECONSTRUCTION FOR MASSIVE BONE DEFECT Angelo J. Colosimo, MD -Head Orthopaedic Surgeon University of Cincinnati Athletics -Director of Sports Medicine University of Cincinnati
More informationOSTEOCHONDRAL ALLOGRAFTS AND AUTOGRAFTS IN THE TREATMENT OF FOCAL ARTICULAR CARTILAGE LESIONS
Status Active Medical and Behavioral Health Policy Section: Surgery Policy Number: IV-115 Effective Date: 10/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationRehabilitation Guidelines Following Microfracture Procedures to the Knee
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines Following Microfracture Procedures to the Knee There are two types of cartilage in the knee: meniscus and articular. One type of cartilage is the
More informationChondral Injuries in the Athlete
Chondral Injuries in the Athlete Michael J. Stuart MD Professor of Orthopedic Surgery Chair, Division of Sports Medicine Mayo Clinic 2013 MFMER slide-1 Michael J. Stuart MD February 5, 2014 Financial Relationships
More informationRehabilitation Protocol: Distal Femoral/Proximal Tibial Microfracture and Osteochondral Autograft Transplantation (OATS)
Rehabilitation Protocol: Distal Femoral/Proximal Tibial Microfracture and Osteochondral Autograft Transplantation (OATS) Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650
More informationPATIENT GUIDE TO CARTILAGE INJURIES
Lucas Wymore, MD Sports Medicine 23000 Moakley Street Suite 102 Leonardtown MD 20650 Office Phone: 301-475-5555 Office Fax: 301-475- 5914 Email: lwymore@somdortho.com PATIENT GUIDE TO CARTILAGE INJURIES
More informationAUTOLOGOUS CHONDROCYTE IMPLANTATION FOR FOCAL ARTICULAR CARTILAGE LESIONS
CARTILAGE LESIONS Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
More informationRunning Athlete: Part C. Case Analysis Materials
Running Athlete: Part C Case Analysis Materials Case 1 Subjective Examination (performed offcamera) Runs very sporadically, but generally 2-3 x per week around 2-4 miles Play recreational soccer Denies
More informationHip Arthroscopy Labral Repair Protocol
Hip Arthroscopy Labral Repair Protocol Applicability: Physician Practices Date Effective: 09/2013 Department: Rehabilitation Services Date Last Reviewed: 1/2018 Supersedes: n/a Administration Approval:
More informationACL Rehabilitation and Return To Play
ACL Rehabilitation and Return To Play Seth Gasser, MD Director of Sports Medicine Florida Orthopaedic Institute Introduction Return to Play: the point in recovery from an injury when a person is safely
More informationFunctional biomechanics of the lower limb
Functional biomechanics of the lower limb Ben and Matt. 24th July 2011 Principles of function Gravity Ground reaction Eco-concentric eccentric loading (preload) of a muscle (or group) is essential for
More informationHip Arthroscopy Protocol
The intent of this protocol is to provide guidelines for progression of rehabilitation, it is not intended to serve as a substitute for clinical decision making. Progression through each phase of rehabilitation
More informationArticular Cartilage Surgical Restoration Options
Articular Cartilage Surgical Restoration Options Randy Schwartzberg, M.D. Assistant Professor - UCF College of Medicine Rationale Our bodies do not make articular/hyaline cartilage. gics injections to
More informationHip Arthroscopy Femoroacetabular Impingement (FAI) Ryan W. Hess, MD Tracey Pederson, PCC Office: (763) Fax: (763)
Hip Arthroscopy Femoroacetabular Impingement (FAI) Ryan W. Hess, MD Tracey Pederson, PCC Office: (763) 302-2223 Fax: (763) 302-2401 GENERAL GUIDELINES: Despite the minimally invasive nature of hip arthroscopy,
More informationExercises to Correct Muscular Imbalances. presented by: Darrell Barnes, LAT, ATC, CSCS
Exercises to Correct Muscular Imbalances presented by: Darrell Barnes, LAT, ATC, CSCS Objectives Review Functional Anatomy Identify physical imbalances that lead to injury and/or decrease performance
More informationFunctional Movement Screen (Cook, 2001)
Functional Movement Screen (Cook, 2001) TEST 1 DEEP SQUAT Purpose - The Deep Squat is used to assess bilateral, symmetrical, mobility of the hips, knees, and ankles. The dowel held overhead assesses bilateral,
More information2/24/2014. Outline. Anterior Orthotic Management for the Chronic Post Stroke Patient. Terminology. Terminology ROM. Physical Evaluation
Outline Anterior Orthotic Management for the Chronic Post Stroke Patient Physical Evaluation Design Considerations Orthotic Design Jason M. Jennings CPO, LPO, FAAOP jajennings@hanger.com Primary patterning
More informationBiokinesiology of the Ankle Complex
Rehabilitation Considerations Following Ankle Fracture: Impact on Gait & Closed Kinetic Chain Function Disclosures David Nolan, PT, DPT, MS, OCS, SCS, CSCS I have no actual or potential conflict of interest
More informationIFAST Assessment. Name: Date: Sport: Review Health Risk Assessment on initial consult form. List Client Goals (what brings you here?
IFAST Assessment Name: Date: Sport: Review Health Risk Assessment on initial consult form List Client Goals (what brings you here?) Cardiovascular Measurements Blood Pressure Resting Heart Rate Body Composition
More informationRunner s Injury Prevention Program
Runner s Injury Prevention Program www.healthfitchiro.com Comprehensive Running Analysis Report Health-Fit Chiropractic & Sports Medicine Kevin M. Christie D.C. CSCS Report Summary (Phase 1) Dear Janet,
More informationCARTILAGE REPAIR PROCEDURES IN LARGE CARTILAGE DEFECTS
CARTILAGE REPAIR TECHNIQUES CARTILAGE REPAIR PROCEDURES IN LARGE CARTILAGE DEFECTS Written by Steffano Zaffagnini, Francesco Perdisa and Giuseppe Filardo, Italy Knee articular cartilage defects greater
More informationCorporate Medical Policy
Corporate Medical Policy Autologous Chondrocyte Implantation File Name: Origination: Last CAP Review: Next CAP Review: Last Review: autologous_chondrocyte_implantation 4/1996 6/2017 6/2018 6/2017 Description
More informationBalanced Body Movement Principles
Balanced Body Movement Principles How the Body Works and How to Train it. Module 3: Lower Body Strength and Power Developing Strength, Endurance and Power The lower body is our primary source of strength,
More informationAutologous Chondrocyte Implantation. Gerard Hardisty FRACS
Autologous Chondrocyte Implantation Gerard Hardisty FRACS Disclosure Orthopaedic Surgeons Strong as an OX and half as bright Orthopaedic Innovation Arthroscopy Joint replacement Trauma management MIS Early
More informationEvaluation of Gait Mechanics Using Computerized Plantar Surface Pressure Analysis and it s Relation to Common Musculoskeletal Problems
Evaluation of Gait Mechanics Using Computerized Plantar Surface Pressure Analysis and it s Relation to Common Musculoskeletal Problems Laws of Physics effecting gait Ground Reaction Forces Friction Stored
More informationSpecialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries. Cartilage Surgery. The Knee.
Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries Cartilage Surgery The Knee CARTILAGE INJURY Treatment of cartilage injury remains one of the most significant challenges
More informationGreetings From SCOI. Richard D. Ferkel, M.D
Greetings From SCOI Richard D. Ferkel, M.D OLT In the Athlete Operative Treatment and Return to Play The Following relationships exist: Royalties and stock options Smith and Nephew Consulting income
More informationStrategies for Pediatric Sports Rehabilitation. Marc Sherry PT, LAT, CSCS, PES
Strategies for Pediatric Sports Rehabilitation Marc Sherry PT, LAT, CSCS, PES 11-14-08 4 Pediatric Rehab Goals 1. Create athlete centered / parent supported treatment and education 2. Understand differential
More informationOsteochondritis Dissecans
Osteochondritis Dissecans Introduction Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn't
More informationMarrow (MSC) Stimulation Techniques: Microfracture/Microfracture Plus/Cartiform Kai Mithoefer, MD
Marrow (MSC) Stimulation Techniques: Microfracture/Microfracture Plus/Cartiform Kai Mithoefer, MD Harvard Vanguard Medical Associates New England Baptist Hospital Boston, USA Cartilage Repair Marrow Stimulation
More informationACI < > < > +/- MSC MSC MASS
Articular Cartilage Injury Natural History Management of Small Articular Cartilage Lesions Kai Mithoefer, MD Harvard Vanguard Medical Associates Harvard Medical School New England Baptist Hospital Boston,
More informationREHABILITATION FOLLOWING ACL RECONSTRUCTION PROTOCOL. WEEK 1: Knee immobilizer locked in extension. WBAT with bilateral crutches.
REHABILITATION FOLLOWING ACL RECONSTRUCTION PROTOCOL IMMEDIATE POST OPERATIVE PHASE Week 1: WEEK 1: Knee immobilizer locked in extension. WBAT with bilateral crutches. Ankle Pumps Passive knee extension
More informationDisclosures. How to approach cartilage repair. Articular Cartilage Problems: Surface Options
Disclosures I have the following potential conflicts of interest: Consulting payments/royalties and research support directly related to products discussed: Vericel (ACI) [consultant] SLACK publishing
More informationRehabilitation Guidelines for Anterior Cruciate Ligament (ACL) Reconstruction
Rehabilitation Guidelines for Anterior Cruciate Ligament (ACL) Reconstruction The knee is the body's largest joint, and the place where the femur, tibia, and patella meet to form a hinge-like joint. These
More informationTotal Hip Replacement Rehabilitation: Progression and Restrictions
Total Hip Replacement Rehabilitation: Progression and Restrictions The success of total hip replacement (THR) is a result of predictable pain relief, improvements in quality of life, and restoration of
More informationRunner with Recurrent Achilles Tendon Pain 4/21/2017
Young Runner with Recurrent Achilles Pain In alphabetical order: Kornelia Kulig PT, PhD, FAPTA Los Angeles, CA Lisa Meyer PT, DPT, OCS isports Physical Therapy Los Angeles, CA Liz Poppert MS, DPT, OCS
More informationright Initial examination established that you have 'flat feet'. Additional information left Left foot is more supinated possibly due to LLD
Motion analysis report for Feet In Focus at 25/01/2013 Personal data: Mathew Vaughan DEMO REPORT, 20 Churchill Way CF10 2DY Cardiff - United Kingdom Birthday: 03/01/1979 Telephone: 02920 644900 Email:
More informationFunctional Movement Test. Deep Squat
Functional Movement Test Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional
More informationAN OVERVIEW : Cartilage Treatment. Eric Thiel, MD. WVAM Conference 01/25/2019
AN OVERVIEW : Cartilage Treatment Eric Thiel, MD WVAM Conference 01/25/2019 No Disclosure The Science of Hyaline Cartilage I. HYALINE CARTILAGE BASIC SCIENCE Normal Anatomy Cartilage is hypocellular, avascular,
More information3/13/2018. Cartilage Cases. Case. Physical exam
Cartilage Cases Aaron J. Krych, MD Professor, Orthopedic Surgery Sports Medicine Fellowship Director Sports Medicine Research Fellowship Director Mayo Clinic 2014 MFMER slide-1 Case 19 yo F division I
More informationConnecting the Core. Rationale. Physiology. Paul J. Goodman, MS, CSCS. Athletes have been inundated with terminology
Connecting the Core Paul J. Goodman, MS, CSCS Athletes have been inundated with terminology and references to core development in recent years. However, little has been conveyed to these athletes on what
More informationAutografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions Policy Number: 7.01.78 Last Review: 2/2018 Origination: 8/2002 Next Review: 2/2019 Policy Blue Cross and Blue Shield of Kansas
More informationRN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT ***
HISTORY *** MECHANISM OF INJURY.. MOST IMPORTANT *** Age of patient - Certain conditions are more prevalent in particular age groups (Hip pain in children may refer to the knee from Legg-Calve-Perthes
More informationAnatomy. Anatomy deals with the structure of the human body, and includes a precise language on body positions and relationships between body parts.
Anatomy deals with the structure of the human body, and includes a precise language on body positions and relationships between body parts. Proper instruction on safe and efficient exercise technique requires
More informationTREATMENT GUIDELINES FOR GRADE 3 PCL TEAR
GENERAL CONSIDERATIONS Posterior cruciate ligament (PCL) injuries occur less frequently than anterior cruciate ligament (ACL) injuries, but are much more common than previously thought. The PCL is usually
More informationDorsal surface-the upper area or top of the foot. Terminology
It is important to learn the terminology as it relates to feet to properly communicate with referring physicians when necessary and to identify the relationship between the anatomical structure of the
More informationS p o r t s & O r t h o p a e d i c S p e c i a l i s t s D R. R Y A N F A D E R
S p o r t s & O r t h o p a e d i c S p e c i a l i s t s D R. R Y A N F A D E R H I P A R T H R O S C O P Y W I T H This protocol provides appropriate guidelines for the rehabilitation of patients following
More informationOSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION
OSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION FEMORAL CONDYLE REHABILITATION PROGRAM PHASE I - PROTECTION PHASE (WEEKS 0-6) Protection of healing tissue from load and shear forces Decrease pain and effusion
More informationDOES ALTERED BIOMECHANICS CAUSE BONE MARROW EDEMA?
DOES ALTERED BIOMECHANICS CAUSE BONE MARROW EDEMA? Alicia M. Yochum RN, DC, DACBR, RMSK DOES ALTERED BIOMECHANICS CAUSE BONE MARROW EDEMA? Mark E. Schweitzer, MD and Lawrence M. White MD Department of
More informationWhen are athletes ready for return to sports??? Functional Testing for Return to Sports. Important Factors Involved in Return to Sport
Functional Testing for Return to Sports Meg Jacobs PT Momentum Physical Therapy and Sports Rehab Mjacobs@wegetyouhealthy.com When are athletes ready for return to sports??? Post ACL reconstruction, average
More informationThese are rehabilitation guidelines for OSU Sports Medicine patients. Please contact us at if you have any questions.
OSU Sports Medicine Knee Microfracture Rehabilitation Guidelines These are rehabilitation guidelines for OSU Sports Medicine patients. Please contact us at 614-293-2385 if you have any questions. Rehabilitation
More informationREHABILITATION FOLLOWING ACL PTG RECONSTRUCTION
REHABILITATION FOLLOWING ACL PTG RECONSTRUCTION I. IMMEDIATE POST OPERATIVE PHASE POD 1 POD 2 to 3 Brace: EZ Wrap brace locked at zero degrees extension or Protonics Rehab System (PRS) as directed by physician
More informationRehabilitation Following ACL with Semitendinosus Reconstruction
Page 1 of 5 Rehabilitation Following ACL with Semitendinosus Reconstruction I. IMMEDIATE POSTOPERATIVE PHASE : Goals: 1) Protect ACL reconstruction 2) Reduce swelling & inflammation 3) Restore & maintain
More informationORTHOPEDICS BONE Recalcitrant nonunions In total hip replacement total knee surgery increased callus volume
ORTHOPEDICS Orthopedics has to do with a variety of tissue: bone, cartilage, tendon, ligament, muscle. In this regard orthopedic and sports medicine share the same tissue targets. Orthopedics is mostly
More informationKnee Articular Cartilage Restoration: From cells to the patient. Professor Lars Engebretsen, University of Oslo, Norway
Knee Articular Cartilage Restoration: From cells to the patient Professor Lars Engebretsen, University of Oslo, Norway Much of this started in 1994: I 1989 Grande et al -cartilage cell transplantation
More informationAMIC or ACI for arthroscopic repair of grade IV acetabular cartilage defects in femoroacetabular impingement.
AMIC or ACI for arthroscopic repair of grade IV acetabular cartilage defects in femoroacetabular impingement. Dr. Andrea Fontana Istituto Auxologico Italiano Milan - Italy Introduction Chondropathies of
More informationWhat This Is! What This Isn t! Insights Into Functional Training 5/27/15. #ideaworld. Chuck Wolf, MS, FAFS Thank you for coming!!!
Insights Into Functional Training Insights Into Functional Training 2015 IDEA Health & Fitness Association. All Rights Reserved. www.ideafit.com/world P R E S E N T E D B Y Chuck Wolf, MS, FAFS Human Motion
More informationCartilage Repair Options
Imaging of Cartilage Repair Carl S. Winalski, MD Imaging Institute Department of Biomedical Engineering Cleveland Clinic Cartilage Repair Options Direct repair Marrow stimulation Autologous transplantation
More informationCARTILAGE REPAIR INTRODUCTION. M. BERRUTO and G.M. PERETTI 1,2. Received January 6, Accepted January 8, 2013
CARTILAGE REPAIR INTRODUCTION M. BERRUTO and G.M. PERETTI 1,2 Gaetano Pini Orthopedic Institute, Milan; 1 Department of Biomedical Sciences for Health, University of Milan, 2 IRCCS Galeazzi Orthopedic
More informationHorizon Scanning Centre November Spheroids of human autologous matrix-associated chondrocytes (Chondrosphere) for articular cartilage defects
Horizon Scanning Centre November 2014 Spheroids of human autologous matrix-associated chondrocytes (Chondrosphere) for articular cartilage defects SUMMARY NIHR HSC ID: 8515 This briefing is based on information
More informationOsteochondritis Dissecans of the Knee. M Lucas Murnaghan MD, MEd, FRCSC
Osteochondritis Dissecans of the Knee M Lucas Murnaghan MD, MEd, FRCSC Outline 1. Clinical Presentation 2. Investigations 3. Classification 4. Non-operative Treatment 5. Operative Treatment 6. Treatment
More informationAPTA Intro to Identity. The Movement System The Kinesiopathologic Model Movement System Impairment Syndromes of the Knee THE HUMAN MOVEMENT SYSTEM
The Movement System The Kinesiopathologic Model Movement System Impairment Syndromes of the Knee Shirley Sahrmann, PT, PhD, FAPTA Professor Emerita Statement of Privacy To protect the privacy of the subjects
More informationKNEE MICROFRACTURE CLINICAL PRACTICE GUIDELINE
KNEE MICROFRACTURE CLINICAL PRACTICE GUIDELINE Progression is time and criterion-based, dependent on soft tissue healing, patient demographics and clinician evaluation. Contact Ohio State Sports Medicine
More informationAthletic Preparation ACL Reconstruction - Accelerated Rehabilitation. Autologous Bone-Tendon-Bone, Patella Tendon Graft
Orthopaedic Sports Specialists, P.C. Michael E. Joyce, M.D. 84 Glastonbury Blvd., Suite 101, Glastonbury, Connecticut 06033 Voice: 860-652-8883, Fax: 860-652-8887 Athletic Preparation ACL Reconstruction
More informationS p o r t s & O r t h o p a e d i c S p e c i a l i s t s D R. R Y A N F A D E R
S p o r t s & O r t h o p a e d i c S p e c i a l i s t s D R. R Y A N F A D E R H I P A R T H R O S C O P Y W I T H L A B R A L R E P A I R P R O T O C O L This protocol provides appropriate guidelines
More informationWhat is an ACL Tear?...2. Treatment Options...3. Surgical Techniques...4. Preoperative Care...5. Preoperative Requirements...6
Table of Contents What is an ACL Tear?....2 Treatment Options...3 Surgical Techniques...4 Preoperative Care...5 Preoperative Requirements...6 Postoperative Care...................... 7 Crutch use...8 Initial
More informationAnterior Knee Pain in Children. Joseph Chorley, MD Associate Professor, Pediatrics Baylor College of Medicine
Anterior Knee Pain in Children Joseph Chorley, MD Associate Professor, Pediatrics Baylor College of Medicine Goals and Objectives To learn how to care for patients with chronic knee pain To be able to
More informationGait Analysis: Qualitative vs Quantitative What are the advantages and disadvantages of qualitative and quantitative gait analyses?
Gait Analysis: Qualitative vs Quantitative What are the advantages and disadvantages of qualitative and quantitative gait analyses? Basics of Gait Analysis Gait cycle: heel strike to subsequent heel strike,
More informationHIP ARTHROSCOPY REHAB 0-2 WEEKS
HIP ARTHROSCOPY REHAB 0-2 WEEKS Protect the surgical repair Patient education regarding: gait and surgical findings. o Protected weight-bearing (PWB): weight bearing as tolerated with crutches o Ensure
More informationMost cells in the human body have an assigned purpose. They are liver cells, fat cells, bone cells,
What is a Stem Cell? Most cells in the human body have an assigned purpose. They are liver cells, fat cells, bone cells, and so on. These cells can replicate more of their own kind of cell, but they cannot
More information9180 KATY FREEWAY, STE. 200 (713)
AUTOLOGOUS CHONDROCYTE IMPLANTATION Femoral Condyle Rehabilitation Guidelines PHASE I - PROTECTION PHASE (WEEKS 0-6) Goals: - Protect healing tissue from load and shear forces - Decrease pain and effusion
More informationAnterior Cruciate Ligament Hamstring Rehabilitation Protocol
Anterior Cruciate Ligament Hamstring Rehabilitation Protocol Focus on exercise quality avoid overstressing the donor area while it heals. Typically, isolated hamstring strengthening begins after the 6
More informationBIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY
BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY B.Resseque, D.P.M. ARCH HEIGHT OFF WEIGHTBEARING Evaluate arch height by placing a ruler from the heel to the first metatarsal head Compare arch
More informationVIPR and Power plate EXERCISE - 1 EXERCISE Fitness Professionals Ltd 2011 Job No. 2968
FIT FOR DAILY LIFE To be fit for daily life includes many movement abilities. Dynamic stability, co-ordination, balance, motor control, mobility and efficiency are all vital (including basic strength and
More informationParadigm Shift. Biomedical Model. Regional Interdependence Model. Evidence to Support R-I Exam
A Clinical Approach to Assessing and Addressing Movement Pattern Dysfunction Models of Adverse Health Regional Interdependence Evidence to Support R-I Systematic Assessment Case Studies using System Implementation
More informationBIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY 2017
BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY 2017 B. RESSEQUE, D.P.M., D.A.B.P.O. Professor, N.Y. College of Podiatric Medicine ARCH HEIGHT OFF WEIGHTBEARING Evaluate arch height by placing
More informationMedical Practice for Sports Injuries and Disorders of the Knee
Sports-Related Injuries and Disorders Medical Practice for Sports Injuries and Disorders of the Knee JMAJ 48(1): 20 24, 2005 Hirotsugu MURATSU*, Masahiro KUROSAKA**, Tetsuji YAMAMOTO***, and Shinichi YOSHIDA****
More informationCase Report. Byung Ill Lee, MD and Byoung Min Kim, MD Department of Orthopedic Surgery, Soonchunhyang University Hospital, Seoul, Korea
Case Report Knee Surg Relat Res 2015;27(4):263-268 http://dx.doi.org/10.5792/ksrr.2015.27.4.263 pissn 2234-0726 eissn 2234-2451 Knee Surgery & Related Research Concomitant Osteochondral utograft Transplantation
More informationAnterior Cruciate Ligament (ACL) Rehabilitation
Thomas D. Rosenberg, M.D. Vernon J. Cooley, M.D. Anterior Cruciate Ligament (ACL) Rehabilitation Dear Enclosed you will find a copy of our Anterior Cruciate Ligament (ACL) Rehabilitation program and the
More information3/21/2011 PCL INJURY WITH OPERATIVE TREATMENT A CASE STUDY PCL PCL MECHANISM OF INJURY PCL PREVALENCE
PCL PCL INJURY WITH OPERATIVE TREATMENT A CASE STUDY K. Anderson, S. Hjortedal, Y. Jingi, E. Sutcliffe & S. Witschen Washington State University Origin Posterior aspect of tibia Insertion Medial femoral
More informationRakesh Patel, MD 4/9/09
Rakesh Patel, MD 4/9/09 Chondral Injuries Very common Present in 63-66% patients undergoing arthroscopy 11-19% full-thickness lesions Up to 79% patients with ACL deficient knee have some form of chondral
More informationRoutine Arthroscopic Procedure
Katherine J. Coyner, MD UCONN Musculoskeletal Institute Medical Arts & Research Building 263 Farmington Ave. Farmington, CT 06030 Office: (860) 679-6600 Fax: (860) 679-6649 www.drcoyner.com Avon Office
More informationPrimary Movements. Which one? Rational - OHS. Assessment. Rational - OHS 1/1/2013. Two Primary Movement Assessment: Dynamic Assessment (other)
Primary Movements Practical Application for Athletic Trainers Two Primary Movement Assessment: NASM-CES Overhead Squat Single-leg Squat Dynamic Assessment (other) Single-leg Step Off Functional Movement
More informationAUTOLOGOUS CHONDROCYTE IMPLANTATION (ACI) CLINICAL PRACTICE GUIDELINE
AUTOLOGOUS CHONDROCYTE IMPLANTATION (ACI) CLINICAL PRACTICE GUIDELINE Background Autologous chondrocyte implantation (third generation) is a two stage surgical procedure indicated for medium to large (
More informationOne hundred and ten individuals participated in this study
Purpose The purpose of this study was to compare gait characteristics in an asymptomatic population of younger and older adults to older OA patients of different severities Hypothesis(es) The following
More information9180 KATY FREEWAY, STE. 200 (713)
OSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION Patella/Trochlea Rehabilitation Guidelines PHASE I - PROTECTION PHASE (WEEKS 0-6) Goals: - Protection of healing tissue from load and shear forces - Decrease pain
More informationOTM Lecture Gait and Somatic Dysfunction of the Lower Extremity
OTM Lecture Gait and Somatic Dysfunction of the Lower Extremity Somatic Dysfunction Tenderness Asymmetry Range of Motion Tissue Texture Changes Any one of which must be present to diagnosis somatic dysfunction.
More informationNovel Techniques in Articular Cartilage Restoration
21 Novel Techniques in Articular Cartilage Restoration Adam B. Yanke, MD and Brian J. Cole, MD, MBA PART ONE: DENOVO NT Introduction DeNovo NT (Zimmer) is minced (1-mm cubes) juvenile allograft cartilage
More informationRehabilitation Guidelines for Meniscal Repair
Rehabilitation Guidelines for Meniscal Repair The knee is the body's largest joint, and the place where the femur, tibia, and patella meet to form a hinge-like joint. These bones are supported by a large
More informationLife. Uncompromised. The KineSpring Knee Implant System Surgeon Handout
Life Uncompromised The KineSpring Knee Implant System Surgeon Handout 2 Patient Selection Criteria Patient Selection Criteria Medial compartment degeneration must be confirmed radiographically or arthroscopically
More informationInternal Rotation (turning toes/knee toward other leg) 30 degree limit. limit
Hip Arthroscopy Patient Education Use of Brace and Crutches: - Wear the brace all times of weight bearing for the first 3 weeks after surgery. This is done to protect your hip and motion into hip extension
More informationRehabilitation Guidelines for Knee Arthroscopy
Rehabilitation Guidelines for Knee Arthroscopy The knee is the body's largest joint, and the place where the femur, tibia, and patella meet to form a hinge-like joint. These bones are supported by a large
More informationPART ONE. Belly Dance Fitness Technique
PART ONE Belly Dance Fitness Technique OVERVIEW Understanding belly dance movement The gentle, symmetrical, rhythmic undulations that we practice in Belly dance can help to revitalize almost every part
More informationLabral Repair with a Microfracture
Labral Repair with a Microfracture This protocol should be used as a guideline for progression and should be tailored to the needs of the individual patient. Strict protective weight bearing status for
More informationA Patient s Guide to Osteochondritis Dissecans of the Knee
A Patient s Guide to Osteochondritis Dissecans of the Knee 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 DISCLAIMER: The information in this booklet is compiled from
More informationAutologous Chondrocyte Implantation and Other Cell-based Treatments of Focal Articular Cartilage Lesions. Original Policy Date
MP 7.01.36 Autologous Chondrocyte Implantation and Other Cell-based Treatments of Focal Articular Cartilage Lesions Medical Policy Section Surgery Issue 12:2013 Original Policy Date 12:2013 Last Review
More information