Pre knee replacement surgery for 47-year-old with patellofemoral joint instability

Transcription

1 Pre knee replacement surgery for 47-year-old with patellofemoral joint instability Sara Mijailovic April 10 th, /18 London, UK

2 Abstract Patellofemoral instability is the clinical syndrome in the patellofemoral joint where the patella is prone to recurrent lateral dislocation. In some patients, the kneecap (patella) has a tendency to disengage from its normal position and dislocate to one side. This can lead to a feeling of looseness and giving way of the knee, causing patients to easily lose confidence in their knee. Commonly this is called knee instability. Knee instability is often due to an abnormality in the way the front of the knee joint is formed. For example it may be related to a shallow trochlear groove, a small and high placed patella, or there may be abnormalities in the soft tissues and ligaments around the knee. Occasionally, patella instability can occur in a knee with normal anatomy, following a twisting or sporting injury. This is called a traumatic dislocation. In this study the focus will be the knees with lateral dislocation tendancy

3 Table of contents Title Page Abstract 1 Table of Contents 2 Anatomy of the knee 3 Patellofemoral Joint Instability 6 Case study 7 Conditioning program 8 Conclusion

4 Anatomy of the knee The knee is one of the more complex joints in the human body. The knee is a hinge joint that is responsible for weight-bearing and movement. It consists of bones, meniscus, ligaments, and tendons. The knee is designed to fulfill a number of functions: support the body in an upright position without the need for muscles to work helps to lower and raise the body provides stability acts as a shock absorber allows twisting of the leg whilst bent makes walking more efficient helps propel the body forward Basic components of knee anatomy: Bones The femur (thigh bone), tibia (shin bone), and patella (kneecap) make up the bones of the knee. The knee joint keeps these bones in place. The patella is a small, triangle shaped bone that sits at the front of the knee, within the quadriceps muscle. It is lined with the thickest layer of cartilage in the body because it endures a great deal of force

5 Cartilage There are two dics of cartilage in the knee (menisci): Meniscus: these are crescent-shaped discs that act as a cushion, or "shock absorber" so that the bones of the knee can move through their range of motion without rubbing directly against each other. The menisci also contain nerves that help improve balance and stability and ensure the correct weight distribution between the femur and tibia. The knee has two menisci: medial - on the inner side of the knee, this is largest of the two lateral - on the outer side of the knee Articular cartilage: found on the femur, the top of the tibia, and the back of the patella; it is a thin, shiny layer of cartilage. It acts as a shock absorber and helps bones move smoothly over one another. Ligaments Ligaments are tough and fibrous tissues; they act like strong ropes to attach bones to other bones, preventing too much motion and promoting stability. The knee has four ligaments: ACL (anterior cruciate ligament) - prevents the femur from sliding backward on the tibia, and the tibia from sliding forward on the femur. PCL (posterior cruciate ligament) - prevents the femur from sliding forward on the tibia, or the tibia from sliding backward on the femur. MCL (medial collateral ligament) - prevents side to side movement of the femur. LCL (lateral collateral ligament) - prevents side to side movement of the femur. Tendons These tough bands of soft tissue provide stability to the joint. They are similar to ligaments, but instead of linking bone to bone, they connect bone to muscle. The largest tendon in the knee is the patellar tendon, which covers the kneecap, runs up the thigh, and attaches to the quadriceps

6 Muscles Although they are not technically part of the knee joint, the hamstrings and quadriceps are the muscles that strengthen the leg and help flex the knee. The quadriceps are four muscles that straighten the knee. The hamstrings are three muscles at the back of the thigh that bend the knee. The gluteal muscles - gluteus medius and minimus - also known as the glutes are in the buttocks; these are also important in positioning the knee. Joint capsule The joint capsule is a membrane bag that surrounds the knee joint. It is filled with a liquid called synovial fluid, which lubricates and nourishes the joint. Bursa There are approximately 14 of these small fluid-filled sacs within the knee joint. They reduce friction between the tissues of the knee and prevent inflammation

7 Patellofemoral joint instability A frequent cause of knee pain and knee disability is patellofemoral instability. Patellofemoral instability can be defined in different ways. One way is when the patient has undergone a traumatic dislocation of the patella. It can also describe a sign on physical examination, signifying the ability of the patella to be translated out of the trochlear groove of the femur in a passive manner. Moreover, patellofemoral instability can be a symptom, when the patient gives a feeling that the knee gives way. This feeling occurs when the patella slips out of the trochlear groove. There are two ways to develop patellofemoral instability by dislocation of the patella. It can develop after a traumatic dislocation of the kneecap in which the medial kneecap-stabilisers are stretched or ruptured, which eventually can result in recurrent dislocations of the patella. The other way is caused by anatomical anomaly of the knee joint. Chronic instability of the patellofemoral joint and recurrent dislocation may lead to progressive cartilage damage and severe arthritis if not treated adequately Symptoms Patients experience anterior knee pain and episodes of mechanical instability.the pain can be aggravated by activities such as up and down the stairs, sports such as running, hopping and jumping, and changing direction. Upon functional assessment the patient may struggle with control of the patella, resulting in the patella being pull from midline, therefore to assess this you need to observe what is happening to the patella during static and dynamic movements such as squatting / lunging

8 Case study Luke is a 47-year-old male with a patellofemoral joint instability condition with tendancy for lateral dislocation. He began experiencing pain from a young age and suffered his first lateral dislocation of his left knee at the age of 11 while playing football. Through the years towards aldulthood he has had 11 operations; 4 knee reconstructions and 7 arthroscopies (some of them being Roux Goldthwait knee surgery and driling the bone to encourage fibrous cartilage growth.) Despite his condition he has been active through the years with playing football,hockey, cricket, swimming, skiing, cycling. He hasn t had a dislocation since his Roux Goldthwait operation but he is now missing arterial cartilage on both knees so his bones are touching and making movement painful. He feels pain mostly after exercise, after being inactive for longer periods of time, going up and down the stairs, squating.. The knee condition has also put a strain on Luke s lower back because of calf and glutes taking load from quadriceps and hamstrings. Result is stiffnes and pain all day particularly at night. Some of the movements Luke avoids are sudden changes in direction while walking, crouching, kneeling and standing for long periods of time. His doctor has recommended physical therapy, swimming, cycling, icing the knees, painkillers and knee braces. Luke has decided to give pilates a chance to prepare him for his knee replacement operation on both knees so he can hopefully make a quicker recovery as well as make his daily movements more pleasant until and after the surgery. He would like to gain core strenght and specific muscle strenght (quadriceps and hamstrings) to reduce low back pain

9 Conditioning Beginning and concluding each session with a Roll down. The objective is to provide an opportunity for clients to focus and center themselves and serves as a pre-warm up and a post-cool down. At the same time it provides an opportunity for the instructor to assess the client s alignment, and offer valuable input and correction. Block System Sessions 1-10 Sessions Sessions 20+ Mat Mat Cadillac WARM UP Pelvic Curl, Spine Twist Supine, Chest lift, Chest lift with rotation. Pelvic Curl, Spine Twist Supine, Chest lift, Chest lift with rotation. Add: Leg lifts/leg changes Warm Up Series: Roll Up with RUBar, Mini Roll Up, Mini Roll Up Oblique, Roll Up Top Loaded Reformer Wunda Chair Cadillac FOOT WORK Parallel heels, Parallel toes, V toes, Open V heels, Open V toes, Calf raises, Prances, Single leg heel, Single leg Toes Parallel heels, Parallel Toes, V Toes, Open V Heels, Open V Toes, Calf raises, Single leg heel, Single leg toes Parallel heels, Parallel toes, V toes, Open V heels, Open V toes, Calf raises, Prances, Single leg heel, Single leg Toes ABDOMIN ALWORK Reformer Wunda Chair Cadillac Hundred Prep,Hundred Standing Pike, Standing Pike Reverse Mini Roll-Ups,Mini Roll- Ups Oblique Reformer Cadillac Cadillac HIP WORK Supine Leg Series: Frog,Circles Down, Circles Up, Openings Supine Single Leg Series: Frog, Circle Down, Circle Up, Hip Extension, Bicycle Supine Leg Series: Frog,Circles Down, Circles Up, Walking, Bicycles Wunda Chair Reformer Cadillac SPINAL ARTICULA TION Pelvic Curl (started spinal atriculation from the 1 st session as very beneficial for hamstring activation) Bottom Lift Tower Prep - 8 -

10 Block System STRECHES Sessions 1-10 Sessions Sessions 20+ Ladder Barrel Ladder Barrel Ladder Barrel Gluteals, Hamstrings Gluteals, Hamstrings, Hip Flexors Gluteals, Hamstrings, Hip Flexors FULL BODY INTERGRA TION 1 Cadillac / Sitting Forward, Side Reach Cadillac Sitting Forward, Side Reach Reformer Reformer Wunda Chair ARM WORK Arms Supine: Extension, Adduction, Circles Up, Circles Down, Triceps Arms sitting: Chest Expansion, Biceps, Rhomboids, Hug a Tree, Salute Shrugs, Triceps Press Sit FULL BODY INTEGRATI ON 2 / / Saw Cadillac Leg Weights Leg Weights Reformer and Wunda Chair LEG WORK Gluteals Side Lying Series: Side Leg Lift, Forward and Lift, Forward With Drops, Adductor Squeeze Gluteals Side Lying Series: Side Leg Lift, Forward and Lift, Forward With Drops, Adductor Squeeze Reformer: Hamstring Curl Wunda Chair: Hamstring Curl LATERAL FLEXION/R OTATION Wunda Chair Ladder Barrel Ladder Barrel Side Strech Side Over Prep Side Over Prep BACK EXTENSIO N Mat Reformer Wunda Chair Back Extension Breaststroke Prep Swan On Floor - 9 -

11 Conclusion Even though Luke has had knee issues for most of his life he had managed to be active throughout the years and worked around his condition. Before starting pilates classes he had been feeling physicaly and emotionaly exausted of not being able to easily preform the demands of daily life. After the first few sessions I have noticed a positive change in his attitude towards his journey. With the finishing of the first 10 sessions he said he felt a greater abdominal strenght and improved pelvic lumbar stability. This has kept him motivated to look forward to new changes to come. Through the following sessions we increased the difficulty of the exercises and he responded very well. Luke is a great natural mover so that really helps make his progress quicker. During each pilates session I made sure we are firing up the quadriceps and hamstrings as well as working his transverse abdominals as they are all significantly weaker comparetively to the rest of his body. Using the BASI Block System has allowed us to condition and prepare Luke s body as a whole as well as work specifically around his knee condition, which I think will set him up for a faster recovery when he goes ahead with his knee replacement. Even though Luke will at some point need a knee operation I believe that strenghtening his body with pilates has given him more confidence both physicaly and mentaly in his body

12 Bibliography / References Books: Body Arts and Science International Study Guide, Comprehensive Course Body Arts and Science International Movement Analysis Workbook Websites: