MedRisk Learning CenterKnee Injuries & Surgical Interventions August 4, 2011

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» Your instructor: John Knecht MA, PT, ATC Select Medical Center Manager

Manchester, CT East Hartford, CT

Performs FCEs & Biodex testing

» Please submit written questions by clicking the Q&A tab at top of screen, John will answer at end of presentation

Work Related Knee Injuries and Surgical Interventions

John F. Knecht MA, PT, ATC, SCS

Basic Anatomy of Knee

Largest and most complex joint in the body.

3 joints within a single synovial cavity. Medial Tibiofemoral Lateral Tibiofemoral Patellofemoral

Synovial Joint: Syn = together The bones forming the

joint have a synovial cavity and are united by dense irregular connective tissue of an articular capsule, and often accessory ligaments.

Diarthrosis- free moving joint.

Bone/Synovial Anatomy

Ligament/ Muscle Anatomy

Cruciates Anterior Posterior

Collaterals Medial Lateral

Anatomy:Anterior and Posterior Cruciates

MCL/LCL Anatomy

Common Injuries in Work Setting

TraumaSlip/Trip/Falls (STF)

All Slip, Trip & Fall incidents are preventable through proper awareness and housekeeping practices.

Direct Blow Hyperextension Overuse/Repetitive Motion

Trauma

Slip/Trip/Falls (STF)Cords, Cables, and Tubes – Safely and

appropriately secure all cords, cables, and tubes

from items such as: computers, printers, telephones, extension cords, call buttons, and medical equipment. Where appropriate, use cord ties, cable wraps/clips, hook and loop fasteners, or duct tape to keep these hazards out of the path of travel.

STF continue

Clutter and Debris – Keep floors and stairs free of clutter and debris. A slip on something as small as a needle cap/grape can cause a severe STF injury.

Direct Blow

Landing on bent knee

Object hitting knee Contusion/bruise

Hyperextension Injuries

Knee moves backward, feels like it “gives out” or “buckles”.

Overuse/Repetitive Injuries

Squatting Lunging Kneeling

ACL Surgeries

Approximately 100,000/yr in U.S. B-PT-B Quadruple Hamstring Allograft Quad tendon Primary (partial tears–with bone marrow stimulation)

Gobbi et al, Am J Sports Med 2009 Milan, Italy

Beecher et al, JOSPT May 2010 South Carolina, USA

ACL Reconstruction:Tensile Load

Intact 2160 +/- 157 N Tensile Load

BPTB autograph 2376 +/- 151

Quadruple semi/gracilis 4108 +/- 200

Quad tendon autograph 2352 +/- 495

ACL reconstruction cont

Non-Surgical Intervention

NSAIDS X-ray MRI Physical Therapy

Rehabilitation: Pre, Post and Non-operative Overlapping Stages of Healing

Inflammation

Primary

Obligatory

Individual Adaptation

Inflammation Stage of Healing

Maximum ProtectionCritical to healingWant to control itLimit it to the 1st 24-48 hoursSets up healing process

Primary Stage of Healing

Moderate protectionKitting together of the tissues2 days to 6 weeksDefect is healed, but tissue is not strongNot ready to be tested

Obligatory Maturation Stage of Healing Minimal protection

6 weeks to 1 yearMaturing of the tissues in response to the

stressEverybody’s injured site needs to go through

this phaseDo the stresses that caused the problem

Individual Adaptation Stage of Healing Return to activity

Program adapted to individual

Design treatment programs to stress tissue so it becomes strong

Need to stress in a controlled and gradual way

S.A.I.D.- Specific Adaptations to Imposed Demands

Recuperation time for injuries

Bone 6-8 weeks

Soft tissue healing 8-12 weeks

Criteria to Return to Work

Full ROM Quad strength 85% of

contra-lateral side No pain No effusion No other symptoms

Hamstring strength 85% of contra-lateral side

Ham to quad ratio 70% or greater

Functional testing 85% or greater vs. contra-lateral side

Work Related testing

Lift/CarryWaist to shoulderFloor to waistFloor to shoulder

Push/PullCartsCablesPatients

Conclusion

Thank you!

Questions?

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