Questions related to Knee Injuries
Knee injuries in paediatric population are increasing signifi-
cantly these past few years and become more common because
of rising sports participation and competitive sports. Anterior cru-
ciate ligament (ACL) injuries may represent 30% of all knee injuries
in young soccer players. The number of ACL ruptures in young
population increases also secondary to much more accurate diag-
nosis methods such as early magnetic resonance imaging (MRI).
Because knee injuries in children could easily evolve towards early
arthritis, it should not be mistreated.the treatment of ACL ruptures in skeletally immature patients is not consensual. Several studies reported failure of conserva-
tive management and a more stable and functional knee after
ACL reconstruction in active child.
Physiotherapy and exercise show short-term improvements in physical function. I would like to know particularly cycling exercise for treatment.
Multi ligamentous knee injuries diagnosis and management has always been a challenging problem.
The functional and clinical outcomes differ based on the approach to treatment and post operative rehabilitation.
Need experts opinion regarding the management for optimal outcome.
There are different reconstruction graft options that can be used to reconstruct the native anterior cruciate ligament, with autograft hamstring tendons being one of the most commonly used.
Preparation of a hamstring autograft varies depending on patient characteristics and physician preference.
There are several methods to identify hamstring tendons, graft harvest and graft preparation techniques…to obtain an individualized graft according to patients anatomy and physical activity.
Please share your own tips and tricks!
One of the most critical steps in knee ACL Reconstruction is the anatomic placement of the femoral tunnel – the so-called ACL Femoral Anatomic Footprint. This could lead to tunnel misplacement – the main reason for ACL revision surgery.
The femoral native ACL attachment site is described as an oval-shaped divided into two bundles: the anteromedial (AM) and the posterolateral (PL) bundles.
Several theories and methods have been described to a proper tunnel positioning such as 10 o’clock position (right knee) and 2 o’clock position (left knee) - in a single bundle technique or the use of intraoperative fluoroscopy.
The most accurate anatomic landmark for arthroscopic ACL reconstruction is the native ACL remnant.
The Lateral Intercondylar Ridge (LIR)/”Resident´s Ridge" defines the upper border of the ACL and the ACL femoral drilling should aim for the Lateral Bifurcate Ridge, which divides the AM and PL bundle fibers.
However, cross-sectional area of the PL and AM bundles is variable from patient-to-patient, the location of the Lateral Bifurcate Ridge, when present, does not necessarily represent the true center of the ACL femoral attachment site.
What is right ? To continue with pharmaceutical prophylaxis for fearing DVT or stop (reduce) it to avoid wound complications ?
for example, if i want to examine the correlation between hamstring strength during tow different tasks and hamstring strength was normally distributed in one task but non normally distributed in the other task. what should i do in this case? should i use Spearman ?
I am trying to define the limit or threshold of the knee varus-valgus angle (rotational range) for normal subjects. please suggest good references for me.
It seems cadaveric studies, in vitro, are best.
Best regards: Tserenchimed.
I hope that everybody knows about the curling sport. The literature search reveals there is an evidence that the curlers had severe knee pain in his/her sliding leg (deep flexed knee).
However, I could not found any information about what is the cause of that pain? where is the pain come from (for instance, from muscle or soft tissue overload) or where is the location? (anterior or posterolateral).
please advise to me, share your knowledge, and please refer related publication including unpublished study, useful websites, and injury survey.
I'm currently doing a series of mechanical test in healthy porcine joints. I usually do these tests within hours after hogs are slaughtered. I'd like to quickly induce degeneration on the soft tissues (articular cartilage, tibial cartilage and menisci) by injecting chemicals on the joints.
Any suggestions regarding which chemicals can be used to induce degeneration within 48 hrs after injection?
Traditionally the patella fracture with intact extensor apparatus has been treated by cylinder cast, long knee immobilizer brace as well as percutaneous lag screw.
But is there any evidence in the literature as to what is the best mode of treatment?
Does anyone know what are the specific effects (adaptations) of this particular exercise called: Quadriceps Eccentric Exercise or Reverse Nordic Lower (http://s0www.utdlab.com/contents/image.do?imageKey=EM%2F100189 ) ( https://youtu.be/B6gclHMQDj8 ) on either rehabilitation or prevention of knee injuries, or perhaps on its effects on some performance parameters (RFD, VJ, COD, etc.)?
Also what are the exercise guidelines regarding the FITT-VP principle?
Please provide research articles or anecdotal evidence.
Dear professors and colleagues,
Is it common that MRI of knee of female athletes aged 17-20 years, beside different acute injuries, shows degenerative changes? In last 6 months majority of female athletes of mentioned ages, that I needed to recover had them.
If the MRI of 17 years old female athlete shows non injured ACL but with degenerative changes, what is the risk of ACL rupture, is it drastically increased... ?
Every discussion and advice is welcome.
There may be altered joint arthrokinematics and other mechanical issue of an adjacent structure, which may contribute to lateral knee pain. So, what will be the best physiotherapy management?
A patient had been subjected for ORIF for supracondylar fracture distal femur 5 months earlier, he is presenting with stiff knee to 30 degrees flexion and with no active quadriceps contraction.
A 24 year old fell hard on her knees. A knee examination was not done. Later she complains of left sided lateral knee pain as well as hip pain and left sided low back pain. Her doctor (A GP) prescribed her an analgesic and told her she needs rest. What could be the cause of her pain? Does she need further investigation?
I want to know how in evidence forces are calculated to get safe therapeutic effects of continuous traction in knee osteoarthritis.
Does anyone know some exercises or passive techniques to restore knee extension in early acl postoperative rehabilitation without giving too much strain on the new graft? I'm a physiotherapist and in my clinical practice I often manage patients with incomplete knee extension (PROM). I'm in doubt how I can manage this problem in order to avoid potentially dangerous exercises such as active SLR or OKC extension. What do you do in your clinical practice? Is there any literature about this topic? I'm particularly interested in early rehab after acl reconstruction with semitendinosus-gracilis autograft (po weeks 1st to 5th). Thank you.
What is the appropriate approach for management for a neglected patella fracture of over a year with the proximal fragment at the region of the mid thigh with weakness in the extensor mechanism.
I am trying to find out level of cartilage destroying enzymes which is associated with crepitus sound with pain.
For one of my researches here in Nepal, I needed to know the MCID of "Knee extension angle (KEA)".
KEA is a "reference standard" measure to assess the flexibility of Hamstrings. Through the literature search, I could not locate the answer. Please share if MCID is established for KEA.
I am looking forward for your expert help.
Biomaterial or scaffold for stem cells to transplant in osteo-chondral defects in rat or rabbit. There are large number of biomaterial experts are out there on RG site. My stem cells placed in osteo-chondral defects and later covered with fibrin glue is not helping much for the survival of stem cells checked after few weeks. Many thanks.
I'd like to know if anyone have references about the influence of lumbosacral ROM on anterior knee pain, because we are conducting a study where we will compare the measuring of people with and without anterior knee pain, and I didn't have success in found this relationship
Please add any publications /evidence that may indicate it's reliability at testing quadriceps shortening .thank you
I usually perform distalization of tibial tubercle as the first procedure to correct the patella alta. If need be, I add MPFL reconstruction as the second staged procedure. I never had to add trochlear plasty.
We receive such patients who refuse replacement surgery and expect a 100% recovery by PT Rx in terms of pain, function, gait and even joint space and deformity. We try counseling but they keep on complaining.
Do you face such problems? What's your opinion?
There are three main types of bone marrow stimulation in the literature; microfracture, abrasion chondroplasty, and drilling. Can anybody tell me why microfracture is overwhelmingly more popular than the other techniques? Does anybody have any references on the results of these different techniques? Or do you use other bone marrow stimulation techniques other than microfracture?
During the anterior cruciate ligament reconstruction, my hanstring graft (STG) has fell on the floor accidently twice. I did not have option of the allograft. I only had the options of either harvesting the same side BTB or contralateral hamstring or using the same graft after cleansing it. I exercised the last option of washing the graft with 500 ml saline, soaking it in cidex for 30 minutes and again washing it with saline. I was fortunate enough that in both the patients there was no infection. Both the patients have completed 2 years and 5 years follow up and the KT assessment as well as functional assessment is good.
But is it the right way to go in this situation or we should always harvest another new graft?
It is generally accepted that arthritis of the knee affects the entire joint including menisci, cartilage and synovia. While various studies suggest (partial) meniscectomy being the major trigger for subsequent osteoarthritis, some opinion leaders consider an initial cartilage defect being the reason for further joint degeneration and subsequent meniscus pathologies. What is your opinion regarding the relationship between cartilage injury/defect and meniscus injury and subsequent osteoarthritis?
Since King, 1936 classic research:“For meniscal lesions to heal they must communicate with the peripheral vasculature of the meniscus.” a lot of things have been said. Nowadays, proper patient selection plays a key role in successful outcomes. What do you think?
Presentation Meniscal Injury
Limited range of motion is frequently observed following intra- or periarticular fractures of the knee. What do you consider special about this entity in comparison to other types of arthrofibrosis? What are your criteria to indicate revision surgery and how do you address arthrofibrosis? What time point following fracture treatment is best to perform revision surgery?
I am involved in a project reviewing contemporary clinical management of Patellofemoral Pain (PFP). Please does anyone have any rehabilitation protocols for PFP that they could share.
I'm trying to find quantitative measures to relate to knee stability. I've heard some gait labs use rigs specifically designed for knee stability measurements however haven't found much in the literature.