Idea Transcript
10/10/2016
Post-Operative Rehabilitation for an Uncommon Injury of the Knee: A Case Study
Erin Baumann, PT, DPT, ATC, OCS William Rice, PT, MPT, SCS Nationwide Children’s Hospital Sports and Orthopedic Physical Therapy ………………..……………………………………………………………………………………………………………………………………..
Objectives 1. Review relevant anatomy of the proximal tibiofibular joint (PTFJ) 2. Identify an uncommon cause of lateral knee pain 3. Discuss treatment options for proximal tibiofibular instability Purpose: • Describe post-surgical rehabilitation for an adolescent athlete following proximal tibiofibular joint reconstruction. ………………..……………………………………………………………………………………………………………………………………..
Proximal Tibiofibular Instability • 1 year • Left lateral knee and ankle
• Seen by multiple physicians ………………..……………………………………………………………………………………………………………………………………..
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Case Description • Imaging – X-ray and MRI
• Suspected tibiofibular instability • Proximal tibiofibular reconstruction – February 12th, 2016
………………..……………………………………………………………………………………………………………………………………..
Patient Presentation • PT eval completed on March 2nd, 2016 – 2.5 weeks post-op
• Script: – PWB LE, increase 20lbs each week, WBAT at 6 weeks, advance PROM as tolerated. Avoid excessive hamstring contraction. Quadriceps activation/exercises as tolerated. ………………..……………………………………………………………………………………………………………………………………..
Patient Presentation • Pain via VAS 0-3/10 • AROM knee flexion – Left knee -2⁰ 105⁰ – Right knee -5⁰ 160⁰
• Pt able to perform 20 SLRs with good quad set • Patient Specific Functional Scale (PSFS) – Walking, jogging, golf ………………..……………………………………………………………………………………………………………………………………..
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Rehabilitation Plan of Care • Modified ACL protocol • Progressing weight bearing status by 20lbs each week – WBAT by 6 weeks
• POC 1-2x/week for 10-12 weeks ………………..……………………………………………………………………………………………………………………………………..
Rehabilitation 2-12 weeks • PROM/AROM to tolerance • Strengthening – Ankle (as tolerated) – Knee • Began hamstring strengthening at 6 weeks
– Core/hip
• Balance ………………..……………………………………………………………………………………………………………………………………..
Rehabilitation 12-15 weeks • Running and plyometric progression at 12 weeks • MD cleared for golf at 14 weeks post op • D/C PT on June 27th, 2016 ………………..……………………………………………………………………………………………………………………………………..
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Outcome Measure Patient Specific Functional Scale Activity
03/02/16
05/04/16
Walking
2
10
06/28/16 10
Jogging
1
9
10
Golf
1
8
10
Total
4
27
30
………………..……………………………………………………………………………………………………………………………………..
Key Points • PTFJ instability is often overlooked a differential diagnosis for lateral knee pain • A modified ACL protocol may be beneficial to help athletes safely return to sport • Clinicians should be mindful of PTFJ instability when evaluating a pt with lateral knee/ankle pain
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Questions? Thank you! ………………..……………………………………………………………………………………………………………………………………..
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References
1. Nieuwe Weme, R.A., Somford, M.P., Schepers, T. Proximal tibiofibular dislocation: a case report and review of literature. Strategies in Trauma and Limb Reconstruction. 2014; 9:185-189 2. Goldstein, Y., et al. Dislocation of the Proximal Tibiofibular Joint: a Rare SportsRelated Injury. Isreal Medical Association Journal. 2011;13 3. Bozkurt, M., Yllmaz, et al. The evaluation of the proximal tibiofibular joint for patients with lateral knee pain. The Knee. 2004; 11: 307-312 4. Weinert, C. et al. Recurrent Dislocation of the Superior Tibiofibular Joint. The Journal of Bone and Joint Surgery. 1986 (68) 5. Camarda et al., Proximal Tibiofibular Joint Reconstruction with Autogenous Semitendenosus Tendon Graft. Techniques in Orthopaedics. 2013; 28 6. Foster, B., et al. Proximal Tibiofibular Joint: An Often-Forgotten Cause of Lateral Knee Pain. ARJ. 2007; 188: 359-366 7. Hsieh, C., Chen, J., Acute Dislocation of the Proximal Tibiofibular Joint. Journal of Orthopedic & Sports Physical Therapy. 2009; 39(11) 8. Veerappa, L., Gopalakrishna, C., Traumatic Proximal Tibiofibular Dislocation with Neurovascular Injury. Indian Journal of Orthopedics. 2012; 46(5): 585-588 ………………..……………………………………………………………………………………………………………………………………..
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