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Thursday, 05 May 2016 13:33

ACL Reconstructions

in Knee
A common injury of the knee is a tearing of the ACL (Anterior Cruciate Ligament). This ligamentis very important for stability of the knee and often needs to be repaired surgically. The primary function of the ACL is to keep the bottom surface of the knee joint from sliding forwards during movement. An unrepaired knee may feel unstable or give way suddenly. Not all ACL injuries require surgery and some may heal well with proper rehabilitation, however for those who do need surgery, there is a significant rehabilitation period afterwards.
What does the surgery consist of? 
Every surgeon will have a slightly different technique for surgery. The most common approach is the arthroscopic approach, which uses a small camera and allows the surgeon to make only small incisions into the knee. They will then replace the torn ligament with either a graft from a tendon or ligament at another part of the body or using a synthetic graft.
How long does rehabilitation take?
 Full rehabilitation following surgery can take up to eighteen months and rehabilitation is divided into different stages. As all surgeons will have different protocols for their approaches to surgery, time frames will vary for everyone.  Initially after surgery, the graft will be quite weak while a new blood supply is being established. It can take up to 12 weeks before the graft is at its strongest point and evidence shows that it may never have the strength of the original ligament.  In the early stages, rehabilitation will be focused on restoring movement to the joint and strengthening the
muscles around the knee without putting any undue stress on the graft.  As the graft begins to heal and strengthen, rehabilitation can progress to include stability and control exercises and gradually build up to a complex program that prepares the knee for a full return to sport. The path to full rehabilitation from a knee reconstruction can be a long and bumpy one, however there are high success rates with this surgery, 
particularly when followed up with full 
physiotherapy rehabilitation
Friday, 26 February 2016 01:45

ACL Tears

in Knee

What is an “ACL tear” and how does it occur?

The ACL, or anterior cruciate ligament, is a strong piece of connective tissue which attaches the thigh bone (femur) to your leg bone (tibia). The ACL is referred to as a “crucial” ligament due to the stability it provides to the knee joint. The job of the ACL is to prevent the tibia from sliding forward relative to the femur.

This ligament is injured in athletes more often than other populations, however injury to the ligament may occur in other ways. Injuries tend to occur when landing awkwardly from a jump, twisting the knee, or suddenly stopping from running. The ACL may also be injured during knee hyper-extension, or when hit from the outside. Many times, other tissues surrounding the knee are also damaged, including the medial collateral ligament, meniscus, joint cartilage, and bone marrow.

A musculoskeletal practitioner can formally grade the severity of ACL injuries. A grade I injury occurs when there is minimal damage to the ligament and the joint remains stable on testing. Grade II injuries occur when the ligament is partially torn. The joint becomes loose on testing, but still provides a degree of stability.

Grade III constitutes a full tear or rupture of the ligament. There will be no stability provided to the joint on testing.

What are the signs and symptoms of an ACL tear?

Many people will report hearing a “pop” in the knee associated with pain at the time of injury. Within a few minutes to hours of injury, there is likely to be significant joint swelling. Decreased range of movement of the knee is common, and the injured knee is typically unable to take full weight upon standing or walking. It may also feel unstable at times, such as a “giving way” sensation. Poor balance and coordination may also be experienced.

How can Physio help?

Non-surgical management of the injured ACL is taken when there is a grade I to grade II injury. Surgical management typically occurs for grade III injuries, and occasionally grade II injuries to the ACL. Your doctor or physiotherapist can help you decide whether non-surgical or surgical management is best for you.

Regardless of surgical or non-surgical management, your physiotherapist will assist you with improving your knee’s range of movement, lower limb strength, balance, stability and coordination. You will re-learn the tasks of walking, using stairs, and negotiating obstacles.

Early in rehabilitation, the RICE protocol (rest, ice, compress, elevation) is used in conjunction with static resistance type exercises to improve muscle contraction in the leg and increase blood flow in the area.

Throughout your rehabilitation program, you will progress through a variety of strength and mobility exercises targeted towards your individual needs, with goals of returning to your favourite sport or hobby as soon and as safely as possible.

Thursday, 25 July 2013 10:01

Knee Osteoarthritis

in Knee

With an aging population and one that is getting more overweight, knee osteoarthritis is becoming more and more prevalent.

Osteoarthritis (OA) is a degenerative joint disease, the cartllage in your joints  that usually allows for fluid, smooth, painfree environment, becomes brittle and will break down over time.  You are more at risk of having OA if you have a previous injury of the joint. If you are overweight or if you have a family history. On an xray you may see narrowing and changes in the sdhape of the joint. OA is characterised by joint stiffness in the morniong, joint pain with increased loading, you may even notice fluid around your joint or a crackling sound as you move your joint through range.

 osteoarthritis-knee 133605755-small

For those who suffer with knee osteoarthritis, this description may sound very familiar. Although osteoarthritis is a non-reversible and progressive disease.  there are still things you can do to manage your pain, slow down the rate of degeneration in your knee, avoid having surgery and prolong the life of your knee.

If you have been diagnosed with knee OA, your physiotherapist can formulate a suitable and sensible exercise program aimed at strengthening your lower limb muscles to support your knees which can help reduce your pain for long term management. If you have found that conventional  land-based exercises have been too painful in the past, your physiotherapist may suggest low load exercise classes such as clinical pilates or aquatic physiotherapy.


Wednesday, 15 September 2010 18:29

Patellofemoral (knee cap) Pain

in Knee

“I get pain going up and down stairs”
“My knees crackle crunch when I squat down”
“It hurts at the front of the knee when I stand up after sitting a long time”

If this relates to you, then there is a good chance you are suffering from patello-femoral dysfunction (a knee cap problem).

The most common knee cap problems occur when your knee cap does not travel evenly through the groove at the front of the femur (thigh bone).  This produces uneven pressure on this joint and often inflammation and pain behind the knee cap results.