Recent Advances in ACL Rehabilitation: Clinical Factors that Influence the Program

1997 ◽  
Vol 6 (2) ◽  
pp. 111-124 ◽  
Author(s):  
James J. Irrgang ◽  
Christopher D. Harner
Keyword(s):  
Acl Reconstruction ◽  
Physical Therapist ◽  
Clinical Pathways ◽  
Functional Limitations ◽  
Clinical Factors ◽  
Concomitant Surgery ◽  
Appropriate Treatment ◽  
Acl Rehabilitation ◽  
Secondary Pathology ◽  
Individual Knowledge

Rehabilitation following ACL reconstruction focuses on treatment of impairments and functional limitations. Clinical pathways that have been developed for rehabilitation of the knee are useful for identifying and classifying impairments and functional limitations following ACL reconstruction. Application of these clinical pathways will enable the physical therapist or athletic trainer to select the most appropriate treatment for an individual. Knowledge of secondary pathology and concomitant surgery allows the clinician to modify application of the clinical pathway. The purpose of this manuscript is to describe modifications for rehabilitation of individuals following ACL reconstruction, based on knowledge of secondary pathology and/or concomitant surgery.

scholarly journals THE EFFECT OF AGE AND CONCOMITANT SURGERY ON STRENGTH IN ADOLESCENT ATHLETES WITH PRIMARY QUADRICEPS TENDON ACL RECONSTRUCTION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Sarah E. Reinking ◽  
Kaitlyn A. Flynn ◽  
Alexia G. Gagliardi ◽  
Cassidy J. Hallagin ◽  
Melissa N. Randall ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Steady Increase ◽  
Isokinetic Testing ◽  
Concomitant Surgery ◽  
Effect Of Age ◽  
Meniscus Surgery

Background: Knee extensor strength deficits occur after ACL reconstruction (ACLR). Prior studies have reported that age affects quadriceps strength after ACLR, however strength deficits in relation to age have not been assessed among adolescents. Isokinetic dynamometric strength testing is a tool frequently used to assess strength post-operatively in order to identify these deficits. Purposes: 1) To examine the effect of age on isokinetic extensor and flexor deficits among adolescents who were 5-10 months post-ACLR. We hypothesized that age would be inversely related to extensor strength deficit. 2) To determine if extensor or flexor strength deficits exist between adolescents post-ACLR with and without concomitant meniscus surgery. We hypothesized that those with concomitant meniscus surgery would demonstrate greater deficits in flexor and extensor strength. Methods: Study participants completed isokinetic testing within 5-10 months after primary quadriceps tendon ACLR, but before return to sport. The protocol consisted of assessing peak torque at 60, 180, and 300 degrees/s, through a limited range of knee extension and flexion. Our primary outcome variables were peak torque percent deficit of involved leg compared to uninvolved leg for flexion and extension. To address purpose 1, we constructed a series of multivariable regression models, where age was the independent variable, peak torque flexor/extensor deficits at each testing speed was the dependent variable, and sex and weight were covariates. To address purpose 2, we compared peak torque extensor and flexor deficits between those with and without concomitant meniscus surgery using independent samples t-tests. Results: A total of 44 completed the study protocol. There were no significant demographic differences between those with and without concomitant meniscus surgery (Table 1). The relationship between age at surgery and peak torque extensor deficits at 300d/s demonstrated a linear but non-significant association (Table 2; Figure 1). For every year increase in age, the expected deficit at 300d/s increased by approximately 3%. Patients who underwent isolated ACLR demonstrated significantly greater flexor deficits than those who underwent ACLR with concomitant meniscus surgery when tested at 180d/s and 300d/s (Table 3). Conclusion: Contrary to our first hypothesis, extensor deficits at 300d/s demonstrated an apparent association with older age. We observed a steady increase in strength deficit at 300d/s associated with increasing age. Contrary to our second hypothesis, no significant differences were found in extensor strength between those with and without meniscus surgery. Additionally, those with concomitant meniscus surgery demonstrated significantly less flexor deficit than those without meniscus surgery. [Table: see text][Table: see text][Figure: see text][Table: see text]

The value of secondary pathology review.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 7-7 ◽  
Author(s):  
Lavinia P Middleton ◽  
Tinisha L. Mayo ◽  
Tracy E. Spinks ◽  
Richard Cheney ◽  
Peiguo Chu ◽  
...  
Keyword(s):  
Cancer Care ◽  
Diagnostic Errors ◽  
Near Misses ◽  
Appropriate Treatment ◽  
Level Data ◽  
Secondary Pathology ◽  
Major Discrepancy ◽  
Discrepancy Rate ◽  
Discrepant Case ◽  
Pathology Review

6 Background: Improving the value of cancer care is a major focus for the Alliance of Dedicated Cancer Centers (ADCC). Looking to align with the Institute of Medicine’s (IOM) initiative to “Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice,” the ADCC implemented a study to examine the clinical impact of expert secondary pathology review. The goal of this project was to: 1) demonstrate the value of secondary review of outside pathological specimens by ADCC subspecialty pathologists in identifying significant errors that can potentially impact treatment; and 2) create an opportunity to improve patient cancer care. Methods: All consult slides from patients referred to each ADCC center were reviewed by designated pathologists. Patient-level data for original and revised diagnoses were collected for two months in 2014. Discrepancies were classified as: 1) major - diagnosis changes treatment or surveillance; or, 2) minor - diagnosis does not change affect treatment or surveillance. To verify these assessments, disease-specific, multi-center teams of clinical experts reviewed each discrepant case and provided treatment recommendations for the original and revised diagnoses. Results: A total of 13,109 cases were collected across all ADCC centers and the discrepancy rate was 11% (1,488/1309); 3% (359/13,109) were major and 9% (1,129/13,109) were minor. The most common discrepancy was reclassification of the neoplasm cell type. The highest discrepancy rate was shown in the neuro-oncology and head and neck cases, with a 7% and 4% major discrepancy rate respectively. Conclusions: We identified an overall discrepancy rate of 11%, with 3% of cases leading to a change in treatment or surveillance. This demonstrates the importance of expert pathology review and that secondary pathology review can significantly improve clinical outcomes through precise and accurate pathological diagnoses. As indicated in the recent IOM report, this project further demonstrates that “diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions.”

scholarly journals The Continuum of Care for Individuals With Lifelong Disabilities: Role of the Physical Therapist

2014 ◽  
Vol 94 (7) ◽  
pp. 1043-1053 ◽  
Author(s):  
Margo N. Orlin ◽  
Nancy A. Cicirello ◽  
Anne E. O'Donnell ◽  
Antonette K. Doty
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Health Care Services ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Functional Limitations ◽  
Insurance Coverage ◽  
Comprehensive Health ◽  
Earning Power ◽  
Smooth Transitions

Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.

scholarly journals O DESEMPENHO DA MARCHA DE HEMIPARÉTICOS CRÔNICOS E A CORRELAÇÃO COM A RECUPERAÇÃO E O NÍVEL DE COMPROMETIMENTO MOTOR FUNCIONAL

2019 ◽  
Vol 11 (1) ◽  
pp. 63-69
Author(s):  
Alice Haniuda Moliterno ◽  
Bruna de Mello Padovan ◽  
Juliana de Souza Viana ◽  
Andressa Sampaio Pereira ◽  
Katiane Mayara Guerrero ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Functional Impairment ◽  
Functional Limitations ◽  
Motor Impairment ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Walking Test ◽  
Appropriate Treatment ◽  
Physical Deconditioning ◽  
Impaired Motor Function

As a result of stroke, impairments such as hemiparesis, gait deficits, impaired motor function and physical deconditioning can occur. In which, gait is one of the most important functional limitations and this way the evaluation becomes important to determine the functional profile and consequently to develop an appropriate treatment. The objective of this study was to evaluate and correlate functional capacity with the level of motor and functional impairment in chronic hemiparetic. This is a cross-sectional study using the Six-Minute Walking Test (6MWT) to assess functional capacity and the Fugl Meyer Protocol (FM) to assess the level of motor and functional impairment. Twelve hemiparetic subjects were included. Statistical analysis revealed no significant correlation between the 6MWT and FM. We conclude that the present study revealed a non-correlation between functional capacity and motor impairment in chronic hemiparetic.

Assessment of Impairments That Limit Exercise and Use of Impairment Information to Generate an Exercise

2007 ◽  
Vol 15 (4) ◽  
pp. 459-479 ◽  
Author(s):  
Mirja Hannele Hirvensalo ◽  
Jiska Cohen-Mansfield ◽  
Shlomit Rind ◽  
Jack Guralnik
Keyword(s):  
Physical Therapist ◽  
Functional Limitations ◽  
Exercise Program ◽  
Assessment Instrument ◽  
Stair Climbing ◽  
Objective Measures ◽  
Physical Endurance ◽  
Balance Exercises ◽  
Impaired Balance ◽  
Total Impact

Prescribing the correct exercise program is a challenge for older adults with multiple physiological impairments. The authors evaluated an assessment instrument that incorporates results of multiple categories of impairment, including strength, balance, gait, vision, and cognitive function. The physical therapist made judgments on the relative impact of 9 different impairments on specific exercises and on the total impact of all impairments on particular exercises. In a cohort age 75–85 y, functional limitations, impaired balance, pain, and low physical endurance were estimated to have the largest impact on the ability to carry out exercise activities, primarily walking, stair climbing, balance exercises, and stationary bicycling. The assessments revealed that the ability to exercise was related to objective measures of function, indicating that the therapist incorporated such objective measures into the impairment-impact rating. The impairment-impact assessment facilitates creating individualized exercise prescriptions for individuals with impairments.

Kinesiophobia After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals

2015 ◽  
Vol 24 (4) ◽  
pp. 434-439 ◽  
Author(s):  
Arika L. Cozzi ◽  
Kristina L. Dunn ◽  
Josie L. Harding ◽  
Tamara C. Valovich McLeod ◽  
Cailee E. Welch Bacon
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
The United States ◽  
Full Potential ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Physically Active ◽  
Acl Rehabilitation ◽  
Anterior Cruciate

Clinical Scenario:There are approximately 200,000 anterior cruciate ligament (ACL) tears reported annually in the United States. Patients who undergo ACL reconstruction followed by an aggressive rehabilitation protocol can often structurally and functionally progress to a preinjury level. Despite physical improvements with ACL-rehabilitation protocols, however, there are still a substantial number of individuals who do not return to preinjury level, particularly physically active individuals, of whom only 63% return to their full potential preinjury level. This may be due to continued pain, swelling, stiffness, and weakness in the knee. In addition, research concerning the topic of kinesiophobia (ie, fear of reinjury), which may prevent individuals from returning to their activities, has increased over the past several years. Kinesiophobia is defined as the irrational or debilitating movement of physical activity resulting in the feeling of vulnerability to painful injury or reinjury. Kinesiophobia may have a significant impact on physically active individuals, considering the proportion of patients who do not return to their sport. However, it is unknown whether kinesiophobia is associated with patients’ perceived physical-impairment levels after ACL reconstruction.Focused Clinical Question:Is kinesiophobia associated with self-perceived levels of knee function after ACL reconstruction?

scholarly journals Twice-Weekly Complete Decongestive Physical Therapy in the Management of Secondary Lymphedema of the Lower Extremities

2006 ◽  
Vol 86 (8) ◽  
pp. 1128-1136 ◽  
Author(s):  
Karen M Holtgrefe
Keyword(s):  
Physical Therapy ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Knee Flexion ◽  
Intervention Program ◽  
Physical Therapist ◽  
Functional Limitations ◽  
Skin Care ◽  
Bilateral Lower Extremity ◽  
Left Lower Extremity

Abstract Background and Purpose. This case report describes the physical therapist examination, evaluation, and intervention for a patient with bilateral lower-extremity lymphedema who received complete decongestive physical therapy 2 days per week instead of the recommended daily frequency. Case Description. The patient was a 55-year-old woman who developed bilateral lower-extremity grade II lymphedema 3 years after surgery and radiation for cervical cancer. She had impairments in hip and knee flexion range of motion and functional limitations in transfers, gait, and activities of daily living. Intervention. A twice-weekly intervention program was implemented consisting of education in skin care, manual lymph techniques, compression, and exercise. Outcomes. Outcomes related to the lymphedema were measured using the sum of the circumference of each limb. At discharge, the patient had reductions in lymphedema of 9% for the left lower extremity and 10% for the right lower extremity. Her hip flexion range of motion increased from 95 degrees to 110 degrees, and her knee flexion range of motion increased from 95 degrees to 130 degrees. She had resumed all premorbid activities and was independent in self-management. Discussion. Twice-weekly management of lymphedema using a program of skin care, manual lymph techniques, compression, and exercise was followed by reduction of the impairments and functional limitations in a patient with bilateral lower-extremity lymphedema.

scholarly journals ACL reconstruction with BTB graft: Unusual evolution of knee arthrofibrosis case report

2005 ◽  
Vol 52 (2) ◽  
pp. 125-129 ◽  
Author(s):  
Z. Blagojevic ◽  
V. Stevanovic ◽  
N. Radulovic
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Growth Factors ◽  
Acl Reconstruction ◽  
Treatment Regimen ◽  
Inflammatory Mediators ◽  
Tissue Proliferation ◽  
Appropriate Treatment ◽  
Joint Biomechanics

Knee arthrofibrosis, which usually occurs after trauma or surgery, can inhibit joint biomechanics. An elaborated interaction of growth factors and other inflammatory mediators initiates and coordinates this deleterious tissue proliferation. Knowledge of risk factors can aid clinicians in helping patients avoid knee arthrofibrosis. Once the condition is present, a history and examination are imperative to institute the most appropriate treatment regimen. Nonoperative measures can be used as therapy, though surgery is often necessary for optimal results. We have analyzed problems in patient with uncommon evolution of knee arthrofibrosis following ACL recontruction with BTB autograft.

scholarly journals Issues Affecting the Delivery of Physical Therapy Services for Individuals With Critical Illness

2013 ◽  
Vol 93 (2) ◽  
pp. 256-265 ◽  
Author(s):  
Amy J. Pawlik ◽  
John P. Kress
Keyword(s):  
Critical Illness ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Interprofessional Collaboration ◽  
Functional Limitations ◽  
Early Mobilization ◽  
The Body ◽  
Routine Practice ◽  
Therapist Competence

Research supports the provision of physical therapy intervention and early mobilization in the management of patients with critical illness. However, the translation of care from that of well-controlled research protocols to routine practice can be challenging and warrants further study. Discussions in the critical care and physical therapy communities, as well as in the published literature, are investigating factors related to early mobilization such as transforming culture in the intensive care unit (ICU), encouraging interprofessional collaboration, coordinating sedation interruption with mobility sessions, and determining the rehabilitation modalities that will most significantly improve patient outcomes. Some variables, however, need to be investigated and addressed specifically by the physical therapy profession. They include assessing and increasing physical therapist competence managing patients with critical illness in both professional (entry-level) education programs and clinical settings, determining and providing an adequate number of physical therapists for a given ICU, evaluating methods of prioritization of patients in the acute care setting, and adding to the body of research to support specific functional outcome measures to be used with patients in the ICU. Additionally, because persistent weakness and functional limitations can exist long after the critical illness itself has resolved, there is a need for increased awareness and involvement of physical therapists in all settings of practice, including outpatient clinics. The purpose of this article is to explore the issues that the physical therapy profession needs to address as the rehabilitation management of the patient with critical illness evolves.

Sign in / Sign up

Export Citation Format

Share Document