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Total knee athroplasty is a major surgical procedure applied to those who are suffering from many different etiologies. Osteoarthritic destruction of the knee is the most common reason for total knee replacement. Osteoarthritis may be primary or secondary. Mechanical derangements (e.g., previous meniscal or cruciate ligament damage), pyogenic infection, and ligamentous instability could also qualify a patient for this procedure. Contraindications include knee sepsis, a remote source of ongoing infection, extensor mechanism dysfunction, severe vascular disease, and the presence of a well-functioning knee arthrodesis. Complications include thromboembolism, infection, patellofemoral and neurovascular complications, as well as periprosthetic fractures and arthrofibrosis. Following the procedure the patient should go through a rehabilitation program in order to increase normal range of motion and strength, and also gait training with or without an assisted device. First, the patient might be put through a short bout of inpatient physical therapy and then the patient can complete the rehabilitation exercises either from the privacy of their home or in an outpatient clinic, which is recommended. Generally the rehab protocol is a safe program with little to no risk involved. A majority of the patients return to their normal physical activity on a timeline that is case specific.
A Jones Fracture is defined as a transverse fracture of the proximal fifth metatarsal at the metaphyseal-diaphyseal junction. Different types of fractures at the fifth metatarsal are common, but the Jones Fracture is particularly popular to the athletic population. This pathology is unique because it occurs in a poorly vascularized environment leading to difficulty in healing. Due to the extensive healing process, operative treatment is strongly encouraged initially to achieve return to activity standards in a timely fashion. Surgical treatment is usually conducted by intramedullary screw fixation utilizing a 4.5 mm, cannulated screw. Postoperative rehabilitation has an immense opportunity to promote the optimal healing environment by using exercises to increase range of motion, proprioception, and muscular strength while reducing bone stiffness, maintaining cardiovascular fitness, and regaining functional ability.
The Achilles tendon is a strong band of connective tissue that connects the gastrocnemius and soleus muscle of the calf to the calcaneus bone of the heel. It is the strongest yet most often ruptured tendon in the body. The injury, if severe enough, can be debilitating to athletes and entails a prolonged recovery. There are a variety of techniques to repair the tendon, and it is still under debate which procedure yields the best outcome. A percutaneous repair involves several small incisions in the injured area and also shows healing advantages in comparison to an open, one incision surgery technique. During the percutaneous repair, sutures are used to connect the torn ends of the Achilles tendon. After a percutaneous repair, a rehabilitation plan must be enforced that promotes strengthening, neuromuscular control, balance, flexibility, and a pain free recovery. This rehabilitation plan accounts for the healing process and uses a mixture of exercises to return a patient with an injured Achilles tendon to functional daily life.
One of the most common causes of chronic wrist pain is the undiagnosed scaphoid fracture. Scaphoid fracture is often first misdiagnosed as a simple wrist sprain, which, however, can be identifies with the assistance of x-ray. The common method of treatment for scaphoid fracture is immobilization. What happens if the fracture fails to heal due to its avascular characteristics? In cases where the fracture does not heal, a procedure involving a bone graft from the hip is often used. In this procedure a portion of the iliac crest is harvested and inserted in the wrist to encourage healing. Although this surgical procedure has a good success rate it is important to consider the implications on post surgical rehabilitation with regards to the wrist as well as the hip.
A Bankart lesion is when the labrum and capsule that surrounds the head of the humerous (glenoid fossa) gets disrupted during backwards extension of the arm. As a result of this injury, the shoulder will feel unstable due to the anterior, low dislocation or tear of the glenoid labrum. One can relocate the shoulder, but it will continue to dislocate and could increase the risk of a more serious injury or dislocation. There are opposing opinions on the treatment plan for a Bankart lesion. One option is to perform a Bankart procedure to restore the stability of the shoulder. The other option is nonoperative treatment for Bankart repair to restore the stability of the shoulder. The research investigates the pros and cons of both methods. If manual therapy can be done to reduce pain surrounding the lesion or tear that it should be performed long before surgery is considered.
Achilles tendon ruptures are becoming a more common injury with all the weekend warriors that have the tendency to not take care of themselves. When an Achilles tendon rupture occurs, the patient experiences severe pain with everyday activity as well as losing the ability to walk. This report discusses a new surgical procedure that uses the tendon of the flexor hallucis longus muscle to repair the ruptured Achilles tendon. This research review is based on follow-up studies and journal articles on the topic of Achilles Tendon Repair surgical technique. The results of this surgical technique, its durability and rehabilitation are looked at closely and compared to other forms of repair. This comparison identifies which technique is better for the different patients.
A rupture of the pectoralis major muscle is a very uncommon injury. It is mainly seen in male athletes between the ages of 20 and 30. The injury results from violent, eccentric contraction of the muscle or when the pectoralis major muscle is in maximal contraction, while the arm is externally rotated and abducted. Because this injury is rare, the rupture is often overlooked as a muscle strain and more damage is then done to the muscle. This requires surgical intervention. After the surgery, the patient is immobilized for two to five weeks followed by a progressive rehabilitation program with a focus on range of motion and strengthening of the shoulder.
Dislocating or subluxing peroneal tendons are a rare injury in athletics. First described by Monteggia (1803), it was not until the Stover & Bryan (1962) and McLennan (1980), that studies were published in major medical journals. The dislocation is a result of forced dorsiflexion with eversion causing a strong contraction of the peroneal tendons, and the superior peroneal reticulum is torn. Once the retinaculum is torn, the peroneal longus and brevis are able to slip anteriorly over the lateral malleolus. In most cases, subluxing peroneal tendons are misdiagnosed as acute lateral ankle sprains. Conservative treatment can be used and only successful about 50% of the time so many cases require surgery. Of the many sports that report dislocating or subluxing peroneal tendons, the least common is football. A star Division III college wide receiver sustained an injury that caused subluxing peroneal tendons. This case study follows the efforts of the athletic training staff to return him to playing condition before and after surgery.
One of the most common elbow surgeries performed today is a Tommy John’s surgery. The Tommy John’s surgery involves the reconstruction of the ulnar collateral ligament. This injury occurs most commonly in the throwing arm of baseball pitchers due to an increased stress placed on the ligament during excessive throwing or improper mechanics. This project investigates possible etiologies, the pathology, along with the surgical technique for this procedure. The most common technique used is the harvesting of the palmaris longus tendon. The rehabilitation protocol is investigated along with potential set-backs for the recovery from this procedure. The recovery can take anywhere from 6-12 months depending on the activity type and level of the athlete. Potential set-backs can range from pain to deceased range of motion.
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