Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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Special Collection - Knee
Table of Contents

UPDATE ON ANTERIOR CRUCIATE LIGAMENT INJURIES:
DESIGNING AN ANTERIOR CRUCIATE LIGAMENT INJURY PREVENTION TRAINING PROGRAM

Abstract:

CONTENT: In the monograph, Dr. Sigward goes into detail on explaining the importance of key neuromuscular risk factors for anterior cruciate ligament (ACL) injury and how such risk factors can be used in the design of effective injury prevention strategies. She also discusses the key components that are needed to carry out a successful injury prevention program. A unique portion of the paper is the author's clear and systematic writing style that discusses principles underlying the appropriate progression of exercises. In addition, the inclusion of a DVD demonstrates comparative performances of an ACL injury prevention program, which will help readers implement their own program. Throughout the monograph the author has provided an evidence-based methodology in deciphering the current literature on ACL injury.

Keywords:​

anterior cruciate ligament, knee, risk factors

References:

Click here.

UPDATE ON ANTERIOR CRUCIATE LIGAMENT INJURIES:
REHABILITATION FOR THE ANTERIOR CRUCIATE LIGAMENT-DEFICIENT KNEE

Abstract:

CONTENT: In their monograph, Drs. Chmielewski and Hurd describe the historical findings one can expect in individuals with an anterior cruciate ligament (ACL)-deficient knee. The differences and clinical decision-making considerations regarding nonoperative versus surgical management for acute ACL rupture are then discussed. The authors identify factors that influence the outcome of nonoperative management of ACL rupture, in particular those that contribute to dynamic knee stability after ACL rupture. A unique and distinguishing portion of the monograph is the section in which the authors compare and contrast outcomes of nonoperative management for ACL rupture when patients are self-selected versus selected using an algorithm-guided decision-making scheme. The important components of a nonoperative rehabilitation program for patients with acute ACL rupture are also highlighted. Key points related to returning to preinjury activities after ACL rupture are then discussed along with pertinent topics related to counseling patients who sustain an ACL injury. The authors do an excellent job describing the factors that impact disability following ACL rupture, the realistic outcomes that can be expected with nonsurgical and surgical interventions, and the importance of comprehensive rehabilitation in returning patients to optimal function. CASE ANALYSES: The authors conclude with 2 excellent case studies detailing the management and rehabilitation guidelines that demonstrate how to apply information presented from the previous portions of the monograph. The first case involves a 45-year-old woman who injured her right ACL while playing outside with her dog. The second case is a 17-year-old football player who ruptured his ACL in a contact injury during a scrimmage.

Keywords:​

anterior cruciate ligament, injuries, nonoperative

References:

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UPDATE ON ANTERIOR CRUCIATE LIGAMENT INJURIES:
REHABILITATION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Abstract:

CONTENT: In the monograph, the authors discuss the rehabilitation priorities following primary and revision anterior cruciate ligament (ACL) reconstruction. Each area is organized into phases that progress the reader through preoperative and early and end postoperative phases. The authors propose criterion-based guidelines and stress the importance of such criteria in progressing patients at the proper functional pace. Their discussion of clinical milestones is predi-cated on evidence-based principles of healing and also account for individual variance in the healing process. All rehabilitation schemes are discussed in detail, thus providing the reader with specific and useful information on how to prioritize preoperative and postoperative impairments, and a rationale for interventions and progression criteria aimed at resolving identified impairments. In addition, the authors have included a separate section on accompanying meniscal, chondral, and ligamentous injuries that can often complicate an ACL rehabilitation program. There is also a section on management of the stiff knee following ACL surgery. CASE ANALYSES: Two interesting case studies conclude the monograph. One case focuses on outcomes following revision ACL. The other case describes a patient who has undergone a primary ACL reconstruction that was accompanied by poor immediate postsurgical management. This case highlights the orthopaedic challenges that result in delayed achievement of important rehabilitation milestones.

Keywords:​

anterior cruciate ligament, injuries, knee

References:

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JOINT ARTHROPLASTY: ADVANCES IN SURGICAL MANAGEMENT AND REHABILITATION:
SURGICAL MANAGEMENT AND REHABILITATION OF KNEE ARTHROPLASTY

Abstract:

CONTENT: Conservative and surgical management for the patient with knee osteoarthritis are discussed. The surgical section also includes surgical alternatives to knee arthroplasty as well as indications, contraindications, and prognostic indicators to knee arthroplasty. A very detailed discussion of the various surgical procedures and how they impact rehabilitation programs are emphasized. This is followed by an important section on potential complications from knee arthroplasty including infections, deep venous thromboembolism, peripheral nerve injuries, component loosening, extensor mechanism rupture, and the stiff knee. Common outcome measures and return to function considerations are discussed. A very comprehensive section on rehabilitation follows which takes the reader through the perioperative considerations, home health physical therapy, and outpatient physical therapy services. The authors have done an excellent job taking a wealth of information on the broad topic of knee arthroplasty and created a very practical and easy to follow learning resource for the physical therapist. CASE ANALYSES: Two case reports conclude the monograph. The first case describes a 69-year-old male who was seen before surgery, but was also followed for 8 weeks after unilateral total knee arthroplasty. The second case describes a 54-year-old male who receives outpatient physical therapy 3 weeks after a primary, unilateral total knee arthroplasty.

Keywords:​

joint replacement, arthritis, surgery

References:

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ALTERNATIVE SPECIAL TOPICS: INNOVATIONS IN PRACTICE:
ADVANCES IN ANTERIOR CRUCIATE LIGAMENT SURGERY AND REHABILITATION

Abstract:

CONTENT: The monograph provides a strong foundation of knowledge in understanding the current evidence regarding prevention, evaluation, and management of ACL injury. In the monograph, Dr Campanella provides a much needed comprehensive review of the current state of ACL prevention injury and treatment. A detailed review regarding ACL anatomy and biomechanics provides a nice introduction to understanding ACL injury. Mechanisms of injury are discussed in detail including the effect of gender on injury. The diagnosis of an ACL tear and confirming clinical tests are then reviewed. Surgical methods to restore the ACL are covered along with possible complications following repair of the ACL. A separate section on ACL injury for the pre-adolescent and adolescent age groups is included. Postsurgical protocols and factors to consider when choosing a rehabilitation approach are deliberated by the author along with specific functional therapeutic exercise recommendations. Bracing, return to sport, and outcome measures are also covered. CASE ANALYSES: Two case studies integrate the concepts covered in the monograph. The first is 35-year-old female who sustained an ACL tear of her left knee when she was tackled while playing in an all-female football league. The second case describes a 57-year-old female who suffered an ACL tear from a fall but was unable to pursue surgery until a few years later due to extenuating circumstances.

Keywords:​

prevention, evaluation, management

References:​

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CURRENT CONCEPTS OF ORTHOPAEDIC PHYSICAL THERAPY, 4TH ED.
THE KNEE: PHYSICAL THERAPY PATIENT MANAGEMENT USING CURRENT EVIDENCE

Abstract:

In this monograph, readers will review the clinical anatomy and biomechanics of the patellofemoral and tibiofemoral joints and how this can affect the evaluation and treatment of a variety of knee pathologies. After determining the differential diagnosis of common conditions affecting the knee joint by recognizing signs and symptoms, the reader will be able to test each hypothesis with research supported evaluation tests and measures. The authors summarize a variety of treatment interventions and discuss optimal situations to use these techniques in order to resolve impairments and help restore the patient's function. An emphasis is placed on procedure-modified and pathology-modified rehabilitation, to guide the reader through the treatment of several surgical and nonsurgical conditions such as anterior and posterior cruciate ligament, posterior lateral corner, collateral ligament and meniscal injuries; osteoarthritis; articular cartilage injuries; and patellofemoral pain. Several operative and nonoperative rehabilitation guidelines are included to facilitate treatment progression in an evidence-based manner. Five patient case scenarios challenge the reader to critically think about all aspects of patient care and apply the knowledge gained within the monograph.

Keywords:​

anterior cruciate ligament, evaluation, guidelines, impairments, meniscal, osteoarthritis, patellofemoral, pathology modified, procedure modified, rehabilitation, tibiofemoral, treatment

References:

Click here.

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