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Re: Att SueBW

Posted By: SueBW
Date: Sunday, 31 August 2008, at 3:38 p.m.

In Response To: Att SueBW (drmark)

> Sue, are you saying that the Cincinatti approach is NOT to
> acutely repair/reconstruct complete lateral and
> posterolateral injuries, but to do ordinary prehab type of
> rehabiliation????

> I would have thought that such would be reasonable in mild
> to at most moderate lateral sided injuries, although
> LaPrade says in his book to immobilize them for s short
> time, so that too is probably reasonable.

> I hope that the Goose hasn't done too much damage to my
> brain.

Depends on the patient and other circumstances - we will do an acute posterolateral repair (combined with the cruciate reconstruction if required) if pain, effusion, swelling, and motion are OK at about 1 week post-injury AND if the patient is a high level athlete or involved in a very strenuous occupation. The advantages include being able to usually do a "smaller" PL procedure, such as primary repair combined with a proximal advancement of the PL complex. Chronic PL reconstructions required 1-2 grafts, which are much more involved. However, in cases of combined ligament injuries, it is not too common to have a knee that isn't still swollen, painful, and demonstrates a significant limitation of knee motion that early after injury. As you know, those knees shouldn't be rushed to surgery.

We do use a brace for immobilization and crutches initially after the injury, but have the patient take off the brace and perform careful passive ROM exercises 3-4 times a day. If they are taught to do this correctly, by applying a 10-pound valgus load (with their hand to the lateral aspect of the knee) to decrease lateral joint forces, then we believe this is safe and effective in preventing an arthrofibrotic problem. In addition, patellar mobilization, quadriceps isometrics, electrical muscle stimulation, and leg raises are encouraged.

4-6 weeks later, the exam will determine the amount of healing that has occurred to the lateral and posterolateral structures. The necessity to perform an ACL reconstruction (and PL reconstruction) can then be determined in a relaxed manner. Plus, some patients still aren't ready for surgery and require more preop rehab.

It's all covered in 4 chapters in Section V of the book! By the time it's published, you'll have recovered from studying for "the test".

SueBW

SueBW

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