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Proposal for a rehabilitation regimen for patients after posterior cruciate ligament reconstruction surgery. A model of biomechanical study ofthe rehabilitation process

Przemysław Lisiński, Agnieszka Gronek, Włodzimierz Samborski, Lechosław B. Dworak

Przemysław Lisiński, Agnieszka Gronek, Włodzimierz Samborski, Lechosław B. Dworak – Proposal for a rehabilitation regimen for patients after posterior cruciate ligament reconstruction surgery. A model of biomechanical study ofthe rehabilitation process. Fizjoterapia Polska 2010; 10(1); 1-11

Abstract

Background. Few rehabilitation problems raise so much controversy as the timing of rehabilitation and the choice of rehabilitation techniąues in patients following posterior cruciate ligament (PCL) reconstruction. PCL damage occurs in almost 37% of injuries to the knee joint. PCL plays a significant role in stabilising the knee joint. As the signs and symptoms of PCL damage are not so clear-cut as in injuries of other ligaments, a correct diagnosis and institution of treatment are often delayed. A key problem in rehabilitation of these patients is the need to protect the graft. Accordingly all rehabilitation procedures should be carefully supervised. Since there are few available publications concerned with the rehabilitation of patients following PCL surgery, the authors decided to present their own model of rehabilitation. The key elements of this scheme, such as the timing and choice of diagnostic and therapeutic procedures are compared to other methodologies presented in the literaturę.Fuli recovery reąuires a long period of rehabilitation that is dwided into several stages. Ultimately the fuli rangę ofmovement and appropriate muscle strength are restored, and the patient regains fuli motor control thanks to the restoration of proprioception. The authors propose a model of biomechanical investigations enabling objective evaluation ofthe rehabilitation process following PCL reconstruction surgery.

Key words:

posterior cruciate ligament, trauma, reconstruction, physiotherapy, biomechanical investigations

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A Comparative analysis of early results of surgical treatment of Achilles tendon injuries with the minimally invasive and classic methods – physiotherapy options. A Randomized Controlled Trial

Michał Konik, Ireneusz Kotela, Jacek Lorkowski, Tomasz Chruściak, Emilia Sołtan, Monika Chruściak, Sebastian Zduński

M. Konik, I. Kotela, J. Lorkowski, T. Chruściak, E. Sołtan, M. Chruściak, S. Zduński – A Comparative analysis of early results of surgical treatment of Achilles tendon injuries with the minimally invasive and classic methods – physiotherapy options. A Randomized Controlled Trial. Fizjoterapia Polska 2020; 20(5); 182-191

Abstract

Background. The Achilles tendon is the strongest tendon in the human body. Despite the high incidence of injuries and a well-known problem of treating heel tendon injuries, there has been no consensus on the proper treatment, (both surgical and rehabilitation) in professional literature so far. Choosing an operating method that gives “better” treatment results can facilitate the choice of a more effective treatment. It should also be remembered that a properly conducted rehabilitation process is an extremely important element following the surgery.
Aim of the study. The study aimed to evaluate the effectiveness of the surgical treatment of patients with Achilles tendon injuries using the minimally invasive and classic methods.
Material and Methods. The study material included 62 patients treated surgically for Achilles tendon injury in the Department of Orthopedics and Traumatology of CSK MSW in Warsaw in the years 2011-2016. 31 patients were operated using the minimally invasive method (the study group) and 31 patients using the conventional method (the control group). The research group consisted of 27 men and 4 women. The comparative group consisted of 27 males and 4 females. The following research tools were used to evaluate the treatment results: 1. Author’s questionnaire 2. AOFAS score (American Orthopedic Foot and Ankle Society Score) 3. Measuring instrument for maximum force moments in ankle joint JBA “Staniek” 4. HUR stabilographic platform 5. Ultrasonography.
Results. 4 patients, (12.9%) in the control group re-ruptured the tendon after operative treatment. In the study group, 2 patients (6.5%) experienced a complete heel tendon rupture in the postoperative period. The problem of postoperative wound healing disorders was observed among 2 patients (6.5%) from the study group. In the group treated with the classical technique, 5 (16.1%) patients experienced a delay in the healing of the surgical wound due to bacterial infection. Paresthesia, from the sural nerve was observed in only 1 patient in the MIS (Minimal Invasive Surgery) group. 27 patients (87.1%) returned to their sports activity after percutaneous surgery, and 22 patients (71%) after conventional treatment. On average, patients from both groups needed 6 months to return to sports activities.
Conclusions. 1. The number of renewed ruptures after minimally invasive treatment of a damaged Achilles tendon is low and comparable to that of a group of patients treated with the classic technique. 2. Postoperative wound healing disorders are rare in both groups. 3. Calf nerve injury was reported only in one case, while using a minimally invasive procedure. 4. Patients return to work and sports at the same time after surgery in both groups which is influenced by properly implemented physiotherapy 5. Patients presented a similar balance control on the stabilographic platform in both groups. 6. Similar values of maximum force moments in ankle joint were recorded in both groups. 7. In the ultrasound image, there were no morphological differences in Achilles tendon formation in either study group.

Key words:

Achilles tendon, surgical treatment, injury, rupture, physiotherapy

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Mobilisation of proximal radioulnar joint and functioning of the arm after forearm fracture

Marek Woszczak, Katarzyna Syrewicz, Marcel Kotkowski, Marek Kiljański

M. Woszczak, K. Syrewicz, M. Kotkowski, M. Kiljański – Mobilisation of proximal radioulnar joint and functioning of the arm after forearm fracture. FP 2015; 15(1); 58-73

Abstract

Research objective. The research aims to evaluate the effect of mobilisation of proximal radioulnar articulation on the hand function after a forearm fracture.
Material and methods. The research involved 60 patients over the age of 50 who were subject to treatment for limitation of hand function resulting from a forearm fracture. The respondents were randomly divided into equal research and control groups and subjected to a series of ten physiotherapy treatments, including low-frequency electromagnetic field therapy, blue filter Sollux lamp and physiotherapy in the form of free active exercises of the elbow, wrist and fingers. The research group also underwent the mobilisation of proximal radioulnar articulation using the Kaltenborn-Evjenth method.
Results. The analysis of the data obtained showed that mobilisation of proximal radioulnar articulation improved the clinical and functional condition of patients after a forearm fracture.
Conclusions. The respondents who went through a rehabilitation program which included mobilisation of proximal radioulnar articulation, assessed their pain level as being lower. They also achieved a wider range of dorsiflexion, palmar flexion, ulnar and radial deviation as well as supination and pronation motion in the radioulnar joint. Additionally, therapy that included the mobilisation resulted in improved strength of cylindrical grip.

Key words:
injury, forearm fracture, mobilisation, VAS scale, Laitinen scale

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Charakterystyka więzadła przedniobocznego stawu kolanowego oraz jego korelacja z urazami więzadła krzyżowego przedniego u sportowców

Patrycja Szkutnik, Marcin Domżalski

P. Szkutnik, M. Domżalski: Characteristic of the anterolateral ligament of the knee and its correlation with trauma of the anterior cruciate ligament in athletes. FP 2015; 15(4); 74-81

Streszczenie
Urazy więzadła krzyżowego przedniego (ACL) są najczęstszymi urazami stawu kolanowego u sportowców. Diagnozujemy je specyficznymi testami klinicznymi – test Lachmana, szuflady przedniej, pivot-shift oraz dodatkowymi badaniami obrazowymi. Formą leczenia jest rekonstrukcja więzadła z pobranego przeszczepu mięśniowego. Po leczeniu wciąż pojawia się problem z niestabilnością rotacyjną. Tylko 60% sportowców wraca do formy sprzed urazu. Ma to związek z więzadłem przedniobocznym stawu kolanowego (ALL). Jest to więzadło występujące u ok. 95% populacji. Znajduje się na przedniobocznej stronie stawu kolanowego łącząc kość udową z kością piszczelową. Odpowiada za stabilność rotacyjną kolana, szczególnie przy zgiętym kolanie (30-90o), wspomaga funkcję więzadła ACL. Uszkodzenia ALL, które mogą być bezobjawowe, mogą prognozować następowe zerwanie ACL. Natomiast przy zerwaniach więzadła ACL prawie zawsze jest uszkodzone więzadło ALL. Zerwania i uszkodzenia więzadła ALL wykazują związek ze złamaniami Segonda. Niewykryte uszkodzenia ALL powodują niepowodzenia leczenia urazów więzadła krzyżowego przedniego. Należy zastanowić się czy przy współistniejących urazach ACL i ALL wystarczyłoby leczenie zachowawcze uszkodzonego więzadła ALL, aby leczenie i rehabilitacja zakończyły się sukcesem, czy konieczna jest również rekonstrukcja więzadła ALL. Celem publikacji jest zwrócenie uwagi na powszechny problem urazów stawu kolanowego u sportowców i sposób ich leczenia, które doprowadzą do pełnego wyzdrowienia zawodnika oraz jego szybszy powrót do gry.