Tag: chrząstka stawowa

Treating damage to the cruciate ligaments of the knee

Tomasz Andrzejewski, Agnieszka Trytek-Pysiewicz

Tomasz Andrzejewski, Agnieszka Trytek-Pysiewicz – Treating damage to the cruciate ligaments of the knee. Fizjoterapia Polska 2004; 4(4); 331-336

Abstract

Background. Damage to the cruciate ligaments of the knee, despite progress in diagnostics and constantly improved treatment methods, is still a major challenge for orthopedics. In ca. 90% of cases the anterior cruciate ligament (ACL) is damaged, often with collateral damage to other joint structures, such as the meniscus and the articular cartilage; in some cases, the lateral fibular ligament is also damaged, additionally complicating the situation. The goal of treatment is to restore the physiological condition of the knee joint (stability, full mobility, pain-free). Thus conservative treatment is aimed at improving the active functions of the knee stabilizers. Surgical treatment presently involves endoscopic reconstruction of the ligament, single- or multi-channel, using free ST and GR grafts and the proper patellar ligament. Physiotherapy is an integral and vital element of treatment. Early, preoperative rehabilitation is particularly important. Material and methods. 300 endoscopic ACL reconstructions were performed in the Department of Orthopedics and Knee Surgery at the EuroMediCare Hospital in Wrocław, Poland, from January 2002 to August 2004, using primarily free ST and GR grafts. After surgery the patients received a standard 25-week rehabilitation program.Results. We achieved 80% excellent or good outcomes, 15% satisfactory outcomes, and 5% poor outcomes.Conclusions. The most effective method for treating ACL damage is endoscopic reconstruction. Proper rehabilitation is an extraordinarily important element of treatment: there is no modern knee surgery without modern rehabilitation.

Key words:
meniscus, articular cartilage, treatment outcome
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Assessment of kinematics of pathological gait after articular cartilage surgery

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski – Assessment of kinematics of pathological gait after articular cartilage surgery. Fizjoterapia Polska 2006; 6(4); 304-309

Abstract
Background. This paper presents a biomechanical assessment of changes in the kinematics of gait of patients following selected types of articular cartilage surgery of the knee joint, examined with a 3D motion analysis system (SIMI Reality Motion Systems GmbH, Germany). Material and methods. The gait of thirty-two patients after articular cartilage surgery of the knee joint was analyzed in the course of 2 out of 4 stages of our original physiotherapy treatment. Monitoring the progress of the rehabilitation programme involved recording of spatial kinematic data of the gait and angle-time characteristics. The first measurement was taken between the 2nd and 3rd week postoperatively, the second was taken between the 6th and 8th postoperative week. The last measurement was taken between the 10th and 14th week postoperatively, when the patient’s gait was fully restored and being improved. Results. Satisfactory individual results in patients undergoing our rehabilitation programme were obtained in test patients compared to the control group between the 10th and 14th postoperative week. The spatial gait parameters: step and stride lengths were significantly increased and the stance-to-swing ratio decreased for the affected limb compared to the first measurement. Gait velocity was also found to have doubled. In addition the range of motion in the joints was increased and the angle characteristics were similar in the test patients and the control group. Conclusions. The extensive surgical and physiotherapeutic management improved gait parameters between the 10th and 14th postoperative week in all patients.

Key words:
gait analysis, pathological gait, articular cartilage, rehabilitation

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Assessment of kinematics of pathological gait after articular cartillage surgery

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski – Assessment of kinematics of pathological gait after articular cartillage surgery. Fizjoterapia Polska 2007; 7(1); 1-9

Abstract

Background. Thirty two male patients with the full-thickness lesion of articular cartilage on the load-bearing surface of the knee joint (Outerbridge Grade III-IV) were involved in the study. The goal of this paper is the biomechanical assessment of changes in the kinematics of gait of patients after selected articular cartilage surgeries of knee joint examined by the 3D motion analysis system (SIMI Reality Motion Systems GmbH, Germany). Material and methods. Gait of thirty two patients with the articular cartilage surgery of knee joint was analyzed while they underwent 2 out of 4 stages of our original physiotherapy treatment. In order to test the progress of the rehabilitation program the spatial kinematic data of the gait was collected and the angle-time characteristics acquired. The first measurement was taken between the 2nd and 3rd week postoperatively, the second was taken between 6th and 8th week postop. The last measurement was taken between 10th and 14th week postoperatively, when the patient’s gait was fully restored and being improved. The values of step and stride lengths (meters), gait velocity (meters per sec.) and the step cadence (steps per sec.) were monitored as well as the stance and swing ratios (percent of the gait cycle) of the affected and unaffected limb. Range of motion in the knee joint was examined in dynamics and the angles at heel-strike and toe-off measured for both lower limbs. Results. As a consequence of our rehabilitation procedure satisfactory results were obtained individually between 10th and 14th week postop. in test patients with reference to the control group. The spatial gait parameters step and stride lengths have significantly increased and the stance to swing ratio have decreased for the affected limb compared to the first measurement. The gait velocity was found to be doubled. In addition an increase in range of motion in the joints was noticed and the angle characteristics was similar to the one of the control group. Conclusions. The extensive surgical and physiotherapeutic procedures applied in the treatment have improved gait parameters between 10th and 14th week postop in all tested patients.

Key words:
biomechanics, gait, gait disorders, articular cartilage, surgery, rehabilitation
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