SLIDE 1 CASE 1: GRAFT TYPE IMPLICATIONS
- 17 y/o senior defensive back
- Injury in 7 v 7 in June
- Already signed with an large D1 program & will “early enroll”
- No other significant injury history
SLIDE 2
IMAGING
SLIDE 3
MRI
SLIDE 4
BONE BRUISING
SLIDE 5 HOW DOES GRAFT CHOICE FOR THIS ATHLETE IMPACT YOUR REHABILITATION PROGRAM?
What really happened…..
- BTB- aggressive patellar/fat pad mobilization
- WB’ing limited to extension with crutches for 6 weeks (persistent effusion & slow return to
quad)
- Passed RTS testing at 28 weeks 12/1) will begin return to sport progression over next 2
months.
- Goal is participation in Spring Football practice
Diagnosis
- ACL rupture, no meniscal tear, no articular cartilage defect at time of surgery
SLIDE 6 ACL Reconstruction in a Skeletally Immature Male: Modifications to Traditional Reconstruction and Rehabilitation
Mark V. Paterno PT, PhD, SCS, ATC
Coordinator of Orthopaedic and Sports Physical Therapy Sports Medicine Biodynamics Center Division of Occupational Therapy and Physical Therapy Cincinnati Children’s Hospital Medical Center Assistant Professor, Department of Pediatrics University of Cincinnati College of Medicine Cincinnati, OH
SLIDE 7 Initial Presentation
History:
- 9 y/o skeletally immature male suffered a
contact, hyperextension injury on 8/15/2006 during a football game
- Current complaints of repeated giving way with
daily activities
- Enters clinic with a functional performance brace
and family is “considering surgical options”
SLIDE 8
Initial Presentation
Physical Exam:
ROM: 0-120 MMT : Knee extension and flexion 4/5 Effusion: 1 cm in suprapatellar region Special Testing: Positive Lachman exam, positive pivot shift exam, Negative meniscal testing KT2000: Increased AP translation of 5 mm Gait: Ambulated with a flexed knee gait pattern
SLIDE 9
Initial Presentation
Chief Complaints:
– Giving way with activity – Mild effusion in anterior knee – Mild discomfort with activity
Patient Goals: Resume football as soon as possible
SLIDE 10
Pre-operative MRI
SLIDE 11 Bone Age Determination
Sex: Male Chronologic Age: 9 years, 6 months (114 months) Estimated Bone Age: 9 years (108 months)
SLIDE 12 Pre-operative Treatment Plan
- 1. Address current impairments:
- Decreased functional ROM/altered gait
- Manage effusion
- Address strength deficits
- Modify home activity in brace
Patient was seen in clinic 1 x/week x 3 weeks to address these impairments. Surgery was scheduled for 11/4/2006
SLIDE 13
Surgical Plan
What is the ideal surgical plan for this skeletally immature patient?
SLIDE 14
Surgical Procedure: Modified Transepiphyeal ACL Reconstruction
SLIDE 15
Post Operative Radiograph
SLIDE 16
Post Operative MRI
SLIDE 17 ACLR in a 73 y/o Skier
John Cavanaugh PT MEd ATC SCS
RESERVATION #:774936759
SLIDE 18 G.L.
- Patient is a 73 y/o criminal defense attorney
- 1St injury left knee getting his skis tangled with his wife’s skis
while getting off a chair lift 12/23/15 in Aspen
- MRI (+) ACL tear, Proximal MCL sprain, LMT,
Contusion Post / Lat Tibial Plateau
O-130 ROM Normal Gait Ascend 8” Descend 6” steps
- ACLR (Achilles Tendon Allogarft) / PLM /
Fat pad excision 2/3/16
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SLIDE 19 G.L.
WBAT, Brace Locked @ 0 AAROM, Quad Re-ed, GT
Aquaciser, CKC Ex, Patella Mobilization, Balance
- Normal Gait @ 4 weeks
- Ascend Stairs @ 6 weeks
- Squats, FSU, Retro TM
- Full ROM @ 11 weeks
19
SLIDE 20 G.L.
20
- Descend Stairs (8”) @ 14 weeks
- Running (AlterG) 15 weeks, Treadmill 18 weeks
- Plyometric / Agility Exercises
- Return to Tennis (Doubles) @ 22 weeks
- Singles Tennis @ 30 weeks
- Return to skiing 12/1/17
10 months
Isokinetic Test @ 10 months
– -13.5 % Quad deficit at 180 Degrees/sec
