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treatment-article

1. august 2011Rupture of the anterior cruciate ligamenturtehave_com

SportNetDoc

Revision ACL reconstruction using autogenous patellar tendon graft.

Eberhardt C, Kurth AH, Hailer N, Jager A. Knee Surg Sports Traumatol Arthrosc 2000;8(5):290-5.

This retrospective study examined revision anterior cruciate ligament reconstruction using a bone-tendon-bone autograft of the patellar ligament. We followed up 44 patients (mean age 27.9 years) for an average of 41.2 months. Clinical examination with the Lachmann and pivot shift tests showed clearly improved stability; KT-1000 arthrometer measurements had a mean difference of 3.5 mm in side-to-side comparison. The evaluated knee scores were significantly improved (P<0.01); the median Lysholm score was 85 and the median Tegner activity score 5.0 at follow-up. In the IKDC ranking system 75.0% of knees were rated normal or nearly normal (grades A and B). According to a modified Fairbank scale, progression of radiographic signs of osteoarthritis was noted in 36.4%. There was a significant difference (P<0.05) in progression of radiographic signs of osteoarthritis between patients with major (grades III, IV) versus minor (grades I, II) lesions of the articular cartilage surface and between knees with versus without extensive synovitis due to previous synthetic graft reconstruction (P<0.05). Revision anterior cruciate ligament reconstruction using an autogenous patellar tendon graft shows good results with improved knee function compared to the prerevision status and is in line with various operative techniques described in the literature. Progression of osteoarthritis must be expected in patients with major lesions of the articular cartilage surface and knees with long-term extensive synovitis due to previous anterior cruciate ligament reconstruction using synthetic grafts.

Week 13-15

1. august 2011Rupture of the posterior cruciate ligamenturtehave_com

[Back]

Training ladder for:
RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 13-15

The following exercises can only be considered as a supplement to the guidelines furnished by the doctor which performed the operation. Specific precautions are necessary as the operation can be complicated. The training must not bring about swelling or pain in the knee.

Unlimited: Cycling. Swimming. Light running.

UDSPÆNDING
(10 min):


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

Stand with one leg outstretched and the other slightly bent. Thrust your weight to the side over the bent leg so that the inner side of the opposite thigh becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(10 min):

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

Stand on the healthy leg with elastic fixed around the hip. The elastic should be fixed to the wall or a wall bar. Take-off on the healthy leg and land on the leg to be trained and keep your balance. Remember that the elastic should be positioned so that it gives resistance at the moment of take-off. Change legs.

Stand on the injured leg with your upper body bent forwards at 90 degrees. Lift the good leg in a straight line behind you. When you feel comfortable with the exercise, it can be made more difficult by closing your eyes.

STYRKE
(40 min):

Stand with your back to the wall with your weight on both feet. Slowly go down and bend the knee to 90 degrees, and slowly rise again.

Stand with elastic around the hip. Step forward over one knee and hold the front foot firmly against the floor. Bend the rear leg and go forward onto your toes. Remember to change leg.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.

Stand on the healthy leg with the elastic around the inside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load.

Stand on the healthy leg with the elastic around the outside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

Week 10-12

1. august 2011Rupture of the posterior cruciate ligamenturtehave_com

[Back]

Training ladder for:
RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 10-12

Unlimited: Cycling with raised saddle. Swimming. Light jogging.

UDSPÆNDING
(10 min):


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

KOORDINATION
(10 min):

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(40 min):


Up and down from the stool with load. Tie elastic around the hip and go up on the stool in a slow movement. The elastic should be fastened to the wall.

Go forward on the injured leg until the knee is bent to max. 90 degrees. Stand up on the same leg and return to the starting position.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.


Lie on the floor with slightly bent knees. Put the elastic under the foot and hold firmly with your hands. Stretch the knee so that the elastic is drawn tight and slowly bend the knee again.

Stand on the good leg with the elastic around the inner side of the injured leg above the knee. Move the injured leg from side to side in a slow movement.

Stand on the good leg with the elastic around the outer side of the injured leg above the knee. Move the injured leg from side to side in a slow movement.

week1

1. august 2011Rupture of the posterior cruciate ligamenturtehave_com

[Back]

Training ladder for:
RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT
(RUPTURA LIGAMENTUM CRUCIATUM POSTERIUS)

Uge 1

The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.

(5 min):

Stand on one leg on the floor or a mattress. Look straight ahead and keep the knee slightly bent.

STYRKE
(25 min):

Sit on a chair with the injured leg on a stool or similar. Lift the leg above the stool with the foot flexed at a maximum, and hold the position for 10 seconds, followed by 10 seconds rest. The exercise should be repeated for approx. 3 minutes.

Lie on the floor with the injured leg. Press the leg against the floor and tip the foot up. Hold the position for approx. 10 seconds. You have to feel a stretching of the anterior thigh. Rest for approx. 10 seconds. Repeat the exercise for approx. 3 minutes.

Lie on your stomach on the floor with your arms above your head and with outstretched legs. Lift right arm and left leg together, changing to lift left arm and right leg together.

step4

1. august 2011Meniscus lesionurtehave_com

[Back]

Training ladder for:
MENISCUS LESION
(LAESIO TRAUMATICA MENISCI)

STEP 4

Training must not bring about swelling in the knee.

Unlimited: Cycling. Swimming. Running and spurting with sudden directional change and jumping.

UDSPÆNDING
(5 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(50 min)


Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Stand with elastic around the hip. Step forward over one knee and hold the front foot firmly against the floor. Bend the rear leg and go forward onto your toes. Remember to change leg.

Stand with your back against a wall with a ball or firm round cushion between the wall and your back. Slowly go down to bend your knee 90 degrees before slowly rising up again.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

step3

1. august 2011Meniscus lesionurtehave_com

[Back]

Training ladder for:
MENISCUS LESION
(LAESIO TRAUMATICA MENISCI)

STEP 3

Training must not bring about swelling in the knee.

Unlimited: Cycling. Swimming. Running with increasing speed and cautious directional change.

UDSPÆNDING
(5 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(50 min)


Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Stand with elastic around the hip. Step forward over one knee and hold the front foot firmly against the floor. Bend the rear leg and go forward onto your toes. Remember to change leg.

Stand with your back to the wall with your weight on both feet. Slowly go down and bend the knee to 90 degrees, and slowly rise again.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

step2

1. august 2011Meniscus lesionurtehave_com

[Back]

Training ladder for:
MENISCUS LESION
(LAESIO TRAUMATICA MENISCI)

STEP 2

Training must not bring about swelling in the knee.

Unlimited: Cycling. Swimming. Light jogging.

UDSPÆNDING
(5 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(50 min)


Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee.

Go forward on the injured leg until the knee is bent to max. 90 degrees. Stand up on the same leg and return to the starting position.


Stand on the injured leg up on a stool with the elastic around your waist. Stand facing the wall. Walk backwards up and down from the stool under resistance from the elastic, alternating between right and left leg first.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

step1

1. august 2011Meniscus lesionurtehave_com

[Back]

Training ladder for:
MENISCUS LESION
(LAESIO TRAUMATICA MENISCI)

STEP 1

Training must not bring about swelling in the knee.

Unlimited: Cycling with raised saddle.

UDSPÆNDING
(5 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(50 min)


Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee.


Pull yourself forward on a chair by use of your heel against the floor. Increase the resistance by having someone hold the chair.


Sit on a chair and lift the knee to a horizontal position. Hold for 1 minute, lower the leg to approx. 45 degrees for 30 seconds. Lower again to the starting position.

Lie on your back with the healthy leg bent and the injured leg against the wall. Place a ball between the foot and the wall. Move the injured leg up and down the wall while applying a slight pressure on the ball.

treatment-article

1. august 2011Inflammation of the bursaurtehave_com

SportNetDoc

Placement of intra-articular injections verified by ultrasonography and injected air as contrast medium.

Fredberg U, van Overeem Hansen G, Bolvig L. Ann Rheum Dis 2001 May;60(5):542.

Intraarticular injection of long-acting corticosteroid is a corner stone in rheumatological treatment. The injected intra-articular corticoid is more effective when the placement is correctly secured. Injection of radiographic contrast material has shown that less than half of the injections are correct placed in the joint space after blind injection. Generally, the clinical application of ultrasonographic examinations can be enhanced by contrast agents. The most common used technique is creation of microbubble contrast agents. Such agents, applied to the bloodstream, have been used for hepatic, nephrologic, cardiologic and transcranial examinations. Obviously, the risk of air embolism depends on the anatomic site of the injected air contrast. Transient ischemic attacks are described after echocardiography with air contrast and in animal models haemodynamic effects during venous air infusion can be measured. Intra-articular injection of air and subsequently lateral and posterior radiographs has shown that this technique can enhance the procedure precision. The disadvantage of this method is that the result can first be seen after the injection, and that a correction can only be made with a new injection. In the joint space the air is separated from the vascular system and when only small amounts of sterile air are used the risk of venous air embolism is neglectable. Air is a very effective contrast medium in ultrasonography. Air sonography has been used for the diagnosis of meniscus lesions in knee joints and for rotator cuff lesions in the shoulder. We expand the applicability of this method to all joints, not only for diagnostic purposes, but also for the correct placement of the needle before injection of medicine (steroid, osmium-acid, viscosupplementation): The sterile air that is contained in the capped vial with lidocain or steroid is used as contrast medium. The needle is ultrasonographic guided placed in the joint space profound for the distended capsule. When the steroid and lidocain are mixed in the syringe a small volume of air will be in the needle itself (˜ 0.05 ml). The air in the needle is clearly seen when the injection is started and will secure the correct placement of the needle. With this technique, it is not necessary to use two separate syringes and the inclination of the syringe will not cause the air to move from the needle to the bottom of the syringe. If the knee is injected, injection directly into the recess is recommended, which will make the small volume of air possible to be seen momentary. Figure 1 illustrates the ultrasonography of a MTP joint in a patient before (UL-34A) and after (UL-34B) injected air. The intraarticular air is clearly seen. We had made more than one thousand ultrasonography guided intraarticular injection without any complications. This method is easy, inexpensive, without risk and radiation and should be used routinely in rheumatology. Especially chemical synovectomy of the knee should always be guided by ultrasonography and with this technique also smaller joins can be considered for chemical synovectomy.

step4

1. august 2011Jumpers's kneeurtehave_com

[Back]

Training ladder for:
JUMPER’S KNEE
(JUMPER´S KNEE)

STEP 4

Unlimited: Cycling. Swimming. Running on a soft surface.

UDSPÆNDING
(15 min)


Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.


Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(40 min)


Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Stand with the elastic around the injured leg, facing away from the elastic. Move the leg forwards and slowly backwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.

Stand with the elastic around the injured leg, facing towards the elastic. Move the leg backwards and slowly forwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.


Lie on the floor with slightly bent knees. Put the elastic under the foot and hold firmly with your hands. Stretch the knee so that the elastic is drawn tight and slowly bend the knee again.

Go up and slowly down from the stool. Go up with the healthy leg first and down with the same leg first. The load can be increased by putting on a rucksack and gradually increasing the ballast in the rucksack.

Stand with your back to the wall with your weight on the injured leg. Lift the healthy leg up on a stool. Slowly go down and bend the knee on the injured leg to 90 degrees. Support then with the healthy leg and use both legs to rise again.


Stand on the injured leg up on a stool with the elastic around your waist. Stand facing the wall. Walk backwards up on the stool with the healthy leg first, and slowly down with the healthy leg first.