Kategoriarkiv: Knee

examination-article1

Inner collateral ligament rupture

SportNetDoc

Ligament lesions of the knee joint in childhood

Ritter G, Neugebauer H. Z Kinderchir 1989 Apr;44(2):94-6. Z Kinderchir 1989 Apr;44(2):94-6
As a matter of principle, all lesions of the knee associated with haemarthrosis must be examined for internal injuries. Ligament ruptures are rare; usually, there are bony ligament tears that show up on x-ray film. Examination of ligament stability in children is useful only if the x-ray is negative and after the knee joint has been punctured under anaesthesia, and can be justified only in that case. Diagnosis is possible only by means of x-ray films taken in forced extreme joint position in two planes, with lateral comparison. Treatment of all non-dislocated ligament tears is conservative; slight dislocations can be tolerated in cruciate and capsular ligaments, since the epiphyseal cartilage is not affected. Surgery should be performed only if tears are considerably dislocated. Proximal tears of collateral ligaments are epiphyseal fractures that can be treated conservatively only if there is no dislocation; if they are dislocated, surgery is absolutely mandatory.
KONDITION

STEP2

Luxation of the knee cap

GENOPTRÆNING

[Back]

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CARTILAGE DAMAGE ON THE KNEE CAP
(CHONDROMALACIA PATELLAE)

STEP 2
KONDITION
Unlimited: Cycling. Swimming. Light jogging.

UDSPÆNDING
(5 min)

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.

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.

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
(20 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.

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.

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.

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.

KONDITION

STEP3

Luxation of the knee cap

GENOPTRÆNING

[Back]

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CARTILAGE DAMAGE ON THE KNEE CAP
(CHONDROMALACIA PATELLAE)

STEP 3
KONDITION
Unlimited: Cycling with raised saddle. Swimming. Running with increasing speed and cautious directional change.

UDSPÆNDING
(5 min)

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.

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
(20 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 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.

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.

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.

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.

KONDITION

STEP4

Luxation of the knee cap
[Back]

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CARTILAGE DAMAGE ON THE KNEE CAP
(CHONDROMALACIA PATELLAE)

STEP 4
KONDITION
Unlimited: Cycling with raised saddle. Swimming. Running and spurting with sudden directional change.

UDSPÆNDING
(5 min)

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.

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.

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
(20 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.

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 side on a mattress or bench. Flex the lower part of the leg and stretch the upper part. It is important to completely stretch the hip. Lift the upper leg upwards with the heel pointing towards the ceiling. Gradually increase the load by attaching a sandbag to the ankle.

Lie on your side on a mattress or bench. Stretch the lower leg whilst the upper leg is slightly bent. Lift the lower leg stretched upwards. Gradually increase the load by attaching a sandbag to the ankle.

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.

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.

KONDITION

STEP1

Luxation of the knee cap

GENOPTRÆNING

[Back]

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR CARTILAGE DAMAGE ON THE KNEE CAP
(CHONDROMALACIA PATELLAE)

STEP 1
KONDITION
Unlimited: Cycling with raised saddle. Swimming.

UDSPÆNDING
(5 min)

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.

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
(20 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 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.

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.

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.

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.

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.

tape-description

Luxation of the knee cap

Tapening



Type: KNEE STABILISING BANDAGE:

Objective: To control the movement of the kneecap so that it glides up and down in a direct line. The tape should immediately provide less pain, and is a good indicator of whether the patient will gain any benefit of a kneecap stabilising bandage.

Application: The knee should be held slightly bent when applying the tape. One anchor is applied above the knee and one below (A & B), and should be open to the rear. A strip is applied (C) over the kneecap’s lower outer half, so that half the tape is over the kneecap. The tape is in line with the edge of the kneecap, and in this way has a sloping course, lifting and pushing the kneecap slightly inwards. The second strip (D) is applied over the kneecap’s upper outer half, so that half the tape is over the kneecap and runs slanting downwards over the first strip. Finish with further strips on top of the anchors A & B.

bandage-article1

Luxation of the knee cap

SportNetDoc

Effect of a patellar realignment brace on patients with patellar subluxation and dislocation. Evaluation with kinematic magnetic resonance imaging.

Muhle C, Brinkmann G, Skaf A, Heller M, Resnick D. Am J Sports Med 1999 May-Jun;27(3):350-3.

The object of this study was to evaluate the effect of a patellar realignment brace on patients with patellar subluxation or dislocation. Twenty-one patients (24 patellofemoral joints) with clinical evidence of patellar subluxation (N = 16) or dislocation (N = 5) were examined with the joint inside a positioning device to allow active-motion, kinematic magnetic resonance imaging. To analyze the patellar tracking pattern, the same imaging parameters (patellar tilt angle, bisect offset, and lateral patellar displacement) and section locations were used before and after application of a patellar realignment brace. No statistically significant differences were found in any of the three parameters for the patellofemoral relationships before or after wearing the patellar brace. The results indicated no stabilizing effect of the tested brace in patients with patellar subluxation or dislocation during active joint motion.

treatment-article2

Luxation of the knee cap

SportNetDoc

Operative versus closed treatment of primary dislocation of the patella. Similar 2-year results in 125 randomized patients.

Nikku R, Nietosvaara Y, Kallio PE, Aalto K, Michelsson JE. Acta Orthop Scand 1997 Oct;68(5):419-23.

To assess whether initial surgery is beneficial for patients with primary dislocation of the patella, we carried out a prospective randomized study. Knee stability was examined under anesthesia, and associated injuries were excluded by diagnostic arthroscopy. 55 patients then had closed treatment and 70 patients were operated on with individually adjusted proximal realignment procedures. Surgery gave no benefit based on 2 years of follow-up. The subjective result was better in the non-operative group in respect of mean Houghston VAS knee score (closed 90, operative 87), but similar in terms of the patient’s own overall opinion and mean Lysholm II knee score. Recurrent instability episodes (redislocation or recurrent subluxation) occurred in 20 nonoperated and in 18 operated patients. Of these, 15 and 12, respectively, then suffered redislocations. Function was better after closed treatment. Serious complications occurred after surgery in 4 patients. In conclusion, the recurrence of patellar dislocation may be more frequent than reported, whatever the form of treatment. Routine operative management cannot be recommended for primary dislocation of the patella.