Articular Cartilage Injury to the Knee: Current Concepts in Surgical Techniques and Rehabilitation Management

Transcription

1 Articular Cartilage Injury to the Knee: Current Concepts in Surgical Techniques and Rehabilitation Management Combined Sections Meeting 2014 Las Vegas, Nevada, February 3 6, 2014 James L. Carey, MD, MPH Assistant Professor of Orthopaedic Surgery Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania Brian J. Eckenrode, PT, DPT, OCS Assistant Professor of Orthopaedic Physical Therapy Coordinator of the Orthopaedic Clinical Residency Arcadia University Glenside, Pennsylvania Mark V. Paterno PT, PhD, MBA, SCS, ATC Coordinator of Orthopaedic and Sports Physical Therapy Associate Professor Sports Medicine Biodynamics Center Division of Occupational Therapy and Physical Therapy Cincinnati Children's Hospital Medical Center Cincinnati, OH Laura Schmitt PT, MPT, PhD Assistant Professor, Division of Physical Therapy School of Health and Rehabilitation Sciences Ohio State University Columbus, OH 1

2 Disclosures: 2

3 Course Description: Rehabilitation of articular cartilage injuries of the knee provide a challenge to the practicing physical therapist due to the complex and variable injury pattern. This course will familiarize the physical therapist with the current palliative, reparative, and restorative surgical techniques for cartilage injuries of the knee. This session will review the basic science of articular cartilage, incidence, diagnostic techniques, and various surgical procedures utilized in the management of knee articular cartilage injuries. The post-operative rehabilitation and return-to-activity guidelines following knee cartilage surgery will be discussed. The format for this session will include lecture and interactive discussions between presenters and attendees. Learning Objectives: Upon completion of this session, learners should be able to: Discuss the basic science of knee articular cartilage and how cartilage pathology can impact function and recovery Compare the different diagnostic techniques and clinical examination findings associated with knee cartilage injuries Differentiate between the various surgical techniques utilized for knee articular cartilage injuries Integrate the knowledge of knee joint anatomy and biomechanics with how it relates to the different knee surgical articular cartilage procedures Review the rehabilitative differences between the various knee cartilage surgical procedures Apply relevant literature findings related to the prognosis for patient with a knee cartilage injury Design an appropriate rehabilitation plan following knee cartilage injury surgery that considers the biomechanical and tissue healing factors utilizing current evidence-based practice Prepare an evidence-based return-to-sport rehabilitation program following knee cartilage surgery 3

4 Outline: I. Introduction/Incidence and associated risk factors II. Cartilage-basic science/age-related changes 1. Articular Cartilage a. Function b. Composition c. Structure d. Biphasic nature 2. Cartilage biomechanics and response to forces a. Tensile, compressive, shear 3. Cartilage response to injury 4. Cartilage factors that influence healing 5. Age-related changes a. In composition, structure and function b. Implications for injury/degeneration III. Diagnostic imaging/clinical diagnosis/surgical management IV. Post-operative rehabilitation 1. Guiding principals of rehabilitation a. Procedure specific i. Tissue healing/maturation process ii. Defect size iii. Defect location b. Rehab specific i. Biomechanical considerations ii. Monitor reactivity iii. Protocol progression iv. Patient education-expectations c. Rehabilitation guidelines i. Microfracture ii. OATS/Mosaicplasty iii. ACI V. Return to sports/activity after articular cartilage Injury a. Evidence regarding return to sports after articular cartilage injury: who can resume impact activity? b. Objective assessment of readiness to return to sport after articular cartilage injury VI. Prognosis 1. Articular cartilage defects a. Natural history i. Risk for osteoarthritis conflicting evidence ii. Function and quality of life b. Outcomes following articular cartilage repair and regeneration procedures i. Muscle strength and Joint mechanics ii. Function patient reported and performance based outcomes iii. Return to sport rates c. Factors that influence outcome d. Implications for rehabilitation 4

5 VII. The future of rehabilitation after articular cartilage injury: Movement towards consensus VIII. Q&A 5

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