Question 1

CHONDRAL REPLACEMENT AND MENISCAL ALLOGRAFTS (CARTILAGE TEARS)

Accepted Answer

One of the most common knee injuries is a meniscal tear (cartilage tear). Often times, this happens with twisting and or compressive forces on the knee joint. The meniscus acts as the cushioning between the femur (long leg bone) and the tibia (the short leg bone). Each supporting bone (femur and tibia) in the knee is covered with cartilage called chondral cartilage. During an injury to the knee, one or both types of cartilage may be damaged. When the damage is so significant that it cannot be repaired, a chondral cartilage replacement or a meniscus replacement may be performed. These are extensive surgeries that are performed by orthopedic surgeons that specialize in cartilage injuries. The damage chondral cartilage or damaged meniscus will be removed and replaced with cadaver cartilage. The new cartilage is secured inside the knee and the rehabilitation process is started shortly thereafter.
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The rehabilitation of these types of surgeries depends on the extent of the surgery as well as the surgeon. Generally the patient will be non-weight bearing (on crutches) for a period of time or limited weight on the leg. Also, a long leg brace will typically immobilize the knee in a straight position and the surgeon will instruct on the amount of knee flexion (bending) that is appropriate at any given phase of the rehabilitation process. The rehabilitation focuses on regaining, the motion of the knee, strength, and overall return to daily life and or sport. Depending on the surgeon and procedure, return to certain sports may not be possible after a chondral replacement or a meniscal allograft as the patient does not want to damage this new cartilage.

Question 2

COMPLEX FRACTURE REPAIR

Accepted Answer

Complex fractures are a common injuries that are sustained in an accident such as a fall, car accident, motorcycle accident, and many others. Some of the most common fractures seen are humeral (long arm bone), femoral (long leg bone), tibia/femoral (ankle bones), or vertebral. A complex fracture typically is repaired surgically by a trauma surgeon. There are multiple techniques to repair complex fractures including rod placement in bones, plates, screws, wires, and at times an external fixator. An external fixator is a rod on the outside of the body that is fixated to non-injured bone in order to stabilize the fracture site.
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Complex fracture patients typically have multiple issues that must be addressed in physical therapy. These can range from nerve injuries/damage, ligament and cartilage problems, soft tissue immobility, joint restrictions and decreased range of motion, as well as decreased strength and function. Depending on the injury, the repair, and the patient deficits, the course of physical therapy will vary. In all cases, maximizing the function of the patient is the main goal.

Question 3

OSTEOTOMIES

Accepted Answer

An osteotomy is a surgical procedure where a bone is cut to shorten, lengthen, or change it alignment. Some of the reasons an osteotomy would be performed are to correct a structural deformity in a bone that has occurred over time (like a bunion), straighten a bone that was fractured and did not heal correctly, or realign a bone that developed abnormally from birth. Misaligned bones can cause undue stress on joints, creating a great deal of pain in some cases. For example, if the femur or the tibia are misaligned or curved, they can put a lot of stress on the hip and/or knee joint, warranting a tibial osteotomy or femoral osteotomy.
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During an osteotomy the bone is cut and then reshaped or partially removed to realign it. The bone is then held together in its new position with plates and screws/pins. Because this procedure is fairly serious and invasive, the recovery period could be quite lengthy. If the surgery was performed on a weight bearing bone, there will most likely be a period of non-weight bearing. It is very important to follow the surgeon’s instructions after the procedure because the bone requires a period of time to heal in its new position, and a traumatic blow or torque to the bone could jeopardize the healing process.
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Anytime a person is instructed to rest a body part for a period of time following a surgical procedure, that person will inevitably lose some joint motion and muscle strength. This is why physical therapy plays such an important role in the recovery process after an operation like an osteotomy. A physical therapist is trained to design specific programs to loosen stiff joints and strengthen weak muscles. This allows patients to return to all of their premorbid activities, including activities they were avoiding due to pain caused by the misaligned bones.

Complex Musculoskeletal Injuries

Restoring function in the complex patient

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