Case Study For Physical Therapy The Effect of Early Surgery vs. Physical Therapy on Knee Function Among Patients with Non-Obstructive Meniscal Tears
Despite recent studies suggesting arthroscopic partial meniscectomy (APM) is no more effective than physical therapy (PT), the procedure is still frequently performed in patients with meniscal tears. Methods: Noninferiority, multicenter, randomized clinical trial conducted in 9 hospitals in the Netherlands. Participants were aged 45 to 70 years with nonobstructive meniscal tears (ie, no locking of the knee joint). Patients with knee instability, severe osteoarthritis, and body mass index greater than 35 were excluded. Recruitment took place between July 17, 2013, and November 4, 2015. Participants were followed up for 24 months (final participant follow-up, October 11, 2017). Three hundred twenty-one participants were randomly assigned to APM (n = 159) or a predefined PT protocol (n = 162). The PT protocol consisted of 16 sessions of exercise therapy over 8weeks focused on coordination and closed kinetic chain strength exercises. Results: Over a 24-month follow-up period, knee function improved in the APM group by 26.2 points (from 44.8 to 71.5) and in the PT group by 20.4 points (from 46.5 to 67.7). The overall between-group difference was 3.6 points (97.5% CI, -∞ to 6.5; P value for noninferiority = .001). Repeat surgery (3 in the APM group and 1 in the PT group) and additional outpatient visits for knee pain (6 in the APM group and 2 in the PT group) were the most frequent adverse events. Conclusions: Among patients with nonobstructive meniscal tears, PT was noninferior to APM for improving patient- reported knee function over a 24-month follow-up period. Based on these results, PT may be considered an alternative to surgery for patientswithnonobstructivemeniscal tears. Subjective: 35 y.o. FwithRmedial knee diffuse
pain that she noticed was worse with box jumps and squats. Denies any distal signs and symptoms currently, mild crepitus with closed kinetic chain flexion/extension, aching worse after workouts and knee is stiff in themornings. Pt. also reported feeling as if her knee would swell after her work outs but goes away after application of ice at night. Objective: Current pain level 5/10, Least: 2/10, Worst: 8/10 ROM: Right knee AROM: 0deg extension to 135 deg flexion with reports of endrange, medial joint line knee pain Strength: Iliopsoas 5/5, TFL: 5/5, GluteMax: 4/5, PGM: 3/5, Quads: 4/5, HS: 5/5, Gastrocnemius: 5/5, Soleus: 5/5 Movement Analysis: Noted R hip anterior glide andmedial rotationwith squatting (both single leg and bilateral). Pt. also reports reproduction of her signs and symptoms with both jumping and landing. Joint Mobility: Noted decrease in R tibiofemoral posterior glides with internal rotation Intervention: Manual Therapy included posterior tibiofemoral joint glides with internal rotation gd III for increasing flexion. Therapuetic exercises included single leg squats with resisted hip abduction, AAROM knee flexion and vigor gymsquatswith resisted hip abduction. Outcome: Post treatment patient reported feeling better in her knee and stating that her left just really felt tired rather than her original signs and symptoms. Pt. was issued a detailed home exercise program that included single leg squats with hip abduction resist to fatigue only, several times a day, modified air squats to fatigue and use of an upright or recumbent bicycle for both repetitive, low load compression and cardiovascular benefits. • The load of the tissue must be monitored and controlled. • Training should also only causeminimal to no fatigue. • Proximal hipmuscular performance and control of compensatory movement at the hip is important todecrease adverse effect at the distal tibiofemoral joint.
HEALTHY RECIPE Cilantro Lime Chicken & Avocado Salsa
• 1.5 lb. boneless chicken breast • 1/4 cup lime juice • 2 tbsp olive oil • 1/4 cup fresh cilantro • 1/2 tsp ground cumin • 1/4 tsp salt INGREDIENTS
For Avocado Salsa: • 4 avocados, diced • 1/2 cup fresh cilantro • 3 tbsp lime juice • 1/2 tbsp red wine vinegar • 1/2 tsp red pepper flakes • 1 garlic clove, minced
DIRECTIONS Add 1/4 cup of lime juice, olive oil, 1/4 cup of fresh cilantro, ground cumin, and 1/4 tsp of salt to a small bowl. Whisk until mixed. Add chicken and marinade to a large ziplock bag. Let chicken marinate for at least 15 minutes. Preheat grill to medium-high heat (about 400°F). Place chicken on grill and grill each side for 4-6 min, until chicken is no longer pink. Remove and let sit. For avocado salsa: add avocado, 1/2 cup fresh cilantro, 3 tbsp lime juice, red wine vinegar, red pepper flakes, garlic clove, and salt to a small bowl. Gently toss to mix. Top the cilantro lime chicken with the avocado salsa and serve.
KEY POINTS
• Signs of Cartilage Overload clinically could include: an increase in joint stiffness, swelling, loss of ROM and dull aches in the knee. • Cartilage is trainable. Repetitive and symptom free compression/ decompression in weight bearing situations is the stimulus.
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