Knee injuries & Surgical Inteventions
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MedRisk Learning CenterKnee Injuries & Surgical Interventions August 4, 2011
To join the conference: Call 866-245-0351Enter Code #770912
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© MedRisk, Inc.
CEU Requirements
» Course is 1 hour for 1.0 credit
» You MUST stay on the webinar for the entire hour, including the Q&A at the end in order to receive credit!
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© MedRisk, Inc.
Thanks for joining us!
» Shelley Boyce, MedRisk’s CEO
» Former nurse
» Founded MedRisk in 1994
» Today MedRisk is the nation’s leading provider of specialty managed care
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© MedRisk, Inc.
Thanks for joining us!
» MedRisk’s goals: Improve quality and delivery of
healthcare in workers’ comp industry Help claims professionals manage their
cases & workload
» National network: Physical Therapy Occupational Therapy Chiropractic Care FCEs Aqua Therapy Certified Hand Therapy Work Hardening Work Conditioning
» Accessible to ALL claims adjusters & nurse case managers Program is not exclusive
to clients
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© MedRisk, Inc.
Thanks for joining us!
» Dedicated website designed for adjusters and nurse case managers Save time submitting
referrals with pre-populated fields
Find a provider anywhere in the US
Access active and closed claims; track patient progress 24/7
Copy and paste information into claims system
Access available IE reports, estimated discharge dates; guidelines, savings per case and more
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© MedRisk, Inc.
Thanks for joining us!
» Your instructor: John Knecht MA, PT, ATC Select Medical Center Manager
Manchester, CT East Hartford, CT
Performs FCEs & Biodex testing
» Please submit written questions by clicking the Q&A tab at top of screen, John will answer at end of presentation
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Work Related Knee Injuries and Surgical Interventions
John F. Knecht MA, PT, ATC, SCS
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Basic Anatomy of Knee
Largest and most complex joint in the body.
3 joints within a single synovial cavity. Medial Tibiofemoral Lateral Tibiofemoral Patellofemoral
Synovial Joint: Syn = together The bones forming the
joint have a synovial cavity and are united by dense irregular connective tissue of an articular capsule, and often accessory ligaments.
Diarthrosis- free moving joint.
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Bone/Synovial Anatomy
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Ligament/ Muscle Anatomy
Cruciates Anterior Posterior
Collaterals Medial Lateral
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Anatomy:Anterior and Posterior Cruciates
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MCL/LCL Anatomy
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Common Injuries in Work Setting
TraumaSlip/Trip/Falls (STF)
All Slip, Trip & Fall incidents are preventable through proper awareness and housekeeping practices.
Direct Blow Hyperextension Overuse/Repetitive Motion
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Trauma
Slip/Trip/Falls (STF)Cords, Cables, and Tubes – Safely and
appropriately secure all cords, cables, and tubes
from items such as: computers, printers, telephones, extension cords, call buttons, and medical equipment. Where appropriate, use cord ties, cable wraps/clips, hook and loop fasteners, or duct tape to keep these hazards out of the path of travel.
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STF continue
Clutter and Debris – Keep floors and stairs free of clutter and debris. A slip on something as small as a needle cap/grape can cause a severe STF injury.
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Direct Blow
Landing on bent knee
Object hitting knee Contusion/bruise
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Hyperextension Injuries
Knee moves backward, feels like it “gives out” or “buckles”.
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Overuse/Repetitive Injuries
Squatting Lunging Kneeling
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ACL Surgeries
Approximately 100,000/yr in U.S. B-PT-B Quadruple Hamstring Allograft Quad tendon Primary (partial tears–with bone marrow stimulation)
Gobbi et al, Am J Sports Med 2009 Milan, Italy
Beecher et al, JOSPT May 2010 South Carolina, USA
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ACL Reconstruction:Tensile Load
Intact 2160 +/- 157 N Tensile Load
BPTB autograph 2376 +/- 151
Quadruple semi/gracilis 4108 +/- 200
Quad tendon autograph 2352 +/- 495
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ACL reconstruction cont
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Non-Surgical Intervention
NSAIDS X-ray MRI Physical Therapy
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Rehabilitation: Pre, Post and Non-operative Overlapping Stages of Healing
Inflammation
Primary
Obligatory
Individual Adaptation
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Inflammation Stage of Healing
Maximum ProtectionCritical to healingWant to control itLimit it to the 1st 24-48 hoursSets up healing process
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Primary Stage of Healing
Moderate protectionKitting together of the tissues2 days to 6 weeksDefect is healed, but tissue is not strongNot ready to be tested
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Obligatory Maturation Stage of Healing Minimal protection
6 weeks to 1 yearMaturing of the tissues in response to the
stressEverybody’s injured site needs to go through
this phaseDo the stresses that caused the problem
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Individual Adaptation Stage of Healing Return to activity
Program adapted to individual
Design treatment programs to stress tissue so it becomes strong
Need to stress in a controlled and gradual way
S.A.I.D.- Specific Adaptations to Imposed Demands
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Recuperation time for injuries
Bone 6-8 weeks
Soft tissue healing 8-12 weeks
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Criteria to Return to Work
Full ROM Quad strength 85% of
contra-lateral side No pain No effusion No other symptoms
Hamstring strength 85% of contra-lateral side
Ham to quad ratio 70% or greater
Functional testing 85% or greater vs. contra-lateral side
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Work Related testing
Lift/CarryWaist to shoulderFloor to waistFloor to shoulder
Push/PullCartsCablesPatients
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Conclusion
Thank you!
Questions?
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© MedRisk, Inc.
CEU Requirements
» Follow this link:
https://secure.blueoctane.net/forms/VDBV7HXEOMZK(we will email it to you as well)
» Complete the CEU Institute survey immediately in order to receive your CE credit. The link is only active for 72 hours!
» Upon completion your certificate will be emailed to you
» Questions? 407-324-0500 [email protected]
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© MedRisk, Inc.
MedRisk Learning Center
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