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DBC Knee Concept - Post-surgery ACL

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Presentation in International Sports Physiotherapy Congress (@FSPACongress) in Helsinki 6/2017

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DBC Knee Concept - Post-surgery ACL

  1. 1. ACL Rehabilitation Some perspectives of using DBC Knee Concept Juha Koistinen Sports Physiotherapist (Cert.), OMT Clinic Owner - Liikuntafysio Consultant - Sports Academy of Helsinki Capital Region, Urhea.
  2. 2. Aim of this session • To provide a short demonstration of post-surgery ACL process in the DBC Concept Clinic Sello • To bring up some functional criteria to follow the process (not based only timeline) • To introduce clinical outcome (within the process)
  3. 3. Tools to provide systematic approach • DBC Medical Background + Knee treatment manual • Treatment devices and facilities • CIS = Clinical information system (software) • Process documentation • Outcome measurement • Quality Assurance • Exercise library
  4. 4. Basic knee process PRE-INFORMATION AND BASELINE ASSESSMENT • Pre-information questionnaire (inc. IKDC) • Clinical assessment and tests • Clinical reasoning => • Diagnosis and functional patterns • [RBDS, FABQ questionnaires if needed] TREATMENT PLAN • Assessment summary report • Goals • # of treatment visits • Frequency • Content: • Active treatment • CBA, manual therapy, pain management if needed TREATMENT  • Evidence based clinical practice • 3-15-25 visits • Small group training, with pain treatment as necessary • Progress checks – for treatment plan adjustments OUTCOME ASSESSMENT • Questionnaires • Clinical assessment • Severity of deconditioning • Individual summary Report • Progress or outcome measures to evaluate against the baseline measures FOLLOW UP • Questionnaires • Clinical assessment • Severity of deconditioning • Individual summary Report • Continued activity to maintain treatment results - Elite vs. recreational athlete - - Training the athlete not just the injury!-
  5. 5. CIS - Pre-information
  6. 6. Process documentation
  7. 7. IKDC Functional Scale Grade symptoms at the highest activity level at which you think you could function without significant symptoms, even if you are not actually performing activities at this level. • What is the highest level of activity that you can perform without significant knee pain? • What is the highest level of activity you can perform without significant swelling in your knee? • What is the highest level of activity you can perform without significant giving way in your knee? • What is the highest level of activity you can participate in on a regular basis?
  8. 8. IKDC Functional Scale • Very strenuous activities  = Jumping or pivoting as in basketball or soccer • Strenuous activities = Heavy physical work, skiing or tennis • Moderate activities = Moderate physical work, running or jogging • Light activities = Walking, housework or yard work • Unable to perform any of the above activities.
  9. 9. IKDC Functional Scale How does your knee affect your ability to: 1. Go up stairs 2. Go down stairs 3. Kneel on the front of your knee 4. Squat 5. Sit with your knee bent 6. Rise from a chair 7. Run straight ahead 8. Jump and land on your involved leg 9. Stop and start quickly • Not difficult at all • Minimally difficult • Moderately difficult • Extremely difficult • Unable to do
  10. 10. Treatment options • Surgical + reconditioning • Hamstring autograft - STG • Patellar tendon autograft - BTB • (Allograft) • Non-surgical = reconditioning
  11. 11. Surgical options PATELLAR TENDON AUTOGRAFT Pitfalls: • Postoperative pain behind the kneecap • Pain with kneeling • Slightly increased risk of postoperative stiffness • Low risk of patella fracture HAMSTRING TENDON AUTOGRAFT (STG) • Single or double bundle techniques • With double bundle graft better rotational stability, functional result seems to be equal • Fewer problems with anterior knee pain or kneecap pain after surgery • Less postoperative stiffness problems, faster recovery • Negative affects of hamstring function (e.g. sprinters), neural irritation
  12. 12. Postop ACL Reconditioning Stages Pre-surgery ˜1-4 wks Acute stage
 ˜1-2 wks Initial stage ˜8 wks Intermediate stage ˜6-7 wks Intensive stage ˜8 wks Functional stage ˜10 wks RETURN TO PARTICIPATION RETURN TO  SPORTS RETURN TO  PERFORMANCE
  13. 13. Process benchmarking STAGE ELEMENT TEST GOAL Presurgery Acute Initial Intermediate Intensive Functional Range of motion Active knee extension-flexion Effusion Swipe test, ballotable patella Patellar movement Gliding / soft tissue tightness Harvest site Palpation - Strength and activation Circumference 5 & 15 cm +VMO Isometric extension Isometric flexion OLHD, CMJ jump height Functional task Gait symmetry, stride length Two leg squat One leg squat Cycling Running Activities index IKDC (9 questions: 0-4) Current function Self reporting (Q’s from IKDC)
  14. 14. Exercise categories • Adjuncts of exercise (GameReady, Compex, mobilizations etc.) • Cardio exercises • Mobility exercises • Muscle performance exercises • Muscle activation exercises • Open kinetic chain exercises • Closed kinetic chain • Functional exercises • Balance (static / dynamic) • Gait • Running (Antigravity treadmill Alter G) • Coordination, muscle specific coordination drills • Eccentric training (YoYo) • Plyometrics RESPECT GRAFT RESPECT CARTILAGE RUNNING FOR RUNNING SAKE?
  15. 15. ACL Protocol (26 wks) • Pre-surgery session (baseline, 1:1) • 5-7 treatment & progress check sessions (1:1) • 2 test sessions (12, 26 wks) • Altogether 8-10 sessions (1:1) • Small group sessions 2-3 times/week (1:3 or 1:6) • Altogether 75+ rehab sessions & other S&C sessions
  16. 16. Post-surgery ACL Results 0 22,5 45 67,5 90 Pain 24h Pain last wk Pain last 6 wks Trouble 24h Trouble last wk Trouble last 6 wks Knee index 19%/ 100% 70%/ 100%
  17. 17. INITIAL STAGE
  18. 18. INITIAL STAGE
  19. 19. INITIAL STAGE
  20. 20. INITIAL STAGE
  21. 21. INITIAL STAGE
  22. 22. INITIAL STAGE
  23. 23. INITIAL STAGE
  24. 24. INITIAL STAGE
  25. 25. INTERMEDIATE STAGE
  26. 26. INTERMEDIATE STAGE
  27. 27. INTERMEDIATE STAGE
  28. 28. INTERMEDIATE STAGE
  29. 29. INTERMEDIATE STAGE
  30. 30. INTERMEDIATE STAGE
  31. 31. Thank you! Kiitos!

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