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admin | Category: Small Elliptical Trainer | 03.12.2013
This is an overuse injury to the patellar tendon (connection between the knee cap and shin bone). This is a self-limiting condition where there is pain below the knee cap of an active adolescent. Osteochondral defect is when a piece of surface cartilage in the knee becomes loosely connected or breaks loose and floats around within the knee. Microfracture can be done in one procedure arthroscopically, and involves placing holes in the bone to encourage bleeding and healing at the site to fill in with a scar-cartilage.
The ACL is a bone-to-bone connection between the femur (thigh bone) and tibia (shin bone) that helps prevent sliding of the tibia when twisting or changing direction while running. For autograft, I use hamstring tendons, which provide the strongest graft according to laboratory studies. The medial collateral ligament connects the femur (thigh bone) to the tibia (shin bone) on the inner side of the knee. The PCL is a bone-to-bone connection between the thigh bone and shin bone, which helps prevent backward sliding of the shin bone.
There are two menisci in the knee, one on the inner side (medial) and one on the outer side (lateral). Arthroscopic surgery to repair the cartilage is what we usually try for in most young patients. The IT-band is a muscle that starts in the pelvis, crosses the hip and extends below the outer-side of the knee. This condition occurs when the surface-covering cartilage (that cushions the joint) erodes and exposes bone. This usually shows up as a burning-numbness sensation on the inner thigh that can extend below the knee to the inner-calf region. A regular exercise regime is essential to recover properly from a total knee replacement surgery. A physical therapist can recommend a number of different types of exercises depending upon the requirements of the knee joint of the patient.
While performing this total knee replacement exercises, the patient has to fully straighten the back of the knee joint and try to touch the knee back to the bed surface. The knee is a major weight-bearing joint that is held together by muscles, ligaments, and other important soft tissue.
Below is an illustration of knee anatomy with its major bones, ligaments and muscles appropriately labeled.
Two structures known as menisci sit between the femur and the tibia and act as cushions or shock absorbers for the knee.
Abstract–A novel gait robot enabled nonambulatory patients the repetitive practice of gait and stair climbing.
Keywords: gait, hemiparesis, locomotor training, mobility, physiotherapy, rehabilitation, robots, spasticity, stair climbing, stroke. Abbreviations: BWS = body-weight support, FAC = Functional Ambulation Categories, MI = Motricity Index, PT = physiotherapy, RMI = Rivermead Mobility Index. INTRODUCTIONStroke annually affects approximately 180 per 100,000 inhabitants in the industrialized world; it is the most common cause of persisting disabilities [1].
Most gait machines restrict themselves to the repetitive practice of simulated walking on the floor. The therapeutic effort needed for relearning stair climbing after stroke is considerable, especially considering the risk of falls. This article presents the first clinical results in nonambulatory patients with subacute stroke allocated to two groups. Participants comprised 30 patients with stroke from one center offering comprehensive inpatient stroke rehabilitation. Wheelchair-mobilized and partially independent in basic activities of living (Barthel Index score from 30–55 out of 100) [19]. Able to sit at edge of bed with hands holding on and feet placed on floor and able to stand for short period with hands holding on. Requiring continuous or intermittent help carrying weight and with balance during gait (Functional Ambulation Categories [FAC] score of 1 or 2 out of 5) [20]. No severe heart disease limiting participation according to examination by cardiologist that included a 12-lead electrocardiogram. Two experienced therapists blinded to group assignment assessed patients at study entry (T0), after 2 weeks (T2), after 4 weeks (T4), and at follow-up (TF–, 3 months after study end). All but one control group patient completed the study (patient did not complete follow-up) (Figure 1).
IQR = interquartile range, NS = nonsignificant, PT = physiotherapy, SD = standard deviation.
The patients rated the G-EO System positively, including the stair-climbing option; initial fears of overexertion expressed by five patients receded after the first sessions.
Mean distances covered and number of stairs climbed during therapy sessions of both groups (mean ± standard deviation). To better understand how knee problems occur, it is important to understand some of the anatomy of the knee joint and how the parts of the knee work together to maintain normal function. The menisci are horseshoe-shaped shock absorbers that help to both center the knee joint during activity and to minimize the amount of stress on the articular cartilage. Knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries. Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Patients as young as age 16 and older than 90 have undergone successful total knee replacement.
In its early stages, arthritis of the knee is treated with conservative, non surgical measures. Lifestyle modifications can include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities such as climbing stairs that aggravate the condition. Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Using supportive devices such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. Other measures may include applications of heat or ice, water exercises, liniments or elastic bandages.Several types of drugs can be used in treating arthritis of the knee. Anti-inflammatory medications can be used to help temporarily reduce swelling in the joint.
If your arthritis does not respond to these non operative treatments, you may need to have surgery. Arthroscopic surgery uses fiber optic technology to enable the surgeon to see inside the joint and clean it of debris or repair torn cartilage. An osteotomy cuts the shinbone (tibia) or the thighbone (femur) to improve the alignment of the knee joint. A total or partial knee arthroplasty replaces the severely damaged knee joint cartilage with metal and plastic. The smooth surface of the artificial implants just like normal knee, can allow for easy, painless movement. Several tests, such as blood samples, a cardiogram, and a urine sample may be needed to help your orthopaedic surgeon plan your surgery.Preparing Your Skin and Leg Your knee and leg should not have any skin infections or irritation. Dental Evaluation Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. After your operation, the staff will be keen to have you move your new knee, so you should plan to be in hospital for few days.
An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and can’t do. All patients are given a set of home exercises to do between supervised physical therapy sessions, and the home exercises make up an important part of the recovery process. For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
No two patients are alike, and recovery varies somewhat based on the complexity of the knee reconstruction, and the patient’s health, fitness, and level of motivation.
Most people walk using walker for 2 weeks, then use a cane for about 2-3 more weeks; sometime between one and two months post-operatively, most patients are able to walk without assistive devices. Most patients obtain and keep at least 90 degrees of motion (bending the knee to a right angle) by the second week after surgery, and most patients ultimately get more than 110 degrees of knee motion. Most patients can return to sedentary (desk) jobs by about 4-6 weeks; return to more physical types of employment must be addressed on a case-by-case basis. Pain often becomes worse navigating stairs or jumping (which increases forces through the knee cap).
Stair climbing and jumping often worsen it due to increased forces through the patellar tendon. These sacks (bursa) are normal throughout the body and serve as a lubricant between skin, bone and muscle. It is thought to result from overuse of the knee with constant pulling on the growth plate where the knee cap tendon attaches to the tibia (shin bone).


Typically the kneecap slides to the outside of the knee and usually goes back into place on its own. This can cause pain and locking or catching of the knee, when performing certain range-of-motion movements. Anterior cruciate ligament injuries typically occur with a “plant and twist” mechanism, so there does not have to be contact from another athlete. When you change direction, you start to miss the ACL and there is subsequent instability of the knee.
For active people, I typically recommend reconstruction of the ligament to facilitate returning to sports or other recreational activities. Autograft has the obvious advantage of no disease transmission risk, but involves a longer surgery and risk of some knee-flexion weakness (though not noticeable by most people). Posterior cruciate injuries are typically sustained during a force on the front of the shin bone pushing backwards (such as a dashboard against the knee during a car accident). Steroid gives the most immediate relief, as an anti-inflammatory, delivered directly into the joint. For younger, active patients with arthritis only on the inner side of the knee, I sometimes suggest a partial knee replacement.
While sitting up and straddling a surfboard in between sets, the saphenous nerve can be compressed. Hence, any surgery in which knee joint is operated upon has to be completed with utmost precision. This is a major surgery in which blood clotting, swelling and stiffness can occur after the surgery.
Time and efforts for total knee replacement exercises should be strictly followed by the patient in order to recover in an efficient manner. Depending on the stability of the knee joint, surgeon or the physical therapist would tell the patient about the walking style. Since stair climbing and descending require more strength, physical therapist suggest a number of other light exercises before advising the patient to go for stair climbing. Here the patient has to tighten the thigh muscle and has to straighten the legs on the bed and then slowly raise the legs few inches above the bed surface. The patient has to tighten the thigh muscles, straighten the knee and hold the leg in this position for five to ten seconds.
Cartilage is the material inside the joint that provides shock absorption to the knee during weight-bearing activities such as walking or stair climbing. The femur and tibia meet to form a hinge with the patella in front of these two bones protecting the joint. The medial (inner) collateral ligament (MCL) and outer (lateral) collateral ligament (LCL) limit sideways motion of the knee.
A torn meniscus is often referred to as “torn cartilage.” Menisci are one of two types of cartilage in the knee. The quadriceps muscles on the front of the thigh are connected to the top of the patella by the quadriceps tendon, which covers the patella and becomes the patellar tendon. Stair climbing up and down, however, is an integral part of everyday mobility both at home and in the community. The patients were either treated on the G-EO System in combination with PT (experimental group) or received individual PT (control group) for 4 weeks. Again, she strongly emphasized the restoration and improvement of gait and stair climbing by applying a task-specific repetitive approach in conjunction with tone-inhibiting maneuvers (technical aids could be used). In addition to the individual PT sessions, patients performed ergometer training on a daily basis, physical therapy (30 min sessions three times a week, including massage and spa therapy), and occupational therapy (45 min sessions five times a week). Because both therapists were team members, knowledge of the group allocation could not be excluded. Table 1 summarizes the demographic and clinical data of the two patient groups at study onset, which did not differ. There are also two shock absorbers in your knee on either side of the joint between the cartilage surfaces of the femur and the tibia. The combination of the menisci and the surface cartilage in your knee produces a nearly frictionless gliding surface. The quadriceps attaches to the patella, and the patellar tendon connects this muscle to the front of the tibia.
You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Recommendations for knee replacement surgery in Jhansi are based on a patient’s pain and disability, not age. Because every patient is different, and because not all people respond the same to medications, your orthopedic surgeon will develop a program for your specific condition. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.
Treatment of significant dental diseases (including tooth extractions and periodontal work) should be considered before your total knee replacement surgery. After four to six weeks, you will have a follow-up appointment and at that time it will be easier for the doctor to assess your progress and to determine how much weight you can put on your knee. Your discomfort should significantly decrease by the third day and only require pain pills before performing therapy.
The implant is made of metal and plastic, and while these implants are designed to last many years, they all will eventually wear out. More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living.
Two to three therapy sessions per week are average for this procedure.At first, physical therapy includes range-of-motion exercises and gait training (supervised walking with an assistive device, like a cane, crutches or walker). Physical therapy can be helpful (especially with inner-thigh muscle strengthening) to help prevent the kneecap from sliding to the outside. When the sacks become inflamed, the recommendation is to avoid mechanical irritation (such as hitting it on things) and take anti-inflammatory medications. If it is the first time this has happened (and there are no loose fragments in the knee), then treatment is non-surgical. Another consideration for surgical intervention is determining if there’s a second injury in the knee (typically a meniscus tear) that can be repaired at the same time as the ligament reconstruction. The other option is to use tissue from someone who has passed away (aka cadaveric or allograft). Long-term studies show there is probably no difference in function between autograft and allograft.
There is typically inner knee pain, sometimes with catching, clicking or even locking of the knee in a given position.
In young patients with an irreparable tear and no arthritic changes in the knee, a meniscus transplant is an option.
It is often associated with a sudden change in training (such as a sudden increase in mileage for long distance runners). For mild to moderate cartilage loss, therapy and anti-inflammatory medications can be helpful. Newer injections (called visco-supplementation) attempt to relieve pain by replenishing lubricating and nourishing substances in the arthritic knee. For more extensive arthritis, total knee replacement is typically the best option.  I now offer uncemented total knee arthroplasty which avoids the use of bone cement which can potentially decrease the stress of surgery on the body and hopefully lead to better longevity of the implants.
This condition is easily confused with a knee problem because the pain presents in the same region where meniscus tears cause pain.
Recovery period is considered to be a very important stage of the whole knee joint treatment. This total knee replacement exercises is primarily to regain the strength and the endurance. However, the knee not only bends back and forth like a hinge, it has a complex rotational component that occurs with flexion and extension of the knee.
The patella slides up and down in a groove in the femur (the femoral groove) as the knee is bent and straightened.
The posterior and anterior cruciate ligaments (PCL and ACL) limit forward motion of the knee bones, keeping them stable. The other type, articular cartilage, is a smooth and very slick material that covers the end of the femur, the femoral groove, the top of the tibia and the underside of the patella.
During 60 min sessions every workday for 4 weeks, the experimental group received 30 min of robot training and 30 min of physiotherapy and the control group received 60 min of physiotherapy. The trajectories of the foot plates and the vertical and horizontal movements of the center of mass were fully programmable, enabling wheelchair-bound subjects not only the repetitive practice of simulated floor walking but also up and down stair climbing.
The absolute session durations were comparable, and the PT of both groups concentrated on restoring gait, including stair climbing. This time included donning and doffing and breaks; the intended net therapy time on the G-EO System ranged from 15 to 20 min. The comprehensive program is intended to improve the abilities in the basic activities of daily living (sessions in the early morning to relearn washing and dressing alternating with sessions during the day to promote upper-limb recovery). The FAC was therefore video-recorded and rated by an experienced therapist on maternity leave, because she was blinded to group assignment.


All but one experimental group patient completed the study (patient stopped G-EO System training after 2 weeks because of knee arthritis). The experimental group patients practiced more intensively; in particular, the numbers of stairs climbed differed in favor of the experimental group. The knee is formed by the femur (the thigh bone), the tibia (the shin bone), and the patella (the kneecap). Both of these ligaments function to stabilize the knee from front-to-back during normal and athletic activities.
Occasionally blood tests, an MRI (Magnetic Resonance Imaging) or a bone scan may be needed to determine the condition of the bone and soft tissues of your knee.
The tibial component sits on the top, and covers the tibia and similarly femoral component covers femur & patella component covers knee cap.
Contact your orthopaedic surgeon prior to surgery if either is present for a program to best prepare your skin for surgery.Blood Donation You may be advised to donate your own blood prior to the surgery.
Full recovery time from the surgery depends on many factors and physical and occupational therapy will play a role in the process too. Doctor will begin your therapy the day of your surgery and emphasize walking, regaining your range of motion and strengthening exercises. Studies have consistently shown knee replacement implants are functioning well in 90-95% of patients between 10 and 15 years after surgery. As those things become second nature, strengthening exercises and transition to normal walking without assistive devices are encouraged.
If there is improper alignment of the leg, then the only effective treatment is surgical re-alignment.
If this approach is ineffective, steroid injection into the bursa can sometimes be helpful. Gradual range of motion, bracing and physical therapy (emphasizing quadriceps strengthening) is the mainstay solution.
If the piece cannot be repaired back into place, then a cartilage restoration procedure may be indicated. Typically there is immediate swelling of the knee due to an artery that feeds the ACL bleeding into the joint.
Continuing to play sports without a functioning ACL increases risk of developing arthritis, due to abnormal forces the knee takes on.
Rehabilitation focuses on quadriceps (thigh muscle) strengthening, to help stabilize the knee. These usually are given once a week for three to five weeks, and take a few weeks to see results.  Platelet rich plasma (PRP) injections are also an option, though most insurance will not pay for this. Treatment aims to remove the offending agent (the surfboard), which isn’t always desirable to the patient.
A number of exercises are suggested by the orthopedic surgeon that should be performed essentially after the surgery. Orthopedic surgeon or the physical therapist can recommend a total of 20 to 30 minutes of exercise and a 30 minute walk. The patient should walk smoothly in the initial period and can subsequently walk and stand for ten or more minutes.
Physical therapist can suggest a number of other total knee replacement exercises depending upon the requirement of the patient. The lower-limb muscle activation patterns of ambulatory subjects with stroke, recorded during the real and simulated stair-climbing condition, corresponded with each other [16].
We treated the two groups consecutively because of the limited availability of the G-EO System.
One therapist, who has 10 years of experience in machine-supported gait rehabilitation, assisted the patients with putting on the harness while sitting in their wheelchair, getting onto the G-EO System in the wheelchair using a ramp from the rear, fixing the feet on the plates, hoisting the patient, attaching the lateral ropes, and setting the therapy parameters memorized by the G-EO System computer. Among the 15 control group patients, 11 practiced stair climbing at least once during the first 2 weeks and 13 practiced during the last 2 weeks. Several muscles and ligaments control the motion of the knee and protect it from damage at the same time.Two ligaments on either side of the knee, called the medial and lateral collateral ligaments, stabilize the knee from side-to-side.
The ligaments of the knee make sure that the weight that is transmitted through the knee joint is centered within the joint minimizing the amount of wear and tear on the cartilage inside the knee. When it wears down, the bones in the knee joint begin to rub against each other – resulting in acute pain.
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement would be the best method to relieve your pain and improve your function. The smooth surfaces of these components work together, as they glide and rotate and give pain free movements.
Sometimes steroid injection into the knee reduces inflammation, but is usually only a temporary relief. If the sack becomes infected (septic bursitis), it may require intravenous antibiotics in the hospital or surgical debridement. Even with reconstruction, there remains increased risk of arthritis, likely due to cartilage damage sustained in the original injury. With a small tear, sometimes you can resume sports in one month (depending on symptoms and physical examination). I typically reconstruct the PCL only when there are multiple ligaments torn in the same injury. You can also try to cushion the inner thigh region in the wetsuit, but this approach is not usually practical. Exercise regime could be changed by the physical therapist depending on the merit of the case. The device follows the HapticWalker, a research prototype with limited clinical applicability because of its dimensions and required high voltage, by applying the same principles of an end-effector device with programmable footplates [17–18].
Our hypothesis was superior gait and stair-climbing ability in the experimental group at the end of the intervention phase. During each session, the patients practiced 5 to 15 min of simulated floor walking followed by 5 to 10 min of repetitive simulated stair climbing up and down. On Saturdays, every patient received two 30 min sessions, either PT or occupational therapy and physical therapy. Injuries, wear and tear, rheumatoid arthritis, and poor leg alignment are another causes of painful knee problems.Pain and swelling are worse in the morning or after a period of inactivity. Other treatment options including medications, injections, physical therapy, or other types of surgery also will be discussed and considered.Your orthopaedic surgeon also will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery. Surgical treatments are limited, and attempts to restore cartilage through procedures (microfracture or carticel transplant) meet with limited success. I typically perform a reconstruction of the medial patellofemoral ligament which connects the femur (thigh bone) to the knee cap on the inner side of the knee. Sometimes it is helpful to wear a hinged knee brace which helps facilitate range of motion while preventing unwanted buckling of the knee inward. The improvements were significantly larger in the experimental group with respect to the FAC, RMI, velocity, and leg strength during the intervention.
The data should help to appraise the feasibility and clinical potential of the G-EO System. The patient practiced a minimum of 300 steps on the simulated floor and climbed a minimum of 50 steps on the simulated stair during each session.
The joints are protected by ligaments and tendons (muscles).In arthritis treatment in Jhansi, wear and tear of the tough elastic cartilage leads to direct contact of the two bones of the joint, leading to acute pain. This structure helps tether the knee cap so it doesn’t slide to the outer side of the knee. Breaks were optional, but uninterrupted training intervals of at least 5 min for simulated floor walking and 3 min of simulated stair climbing were required.
Symptoms include swelling, redness, deformity, pain and loss of motion at the affected areas. If there is a major mal-alignment of the leg, then re-alignment procedures may need to be considered. At the end of the intervention, seven experimental group patients and one control group patient had reached an FAC score of 5, indicating an ability to climb up and down one flight of stairs. During the training, the therapist manually assisted knee extension while standing in front of the patient if needed. In conclusion, the therapy on the novel gait robot resulted in a superior gait and stair climbing ability in nonambulatory patients with subacute stroke; a higher training intensity was the most likely explanation. The treatment parameters were noted for each session, and the steps taken during simulated walking were converted into the distance covered based on chosen step length.Another physiotherapist with 8 years of experience in stroke rehabilitation was responsible for the second 30 min of the session. She worked with the patients on improving gait and stair climbing in real-life situations depending on the individual impairment level. She applied a task-specific repetitive approach in conjunction with tone-inhibiting maneuvers to practice the motor tasks repetitively.



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