J.C.A. Noorduyn, Msc
An 41 year old female was diagnosed with a fractured left lateral tibial plateau after an high impact moment during horseback riding. The high impact moment occured with a fully extended leg when trying to step off as the horse was reared up. After a visit to the emergency room, the patient was sent home with a cast for two weeks before surgery was performed. Thereafter, the fracture was internally fixated with osteosynthetic material and the patient was referred to
physiotherapy directly after surgery. A non-weight bearing policy was applied for the first 6 weeks post-surgery, thereafter weight bearing could be increased guided by the pain.
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The treatment goals set by the patient and therapist were as follows:
Return to normal daily activities
Return to sport activities (horseback riding)
Full weight bearing at 12 weeks post-surgery.
Restore normal range of motion (ROM)
Restore normal gait pattern
Restore normal strength
Restore cardiovascular condition
History / Progression
Initially, the patient showed loss of range of motion (ROM) of flexion and extension of the knee (90/5/0), extra- and intra-articular edema and muscle atrophy of the left lower extremity. During the non-weight bearing phase, the physical therapy treatment consisted mobilizing exercises, non-weight bearing strengthening exercises and soft tissue mobilization. After 3 weeks full ROM (140/0/5) had been restored and edema was reduced.
At 4 weeks post-surgery treatment focused on dynamic mobilizing exercises such as cycling, and increasing muscle strength using the Biodex system pro 4 isokinetic dynamometer (Biodex Medical Systems, Inc., Shirley, New York, USA) for quadriceps and hamstring strength.
At 6 weeks post-surgery, weight bearing gait training was started at 20% of body weight using the AlterG Anti-Gravity Treadmill® walking forward at 2.5 km/u for 10 minutes. The gait training progressed over the next 5 weeks increasing the weight, speed and duration up to 100% at 5 km/u for 30 minutes (see progression table).
Besides gait training a progressive exercise program was performed consisting of strength training, stabilization exercises and coordination exercises. After each exercise session the
involved knee was treated with a cooling and compression system (Game Ready®) to enhance soft tissue recovery.
To see the progression table, please click here.
Three measurements were conducted at onset of the AlterG progressive weight bearing program, 6 weeks post-surgery (Baseline). The measurements were repeated at 9 weeks post-surgery (T1) and at 12 weeks post-surgery (T2).Measurement:
Range Of Motion (ROM)
Knee injury and Osteoarthritis Outcome Score (KOOS)
Patient Specific Complaint questionnaire (PSK); Dutch questionnaire to determine the effort of specific tasks. Consisting of three items:
PSK 1: lying in bed
PSK 2: working
PSK 3: standing for a long period