MENISCAL TEARS

What is Meniscal Tear?

The menisci in the knee joint are cartilage parts in the shape of a half moon. There are 2 meniscus in the knee joint, internal and external. The menisci are located between the tibia and the thigh. Menisci are structures with dense collagen fibers to resist compression, elasticity and therefore have important functions. The menisci absorb the incoming shocks, distribute the load over a wider area and protect the articular cartilages from high pressure and help the stability of the knee.

How Does a Meniscus Tear Occur?

Meniscus tears can occur in people of all ages, although meniscus tears can be seen as an athlete’s disease because it can be seen frequently in athletes. Injuries are mostly seen during sudden rotational movements. Since the meniscus tissue is solid in young individuals, severe trauma must be present in order for meniscus tears to be seen. However, due to the degeneration that occurs in the meniscus at advanced ages, these individuals can have tears even in mild traumas.

What Are Meniscal Tear Symptoms?

The most important clinical finding of meniscus tears is pain. Pain usually occurs during the knee-bending motion. However, depending on the size of the tear, there may also be complaints of locking and snagging in the knee. As there will be compression in the meniscus during stair use and squatting, pain may increase and locking may occur in the bent knee.

There may also be fluid increase in the joint space in the knee where meniscus tears occur. Patients describe this as a feeling of swelling or fullness in the knee. Early diagnosis is important in meniscus tears. As a result of the meniscus being torn for a long time, stability problems may occur in the knee, and accordingly calcification and cartilage damage may occur.

What To Do In Physical Therapy For Meniscus Tears?

Physical therapy methods are used as conservative treatment in incomplete meniscus tears. The purpose of the treatment of these patients is the elimination of complaints such as pain, swelling and joint restrictions and strengthening of the muscles around the knee.

Physiotherapy plays an important role in edema control, prevention of muscle atrophy, pain control and returning the patient to normal daily life activities.

Why Is Physiological Treatment Important After Surgery For Meniscal Tears?

Advanced meniscus tears are now treated surgically. Depending on the meniscus tear, surgery is performed in two ways. Depending on the location and condition of the tear, surgery is performed either as meniscus repair or meniscectomy (removal of the meniscus).

After the surgery, the role of physiotherapy is great. Depending on the type of surgery performed, the duration of physical therapy also varies between 2 weeks and 6 weeks. The main purpose of physical therapy after surgery is reducing pain and inflammation, increasing muscle strength and endurance, helping the joint regain function as the articular cartilage has to adapt to maintain function without  meniscus .

For this purpose, physical therapy modalities and appropriate exercise programs are used. Since the exercises to be performed are determined gradually in the postoperative period and are planned according to the patient’s condition, the exercises should not be applied unconsciously.

REHABILITATION IN ANTERIOR CRUCIATE LIGAMENT INJURIES

What is Anterior Cruciate Ligament Injury?

The Anterior cruciate ligament is an important ligament structure in the knee joint. It prevents the tibia from shifting anteriorly under the femur (thigh bone). It prevents tibial internal rotation. It protects the joint against inward and outward strains.

The anterior cruciate ligament is the one with the least elasticity of the ligaments around the knee. Therefore, the anterior cruciate ligament is the most injured ligament in the knee. Pain, swelling and inflammation symptoms that occur after anterior cruciate ligament injury lead to loss of strength in the muscles, which causes instability in the knee.

What are the Causes of Anterior Cruciate Ligament Injury?

Stress on the knee as a result of sudden turning, stopping or changing direction can cause cruciate ligament and anterior cruciate ligament injuries. Unstable falling after jumping, blows towards the knee can also cause injury.

The use of unsuitable equipment during sports such as football and skiing can also be caused by playing football on unsuitable grounds such as artificial turf.

Treatment with Rehabilitation in Anterior Cruciate Ligament Injuries

In the treatment of anterior cruciate ligament injury, rehabilitation should be applied with a conservative approach, and surgical consultation should be requested when necessary.

Rehabilitation and conservative treatment are decided according to the patient’s age, activity level, profession and future sports-related expectations. The aim of conservative therapy is to return the range of motion in the knee to its normal level, to restore muscle strength, to increase stability and to restore functions to pre-injury levels.

Rehabilitation treatment consists of acute, subacute and chronic phases. The rehabilitation and exercise program to be applied during these periods should be planned individually. Individuals and athletes who want to exercise at a high level in their future life should be evaluated separately according to the degree of damage to the ligament.

Post-Surgical Rehabilitation in Anterior Cruciate Ligament Injuries

After the anterior cruciate ligament operations, the goal is that the patient can continue his / her life without pain and with almost normal joint mobility and muscle strength.

After current anterior cruciate ligament injuries, there are differences in the post operative rehabilitation process according to the graft type preferred in surgery.

After anterior cruciate ligament injury, in the rehabilitation process, the exercises to be done every week are planned according to the condition of the patient, adhering to a certain protocol, and the variety and intensity of the exercises are progressively increased by following the progression.

What are we doing in ROMMER for anterior cruciate ligament injury rehabilitation?

The protocols to be applied after the detailed examination of our specialist physicians to the patients who have undergone an operation or not, who applied to our center after anterior cruciate ligament injuries, are determined. Thanks to this personalized program, it is possible to achieve success in patients with anterior cruciate ligament injury .

SPINAL CURVATURE (SCOLIOSIS)

Spinal Curvature (Scoliosis) is a spinal disorder that is often diagnosed by mothers who hurry to bring their children to the doctor.

Our spine is like a bridge that carries about 3/2 of its body weight and is made of 33 vertebrae. When we look at a normal human spine from the side, mild lordosis in the waist and neck region and four curvatures called mild kyphosis in the back and hip area are detected. When viewed from the front, there is no curvature in the spine and it is expected to show a flat structure.

What is Spinal Curvature?

The curvature of the back and lumbar region of the spine (to the right or left) is called scoliosis. Its incidence is about 2-4%. It is seen 8-10 times more in girls than in boys. In only 10% of people with spinal curvature, the curvature progresses to a level that requires treatment.

Scoliosis causes can be different. Scoliosis, which we frequently encounter in our daily life, are mostly idiopathic scoliosis and congenital scoliosis that occur in the 10s and whose cause is not fully determined. Here we will deal mostly with idiopathic scoliosis.

In scoliosis, the curvature of the spine can occur as a single curve in the shape of the letter “C” or as two curves in the shape of the letter “S”. Although ” S ” shaped spinal curvature is seen at all ages, it may not be diagnosed until adolescence. Often it is the mother who first notices the Curvature.

What Are the Types of Spinal Curvature?

Spinal curvatures can occur due to many different reasons. However, the cause cannot always be determined. The most common type is idiopathic scoliosis of unknown cause.

• Congenital scoliosis (congenital) is usually due to a defect in the spine or fused ribs It progresses very quickly.
• Idiopathic scoliosis; this group comprises more than 80% of scoliosis cases. It is the most common form of scoliosis. It is called infantile onset if it starts in the 0-3 age group, juvenile onset if it occurs between the ages of 4-9, and adolescent-onset idiopathic scoliosis if it occurs between the ages of 10-18.
• Early onset scoliosis is a type of scoliosis that usually occurs under the age of 10.
• Neuromuscular scoliosis occurs as a result of muscle and nerve diseases such as cerebral palsy, polio, cerebral palsy or muscle wasting.

What are the Symptoms of Spinal Curvature?

• One shoulder to be forward, higher and forward,
• Shoulders and hips not being aligned,
• When viewed from behind, one of the shoulder blades is more prominent and protruding,
• One leg appears to be longer than the other,
• The trunk and rib cage appear to have slipped to one side,
• When the person leans forward, the ribs on one side of the body remain higher than the other,
• Asymmetry in the waist or back of the person.

It is not always easy to predict how scoliosis will progress. However, the period in which the current spinal curvature can progress most rapidly is the first 5 years of life and the rapid increase in height during adolescence. If the curvature at the time of diagnosis is high in the curvatures detected in these periods, the rate of progression will be higher than a low grade curvature. Especially in idiopathic scoliosis, when determining the treatment plan, the age of the child should come first among the criteria considered. The degree of curvature is evaluated in the second place. Faster progression can be expected in girls in terms of gender.

The younger the child’s age when diagnosed, the greater the curvature of the spine will grow and progress. The progression of the Curvature in adult individuals who have completed skeletal development is not as pronounced and rapid at this level. For these reasons, spinal curvature should be monitored very closely in children who are diagnosed with scoliosis at young ages and especially in the rapid growth period of adolescence.

How Is Spinal Curvature Diagnosed?

Early diagnosis of scoliosis is very important as it directly affects the success of the treatment. In addition to a good medical history and physical examination, imaging methods involving the whole spine are required for the diagnosis of scoliosis. The curvature angle should be measured on the anterior, posterior and lateral radiographs of the entire spine while standing. This angle that measures the degree of scoliosis is called the Cobb angle. A method called scoliometer is also used for diagnosis.

The important thing in scoliosis is to determine the degree of rotation accompanying the curvature as well as the curvature. Here, the scoliometer shows us this rotation different from the angle of scoliosis. In addition to plain films, methods such as MRI and tomography are also used in diagnosis and differential diagnosis.

How Should Spinal Curvature Be Treated?

In order to decide on scoliosis treatment, many factors such as the degree of curvature, age of the patient, type of scoliosis, etc. are taken into consideration. Since early treatment affects the results positively, early diagnosis is very important.

In this direction, scoliosis treatment should be completely personalized. For example; the treatment of an 8-year-old child with 30 degrees of Curvature will be different than the treatment of a 18-year-old with 30 degrees of Curvature. Because the younger the child’s age, the greater the potential for the Curvature to progress.

The aim of the treatment is to live a balanced and painless life with an aesthetically smooth spine. General treatment is examined in 3 main categories: observation and follow-up, corset treatment and surgery.

• Observation and monitoring; It includes the control of spinal curvature at 4-6 month intervals and is the first treatment option. For patients with curvatures less than 20 degrees, whose skeletal development is close to completion, only follow-up and periodic controls will be sufficient. During this follow-up, the patient should include exercise in his / her daily life and increase his / her general body condition.
• Corset treatment; the aim is to avoid the curvature. It is an effective treatment method for people whose curvature is between 20-40 degrees and continues to grow. However, since corset application is not possible in very young children, general correction and body casts are used. In order for the corset to be effective, the person should apply this treatment for long periods such as 22-23 hours a day. The biggest difference between congenital and idiopathic scoliosis is that corset treatment is not effective in congenital scoliosis.
• Surgery; If the curvature is above 40-45 degrees in scoliosis patients and especially if the growth continues in children, surgical treatment will be inevitable. Correction and fusion (fixation) operations are applied. Implants such as screws and rods are placed on the back and waist.

What Happens If Spinal Curvature Is Not Treated?

Looking at scoliosis treatment just as a correction of a spine Curvature is an incomplete perspective. Because deformities in the spine, when the degree of curvature reaches a certain level (80-100 degrees), will cause deformities in the ribs and rib cage, and will narrow the chest volume. Especially in growing children, this situation will negatively affect lung development and cause respiratory failure. In other words, scoliosis treatment will not only correct the deformity in the spine, but also prevent possible chest deformities, and consequently, preserve lung functions. For this reason, this should be taken into consideration when making an early surgery decision, especially in young children.