When surgery is performed, the rehabilitation program still is designed with the aforementioned concepts, but implementation often is dictated by the surgical impact and the patient's individual response to the intervention. Articular cartilage problems that do not respond to strengthening and the general approach outlined in Table 63-5 are extremely challenging for all concerned parties: patient, surgeon, and therapist. Surgical interventions were outlined in a previous chapter but basically include abrasion/debridement, microfracture, drilling, autograft osteochondral transplantation, allograft transplantation, autogenous chondrocyte implantation, and joint replacement. A recent two-part series on these topics nicely defines a treatment sequence.7,8 Specific protocols are used with each of these, but several special pearls are provided:
1. Passive ROM can be facilitated very nicely in water and gentle assisted/active motion is easily incorporated in this medium as well.
2. It is better to protect the surface from weight-bearing loads and particularly sudden impacts longer rather than shorter time frames.
3. Patients must be able to demonstrate appropriate gait before moving from assistive devices; do not let them apply loads without muscular absorption/protection.
4. General articular surface problems may respond well to quadriceps strengthening, although the radiographic appearance is of significant involvement; we do not treat radiographs. Patients frequently will see dramatic improvements in function and pain through quadriceps strengthening while radiographs would point toward the need for surgical intervention.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.