Clinics in sports medicine
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Treatment of medial and lateral compartment arthritis in the anterior cruciate ligament (ACL)-deficient knee remains a topic of debate among orthopedic surgeons. This article discusses the treatment options for the ACL-deficient knee with unicompartmental arthritis and provides a rationale for clinical decision making in this difficult group of patients. Unicondylar knee arthroplasty (UKA) is a viable option in a select group of patients to decrease pain and maintain an active lifestyle. When performing a UKA in an ACL-deficient knee, it is important to manage appropriate expectations for a successful outcome.
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Bladder injury should be suspected when trauma is followed by gross hematuria, suprapubic or abdominal pain, and difficulty in voiding or the inability to void. Bladder rupture with blunt abdominal trauma is uncommon; however, because of its high mortality rate, recognition of the early signs and symptoms can be life saving. The most common type of injury is a bladder contusion, which is a diagnosis of exclusion. Extraperitoneal bladder ruptures are almost exclusively associated with a pelvic fracture.
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Pulmonary injuries from blunt thoracic trauma are seen regularly with high-energy mechanisms but described less frequently in association with sports. Pneumothorax, hemothorax, pneumomediastinum, and pulmonary contusion are uncommon with athletic participation and often follow a benign clinical course. ⋯ Use of CT for trauma has improved diagnostic sensitivity for occult injury, although this may not alter management or outcomes. Return to play is guided by resolution of symptoms and radiographic findings.
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Rehabilitation after anterior cruciate ligament (ACL) reconstruction should consider control of postoperative pain and swelling, protection of the healing graft, restoration of full range of motion symmetric to the contralateral knee, strengthening of the muscles that stabilize the knee, hip, and trunk, enhancing neuromuscular control, and a gradual progression to functional activities that are required for return to sports. The effects of concomitant injuries and surgical procedures must also be considered in planning an individualized rehabilitation program. This article provides an overview, discusses our experience, and makes recommendations for rehabilitation after anatomic ACL reconstruction rehabilitation.