Co leczymy?

Introduction

Peripheral artery disease is a fairly common chronic condition with the progressive course and serious complications. The lumen of the arteries supplying blood to the tissues of the lower limbs, less often the upper limbs, is gradually reduced. A reduction of the amount of inflowing blood limits the supply of oxygen and nutrients to the tissues. The disease is likely to play an increasing social and economic role as societies continue to age.

Causes

The main causes of the disease include smoking, lipid metabolism disorders (hypercholesterolaemia) and diabetes. Ineffectively treated hypertension and stationary lifestyle also play a role.

Symptoms

The symptoms result from the limited blood flow to the soft tissues. The most common include intermittent claudication, i.e. post-workout muscle pain subsiding after rest. In chronic ischemia of the lower limbs, the symptom is measured by the distance of a leisurely walk after which the calf symptoms appear. In patients with atherosclerosis, hair loss, a feeling of cold and, in extreme forms, non-healing wounds are observed.

Diagnosis

A well-grounded suspicion of the disease can be made after checking pulse on the limbs and measuring the ankle-brachial index (ABI). Imaging examinations, such as ultrasound, conventional angiography, computed tomography angiography and magnetic resonance imaging are used to confirm and complement diagnosis.

Treatment

The treatment is multidirectional, it involves combating risk factors (giving up smoking, treating hyperlipidemia, hypertension and diabetes), using antiplatelet and vasodilating drugs, as well as implementing supervised training programs. Patients refractory to conservative treatment, with a claudication distance that prevents normal everyday functioning and those at risk of losing the limb, are qualified for invasive treatment. Classic surgical procedures involve a mechanical removal of the narrowed or blocked arteries or implantation of bypass grafts. Currently, thanks to the development of minimally invasive techniques, percutaneous procedures, such as restoring patency, balloon angioplasty and vascular stent implantation, play a dominant role.

Type of operation

The aim of endovascular restoration of the patency of the arteries is to force an atherosclerotic lesion using catheters and guides. This can be done from different accesses (puncture of the femoral artery is the most common) and in various directions. After the initial angioplasty with a high-pressure balloon (up to several atmospheres), a vascular stent is implanted at place of occlusion. This management ensures the long-term effect of the procedure, i.e. maintenance of the patency of the affected vessel.

As a rule, patients are discharged home the day after the procedure with the recommendation to take medications, change lifestyle and report for check-ups at the Regional Outpatient Clinic of Vascular Diseases.

Introduction

Arthroscopy of the knee may involve several structures of the knee: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), removal of a fragment of the meniscus, suturing of the meniscus, removal or repair of cartilage fragments or lateral release of the patella. Each damage to one or more structures has an impact on the course of rehabilitation. The common denominator of all these treatments is the time when rehabilitation begins. Rehabilitation should start on the first day after the surgery. The intensity of treatments increases from the seventh day after surgery; rehabilitation should be carried out in close cooperation with a physiotherapist.

How to prepare for the procedure?

It is a good idea to discuss the process of rehabilitation with your physiotherapist before the procedure. Depending on the condition of the knee, the therapy performed before the surgery should be focused on improving the range of motion and strengthening the muscles of the lower limbs, so that after arthroscopy the normal function of the joint can be restored faster. Another important element is to acquire basic equipment for rehabilitation, such as: a ball, elastic band and a stationary bicycle, in order to continue exercises at home. In addition to practicing in the physiotherapist’s office, rehabilitation must be continued at home, and therefore the auxiliary equipment is very important. You should also have elbow crutches because they are necessary in the first weeks after the procedure. In some cases, a knee orthosis will be needed. The last element is to reduce swelling of the knee with gel compresses.

How long does rehabilitation take?

The duration of rehabilitation depends on the type of damaged structure and the method of repair. The shortest recovery time with minor damage to the knee is about six weeks. In ligament reconstructions, this time is at least 6-9 months. However, each person is different and requires an individual approach, therefore the recovery period may be different for each patient.

What will happen if I do not rehabilitate?

Knee arthroscopy is half the battle. The other half is good physical therapy. People who do not exercise at home and do not follow the instructions of the physiotherapist must be aware that they may not return to full fitness or the recovery time will be significantly longer.

The main goals of physiotherapy:

• reduction of pain and swelling, learning to walk with crutches;
• obtaining full mobility of the knee;
• developing the strength of the muscles of the operated limb and the stability of the knee so that the patient can move independently without orthopaedic aids;
• dexterity training with the elements allowing the patient to return to favourite sports activities;

In the Szpital Zakonu Bonifratrów, physiotherapy is performed by a team of specialists:

Rafał Trąbka, PhD

Łukasz Gregulski, MSc

Introduction

Arthroscopy is a minimally invasive surgical technique which minimizes postoperative complications and speeds up recovery. The procedure enables early rehabilitation, which significantly shortens the time of recovery. The most common indications for arthroscopy of the ankle are:

• removal of free bodies,
• excision of degenerative changes,
• treatment of ankle instability.

How to prepare for the procedure?

Before the surgery, it is good to discuss the process of rehabilitation with a physiotherapist, because it depends on the type of surgery. Depending on the condition of the ankle, the therapy should be aimed at improving the range of motion and at strengthening the muscles of the lower limb. This will allow the joint to regain its proper function faster. Another important element is to acquire basic therapy equipment, such as a ball and an elastic band. In addition to practicing in the physiotherapist’s office, rehabilitation must be continued at home, and therefore having your own auxiliary equipment is very important. Also, it is important to have elbow crutches, which are necessary in the first weeks after the procedure. In some cases, you will also need an ankle orthosis. An orthopaedist will inform you about the need to acquire an orthosis. It is also worth buying gel cooling compresses to reduce joint swelling after the procedure.

How long does rehabilitation take?

The duration of rehabilitation depends on the problem solved during arthroscopy. The shortest recovery time with minor ankle surgery is about six weeks. For more complex operations, this time is a minimum of 3 months. Despite the same type of surgery, each patient’s treatment will be slightly different, and the time of rehabilitation is very individual. Hence, the recovery period may be different for each patient.

What will happen if I do not rehabilitate?

Arthroscopy of the ankle is half the battle. The other half is good physiotherapy. Patients who do not exercise at home and do not follow the instructions of a physiotherapist should be aware that they may not regain full fitness or the recovery time will be significantly longer.

The main goals of physiotherapy:

1. Reducing pain and swelling, learning how to walk with crutches,
2. Obtaining full mobility of the ankle,
3. Developing muscle strength of the operated limb and stability of the ankle, so that the patient can move independently without orthopaedic aids,
4. Dexterity training with the elements that help to return to favourite sports activities.

In the Szpital Zakonu Bonifratrów, physiotherapy is performed by a team of specialists:

Rafał Trąbka, PhD

Łukasz Gregulski, MSc

Introduction

Rupture of the anterior cruciate ligament is an injury requiring surgical treatment and a long convalescence combined with arduous rehabilitation. The transplant is usually made of gracilis and semitendinosus muscles which are implanted. A very important, if not the most relevant factor in returning to full fitness, is quick and proper rehabilitation. It should begin in the first week after the procedure and be carried out regularly under the supervision of a qualified physiotherapist.

How to prepare for the procedure?

Before the reconstruction, it is good to discuss the process of rehabilitation with a physiotherapist and prepare the limb for the procedure. Depending on the condition of the knee, the therapy performed before the procedure should be focused on achieving maximum knee flexion and extension as well as rebuild the full muscle mass of the limb. This will facilitate and speed up the process of rehabilitation. Another important element is to acquire basic therapy equipment, such as: a ball, elastic band and a stationary bike in order to continue exercises at home. In addition to practicing in the physiotherapist’s office, the rehabilitation must be continued individually, which is why the auxiliary equipment is very important. You should also have elbow crutches because they are necessary in the first weeks after the procedure. The last element is to reduce swelling of the knee with gel compresses.

How long does rehabilitation take?

Post-reconstruction rehabilitation can be divided into 3 main phases:

• phase 1 – from the surgery to approximately 6 weeks. During this period, the patient moves in an orthosis and with elbow crutches, gradually putting off orthopaedic equipment. We pay great attention to working out full extension of the knee and reaching flexion of around 120 degrees. Another element is to rebuild the muscle mass of the operated limb.
• phase 2 – from approximately 6 to 12 weeks. During this period, the patient usually moves without orthopaedic aids. We focus a lot on strengthening the muscles of the operated limb, knee stabilization and balance exercises. Despite good patient’s condition, at this stage, the ligament is the weakest, therefore great attention ought to be paid to the technique and method of practicing.
• phase 3 – from 3 months to a year after the procedure. During this phase, we focus on dexterity exercises with the elements of sport, we introduce jumps and running. The patient regains full knee mobility and strength.

Rehabilitation ends about a year after the surgery. The patient is subjected to a series of examinations, a positive test result means that the patient is fully rehabilitated.

The main goals of rehabilitation:

1. reduction of swelling and pain;
2. obtaining full extension of the knee and the appropriate knee flexion;
3. developing strength of the muscles of the operated limb and knee stability so that the patient can move independently without orthopaedic aids;
4. dexterity training with the elements allowing the patient to return to favourite sports activities.

In the Szpital Zakonu Bonifratrów, physiotherapy is performed by a team of specialists:

Rafał Trąbka, PhD

Łukasz Gregulski, MSc

ARTHROSCOPY OF THE KNEE

ARTHROSCOPIC RECONSTRUCTION OF THE CRUCIATE LIGAMENT