Case Study: Locked Knee

Bucket handle tear is made when the edge of the medial meniscus is torn and moved from its position.

The most common symptoms are pain, swelling and locked knee.

The displaced fragment comes in between the knee joint and prevents the knee from straightening, it is referred as Locked knee.

In swing phase the knee reaches flexion of 60 degrees maximum and during this due to torn fragment gets stuck in middle of joint and patient is unable to complete his swing phase because of severe pain.

As the knee is constantly in hyper extension it creates the over activity of rectus femoris muscle and keeps the hip in extension too. This over activity is mainly seen in initial pre-swing phase and continued till mid swing.

Repeated concentric contractions of

Terminal swing(87-100%):

The knee joint comes in neutral flexion preparing for stance phase.

Hip is flexed 20 degrees with knee 0-5 degrees.(Perry)

How keyhole surgery might restore normal gait.

In knee arthroscopy if the meniscal tear is repairable it is repaired by stitches. If not then the surgeon will trim the tear out and in that case a patient will lose a lot of meniscus.

This knee surgical procedure requires an intensive rehabilitation program which is divided into three phases.

Phase 1 (0-6 weeks):

Rehabilitation starts 2-4 days after surgical treatment.

The main goals of this phase are

1. To reduce pain and swelling.

2. Ambulation with or without assistive device.

3. Control infection

4. Restore leg control

It involves a series of exercises including Knee extension on bloster, prone hangs, strengthening of quadriceps (isometric).

The patient is advised to use axillary crutches to avoid any load on the surgical knee.

Leg should be in elevation to reduce the swelling. On-weight bearing is advised then the patient is progressed to partial and full weight