Buckethandle tear is made when the edge of the medial meniscus is torn and moved fromits position.
Themost common symptoms are pain, swelling and locked knee.Thedisplaced fragment comes in between the knee joint and prevents the knee fromstraightening, it is referred as Locked knee.Inswing phase the knee reaches flexion of 60 degrees maximum and during this dueto torn fragment is trapped in middle of joint and patient is unable tocomplete his swing phase because of severe pain.Asthe knee is constantly in hyper extension it creates the over activity ofrectus femoris muscle and keeps the hip in extension too. This over activity ismainly seen in initial pre-swing phase and continued till mid swing.Repeatedconcentric contractions of the knee extensors causes fatigue in quadricepsmuscles. Patient is also limping on the left side to avoid the fullweight bearing on the right side.
Due to continous stress on sound limb patientis unable to progress from stance to swing phase.So the patient is said to have stiff leg gait. NormalGait:”Itis the series of rhythmical alternating movements of the trunk and limb whichresult in the forward progression of the center of gravity” Gait Cycle:Itis the time period when one foot is on the ground to when that same foot againcomes in contact with the ground. Phases of Gait cycle:Thegait cycle is divided into two phases:1. Swingphase.2. Stancephase.
1. Swing Phase:Thegait cycle begins with the stance phase and constitutes about 60% of gaitcycle.Inthis phase the foot remains in touch with the ground.Thisphase is divided into five different tasks.Initial Contact (0%):In initial contact, heelis the first part of the foot to come in contact with the ground.
When the foot hits theground in initial contact the angle between thefoot and floor is about 25 degrees in normal conditions.Theankle is in planter flexion probably 3 degrees while the knee is 0-5 degrees offlexion with 30 degrees of hip in flexion.Loading Response(0-12%):Afterheel strike the weight is transferred on the flat foot.Theheel rocker action is initiated and ankle comes in 10 degrees of planterflexion with 15 degrees of knee flexion.Theloading response is important for shock absorption, limb stability and forwardprogression of the body.Mid stance(12-31%):Thisis also known as single limb stance as the other foot is lifted for swing.
Abody weight balancing is the goal of this phase. Ankle rocker action is begunfor body progression.Atthe beginning of mid stance the ankle is planter flexed slightly And then there is gradual dorsiflexion of ankleas the heel rises for terminal stance.Thetibia is moved forward in an organized way.Terminal stance(31-50%):Inthis phase the ankle is dorsi flexed causing the heel to rise off the floor.
The hip is in -20 degrees hyperextension and knee in 0-5 degree of flexion.Theforefoot acts as progressional rocker to create propulsion force for walking.Pre swing(50-62%):Inpre swing the knee joint is passively flexed to about 40 degrees.Theankle is planter flexed while hip is in hyperextension.Theheel of the other foot comes in contact with the ground it is also a phase ofdouble support and the weight is primarily on the other foot.
2. Swingphase:Inswing phase the foot is in the air and not in contact with the ground.Itcompromises about 40% of the gait cycle and is further divided into threestages.Initial swing(62-75%):Ininitial swing hip is flexed in 15 degrees and knee flexion is required forfloor clearance adding 20 degrees of flexion in pre-swing knee flexion (40degree).Mid swing(75-87%):Inthe mid swing the hip is flexed to 25 degrees along with knee flexion.As thelimb is moved forward the tibial alignment is changed for foot clearance.Terminal swing(87-100%):Theknee joint comes in neutral flexion preparing for stance phase.Hipis flexed 20 degrees with knee 0-5 degrees.
(Perry) How keyhole surgery might restorenormal gait.Inknee 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 willlose a lot of meniscus.Thisknee surgical procedure requires an intensive rehabilitation program which isdivided into three phases.Phase 1 (0-6 weeks):Rehabilitationstarts 2-4 days after surgical treatment.Themain goals of this phase are 1.
Toreduce pain and swelling.2. Ambulationwith or without assistive device.3. Controlinfection 4. Restoreleg controlItinvolves a series of exercises including Knee extension on bloster, pronehangs, strengthening of quadriceps (isometric).
Thepatient is advised to use axillary crutches to avoid any load on the surgicalknee. Legshould be in elevation to reduce the swelling. On-weight bearing is advisedthen the patient is progressed to partial and full weight bearing.Thepatient can progress to phase 2 if there is no effusion and full knee range ofmotion is maintained. Phase 2 (6-10 weeks):Phase2 begins after meeting the criteria of phase 1.Thegoals of this phase are 1. Normalgait2. Patientshould she doing pain free movements including step up/down and lunge.
3. Fullweight bearing4. Togain muscle strength (4/5 or 5/5)Theexercises in this phase include are non-impact balances ex, stationary bike,hip and core exercises and quadriceps strengthening.Thepatient can progress to phase 3 if his gait is normal and he can walk on allsurfaces with the help of exercise plan and he is able to maintain single legstand for 15 sec.Phase 3: Thegoal of this phase are 1. returnto normal activities 2.
no pain in sport or work specific activities.3. Educatethe patient the importance of exercise plan particularly joint protection4. Improvecardio pulmonary fitness. Theexercises include are hip and core strengthening, Stretch for muscleimbalances, sports/work balance agility and proprioceptive drills.(Sherry)