Knee osteoarthritis narrows your life gradually. Stairs, the dog walk, standing at the sink, getting out of a low chair — each becomes something to plan around. For many people the next thing offered is a knee replacement, and not everyone is ready for that.

Arthrosamid is a single hydrogel injection that relieves knee osteoarthritis pain, reduces stiffness and restores function, without surgery. Meyer Physio is an approved Arthrosamid clinic, offering it privately in Weybridge, Surrey.

What Is Arthrosamid?

Arthrosamid® is an advanced, long-lasting injectable hydrogel designed to relieve knee osteoarthritis pain without the need for surgery. Made from 97.5% water and 2.5% cross-linked polyacrylamide, it offers long-lasting relief from a single injection — considerably longer than is typically seen with alternative treatments such as hyaluronic acid or Cingal injections.

It integrates with the joint lining, known as the synovium, enhancing lubrication, cushioning the joint, and reducing inflammation to improve comfort and mobility.

Why Choose Arthrosamid?

• Lasting Relief – Benefit from a single injection, with clinical studies showing effects lasting up to three to five years.
• Non-Surgical – Outpatient procedure with no hospital stay or downtime.
• Clinically Proven – The polyacrylamide hydrogel technology is backed by over 20 years of research.
• Delays Surgery – May help to delay knee replacement.
• Excellent Results – 70–75% report a significant improvement in symptoms; up to 50% describe it as “life-changing”. For more on results and outcome studies, see the Arthrosamid website.

How Does Arthrosamid Work?

Knee osteoarthritis leads to cartilage breakdown and inflammation in the synovial lining of the joint.

Once injected, Arthrosamid:

• Bonds with the joint lining to create a soft, cushioning barrier
• Enhances lubrication within the joint
• Reduces synovial inflammation and associated pain
• Improves joint function and mobility

What to Expect

Step 1 – Consultation

Your clinician will assess your knee and determine whether Arthrosamid is suitable for you.

Step 2 – Injection

You will be given antibiotics about an hour before your Arthrosamid treatment to protect you from any potential risk of infection.

To ensure the hydrogel is delivered to the precise location in the joint, we always perform ultrasound guided injection therapy.

Local anaesthetic is used to numb the area, and the hydrogel is then injected directly into the knee joint in a single, one-step procedure.

Step 3 – Aftercare

Mild discomfort may occur once the anaesthetic wears off. We’ll advise you on post-treatment care and symptoms to monitor, though side effects are rare.

The clinician who assessed your knee and gave the injection is the same one who sees you afterwards, so your follow-up carries on from the treatment rather than starting again with somebody new.

Is Arthrosamid Right for Me?

It may be a good option if:

• You have knee osteoarthritis that’s no longer responding to physiotherapy, exercise, or standard pain relief
• You want to avoid or delay surgery
• You’re seeking a long-term solution with minimal disruption to your lifestyle

Private Arthrosamid treatment in Weybridge

This treatment is not routinely funded on the NHS, so it is provided privately on a self-pay basis. We are an approved Arthrosamid clinic and carry out the assessment, the ultrasound-guided injection and your follow-up in Weybridge, so there is no onward referral to another provider and no waiting list.

Your first appointment is a full hour of assessment. Where Arthrosamid is the right option we explain what it involves, what it is likely to achieve and what it costs, and arrange the treatment once you have had time to consider it.

Frequently Asked Questions

How soon will I feel the results?

Most people start noticing improvements around 4 weeks post-injection.

Does the injection hurt?

Local anaesthetic is used to numb the area first, and most people tolerate the procedure well. You may feel pressure as the hydrogel goes in, and the knee can be mildly sore for a few days afterwards. Tell us at any point if you are uncomfortable.

How long does Arthrosamid last?

Clinical studies show benefits may last up to three to five years from a single injection.

What is the recovery time?

This is an outpatient procedure with no hospital stay and no significant downtime. Mild discomfort is common once the local anaesthetic wears off. You will be given specific aftercare advice at your appointment, and the Arthrosamid patient rehab booklet below sets out the exercise guidance that follows treatment.

Are there any side effects?

Side effects are rare. The most common is temporary discomfort or swelling around the knee in the days after the injection. Antibiotics are given about an hour beforehand as a precaution against infection. We will go through the risks with you at your consultation and tell you what to watch for afterwards.

Can I still have knee replacement surgery later?

Yes — Arthrosamid doesn’t interfere with the possibility of future knee surgery.

Can I receive Arthrosamid treatment in both my knees?

Yes, it is possible to have both knees treated with Arthrosamid but your clinician is best placed to decide the time period before the treatments. Please contact us for a discounted price for treatment of more than one joint.

How much does Arthrosamid cost?

It is provided as a single treatment package. Current fees are on our treatment pricing page, and a discounted price applies where both knees are treated.

Where can I get more information?

If you have any questions about this treatment or would like to know whether it’s suitable for you, feel free to get in touch with Meyer Physio by phone or email. You can also explore the patient brochure and leaflets linked below, or the official Arthrosamid website for further information.

Arthrosamid Brochures

To learn more about the Arthrosamid treatment, download a patient brochure or patient leaflet from the Arthrosamid website below:

* Arthrosamid^®, the Arthrosamid logos and images are copyright Contura International Ltd.

Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].
Last reviewed: 10 September 2026.

The post Arthrosamid Knee Injection first appeared on Meyer Physio.

What is hyaluronic acid?

Hyaluronic acid is a naturally occurring substance found in the synovial fluid of your joints, where it acts as a lubricant and a cushion. In a joint affected by osteoarthritis those natural levels are depleted, and an injection supplements them.

Why have a hyaluronic acid injection?

The aim is to lubricate and cushion the joint, reducing pain, improving how the joint moves, and potentially delaying the need for more invasive treatment such as surgery. It is an option where joint pain persists despite rehabilitation and simple pain relief.

Which joints can be treated?

Almost any osteoarthritic joint can be considered. In practice the most common are:

• Knee osteoarthritis, the most frequently treated joint
• Shoulder osteoarthritis
• Hip osteoarthritis
• Ankle osteoarthritis
• The small joints of the hand, including the base of the thumb
• The big toe

Which hyaluronic acid do you use?

We use Durolane, Synvisc One and Biolevox. Durolane is the one we use most often. Which product suits you is decided at your appointment, once the joint has been scanned and assessed, and depends on the joint being treated, the state of the joint and how you responded to any previous injections.

How long does a hyaluronic acid injection last?

This depends on the product. Durolane (Bioventus) is a single injection that works for up to 26 weeks. Some other hyaluronic acid preparations are given as a course of injections over a few weeks rather than as one.

Other options for an arthritic knee

Two related treatments may also be considered. Cingal combines hyaluronic acid with a steroid in a single injection, so it can settle inflammation quickly as well as lubricating the joint. Arthrosamid is not a hyaluronic acid at all but a hydrogel, given as one injection and intended to last considerably longer.

How is the injection done?

The injection is given in clinic as an outpatient procedure, and hyaluronic acid is injected directly into the joint through a fine needle.

Like all injections at Meyer Physio, it is placed under live ultrasound guidance, so the medication reaches the joint space itself rather than the tissue around it. That makes the injection more accurate and more comfortable than one placed by feel, and in small joints such as the thumb or the big toe it is what makes an accurate injection realistic at all.

How effective is it?

Results vary between individuals. Some people get significant pain relief and noticeably better joint function; others benefit less. It is worth having realistic expectations and discussing the likely outcome for your particular joint before going ahead, which is part of what the assessment appointment is for.

Side effects

Common side effects are temporary pain or swelling at the injection site. Infection and allergic reactions are rare. Tell us about any allergies or medical conditions before the procedure.

After your injection

Avoid strenuous activity involving the treated joint for about 24 to 48 hours afterwards. You will be given specific post-treatment instructions at your appointment.

What does it cost?

The fee covers the medication, the sterile consumables and delivery of the injection under ultrasound guidance — there is no separate charge for the guidance. Current fees are on our treatment price list.

Informed Consent

Please follow the link: Informed consent for hyaluronic acid injections

Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].

The post Hyaluronic Acid Injections for Arthritic Joints first appeared on Meyer Physio.

Author: Suegnet Meyer

Introduction

The Anterior Cruciate Ligament (ACL) is the primary knee stabiliser that prevents anterior laxity of the tibia in relation to the femur and provides rotational knee stability (Negus et al., 2012). In the United States, approximately 200,000 Anterior Cruciate Ligament Reconstructions (ACLR) are performed annually at a cost of $3 billion (Brophy et al., 2009). Devastating evidence estimates up to 10% of professional alpine skiers will end their careers due to ACL ruptures or tears (Pujol et al., 2007).

Aim

This Clinical Guidance is aimed at Physiotherapists, Strength & Conditioning Coaches and Doctors to prevent and manage ACL ruptures during professional downhill, freestyle skiing and ski-cross during off-season.

Method

A search was performed on Cochrane Collaboration, the York Centre for Reviews and Dissemination, and the United States Agency for Health Care Policy and Research. These systematic reviews provided guidelines to create this evidence based tool. The level of evidence is graded according to criteria described by the Centre of Evidence Based Medicine Oxford United (CEBM) (http://www.cebm.net/). See Figure 1. Evidence strength was rated according to Guyatt et al. (1995).

	Level 1 Evidence
	Level 2 Evidence
	Level 3 Evidence

FIGURE 1: Level of evidence according to CEBM

Clinical Guidelines recommendations

• Conservative versus Surgical treatment
• Timing of Surgery
• Prehabilitation
• Single versus Double bundle techniques
• Grafts choices
• Outcome measurements
• Cryotherapy
• Therapeutic exercise
• Accelerated versus Non-Accelerated rehabilitation
• Open versus Closed chain exercises
• Neuromuscular Training
• Neuromuscular Electrical Stimulation
• Knee Bracing
• Home-based versus Supervised rehabilitation
• Injury prevention

Injury Incidence

No decline in ACL injuries and re-injury rates in professional alpine skiers is reported (Pujol, 2007). This statistics shows primary ACL injury rate at 5.7 per 100 skier-seasons with a 19% re-injury rate and a bilateral ACL injury incidence of 30.5%. During professional skiing, these injuries affect both sexes equally (Pujol, 2007; Westin et al., 2012). In contrast, more female recreational skiers sustain ACL injuries (Flørenes et al., 2009).

Injury Mechanism

Professional skiers endure deceleration from high speeds, jumping, cutting and pivoting, placing stress on the knees resulting in non-contact ACL injuries (Griffin et al., 2006). Injuries occur during hard landings when rigid ski boots induce tibial anterior drawer injuries (Natri et al., 1999; Flørenes, 2009), while the athletes assume seated posture and quadriceps contracts maximally (Johnson 1995). Bere et al., (2014) described the “slip-catch” mechanism: the skier loses balance backwards or inwards during turning. The inside edge of the outer ski catches the snow causing forced valgus and tibial internal rotation position.

Intervention

1. Conservative versus Surgical Management

Cochrane reported inconclusive evidence of ACL injury management (Linko et al., 2005).
Using a pre-screening criteria can determine the ‘copers’ or ‘non-copers’, indicating who will return to sport (RTS) without surgery (Fitzgerald et al., 2000; Hurd et al., 2008; Logerstedt et al., 2010a). These potential ‘copers’ can be conservatively managed by perturbation neuromuscular training (NMT) (Fitzgerald, 2000). However, this will be a minority of skiers that may be considered for short term conservative management to complete a season (Fitzgerald, 2000).
Anterior Cruciate Ligament Reconstruction (ACLR) is indicated for active adolescents with a good prognosis of 85% to RTS. It is unlikely for active adolescents to return to the same sporting level with conservative management only (Ramski et al., 2013).
ACLR is cost-effective, at $38,121 per repair in comparison to rehabilitation alone that may include knee instability risk at $88,538. (Lubowitz et al., 2011; Mather et al., 2013).

Surgical management is indicated for active adolescents wanting to return to high level sport. ACLR is more cost-effective than rehabilitation only.

2. Timing of Surgery

Optimal surgical timing is controversial. Ideally the outcome must be optimised with minimal post-operative complications.
A systematic review demonstrated surgery may be performed from 2 days post-trauma (Andernord et al., 2013). Another review found that ACLR can be performed from one week post-injury together with a moderately accelerated programme with a low post-operative stiffness risk (Kwok et al., 2013).
Rapid surgical intervention after an acute ACL rupture may cause arthrofibrosis (Cosgarea et al., 1995; Mauro et al., 2008). Delaying surgery for high-level athletes, or athletes with increased knee instability post-injury, may cause secondary meniscal injuries and degenerative Osteoarthritis (OA) (Beynnon et al., 2005; Amin et al., 2008; Ajuied et al., 2013). Post-surgical complications include deep vein thrombosis (Ramos et al., 2008) and septic arthritis (Van Tongel et al., 2007).

Surgery should not be performed too soon due to arthrofibrosis risk but a lengthy delay may cause OA or meniscal injuries.

3. Prehabilitation

Prehabilitation aims to enhance postoperative outcome. Aims and criteria for progression to surgery include: Minimal knee swelling, full range of motion (ROM) including knee extension, normal gait and Quadriceps strength (Ditmeyer et al., 2002).
A pre-operative 6-week home-based and gym programme consisting of NMT and strengthening programme resulted in enhanced postoperative outcomes. Pre-operative improvements (hop tests and quadriceps hypertrophy) were evident. These enhancements were still present 12-weeks post-operative (Shaarani et al., 2013).

A prehabilitation programme will enhance the post-operative outcome up to 12 weeks.

4. Surgical technique: Double-Bundle (DB) or Single-Bundle (SB) choice

The ACL consists of 2 distinct bundles. The ACLR is performed by drilling either a single or double tunnel through the tibia and femur, to pass the graft through.
Cochrane reported no difference in outcome scores when performing SB compared to DB ACLR (Tiamklang et al., 2012; Bjornsson et al., 2013; Xu et al., 2013).
A meta-analysis showed DB as the superior technique since it provides better rotational stability. This may not affect the functional outcome compared to SB (Li et al., 2014). DB may reduce re-rupture rates but is more invasive and technically demanding (Tiamklang, 2012).
In the short term, DB is cost-effective due to low revision rates. However, long term follow-up is indicated (Paxton et al., 2010).

Effective DB technique improves rotational stability, less re-rupture rates and has short term cost-effectiveness, compared to SB technique.

5. Grafts Choices

Cochrane reviews demonstrate no significant difference of knee stability is achieved when using either Hamstring (HT) or Patella tendon (BPTB) graft techniques (Liden et al., 2007; Maletis et al., 2007; Magnussen et al., 2011; Mohtadi et al., 2011).
After discussion with the patient, the surgeon will choose the suitable graft. Consideration should be: type of sport, age, accelerated rehabilitation and RTS (Magnussen, et al., 2010; Rahr-Wagner, et al., 2014).
The more frequently the surgeon performs ACLR the better the outcome. Surgeons with a lower volume ACLR (52 ACLR in 12 months) (Lyman et al., 2009). Hospitals hosting two or fewer ACLR monthly are 32% more likely to have a 90-day post-operative readmission, in contrast to hospitals performing more than 10 ACLR monthly (Lyman, 2009).

ACLR using HT and BPTB showed identical knee stability outcomes.

Different types of grafts

Various graft types are available:

• Autografts
• Allografts
• Artificial grafts

a. Autografts (harvested from the patient)

Hamstring graft (HT)

• Surgical suspension fixation is used. This may increase longitudinal movement between fixation point and graft resulting in bone tunnel enlargement, compromising knee stability (Webster et al., 2001).
• Reduces knee flexion and internal rotation strength.
• Takes longer to heal (9-12 weeks)(Weiler et al., 2002) causing later RTS.
• Additional infection risk (Maletis et al., 2013b).
• Although more popular due to lower donor morbidity, the revision rate during the first year is higher in youngsters (Maletis et al., 2013a; Persson et al., 2014), and re-rupture rate is (1.82 time higher) for the age group

Patella tendon graft (BPTB)

• A screw-in fixation is used (Anderson et al., 2001).
• Complications: anterior knee pain, patella fractures, inability to kneel.
• Heals faster (6 weeks) than HT (Papageorgiou et al., 2001) and quicker RTS (Weiler et al., 2002).
• Used in younger age group (<20 years) when accelerated rehabilitation is required (Magnussen et al., 2010).
• Causes less OA due to increased stability ((Li et al., 2012; Rahr-Wagner, 2014).

b. Allograft (harvested from external donor)

ACLR performed with fresh frozen allograft that has not been chemically treated or irradiated, produced equivalent clinical outcome compared to autografts (Lamblin et al., 2013).

c. Artificial Grafts: Ligament Advance Reinforcement System (LARS)

LARS is a polyester graft that compares well to BPTB. It may be used in athletes performing high demanding sport with a 6-months RTS (Pan et al., 2013). It may cause post-operative synovitis (Klein et al., 1992). Uncertainty exists over long term OA risk (Pichon et al., 2007).

Autografts and untreated fresh frozen allografts produce similar clinical outcome.

6. Outcome measurement

Hop tests

Standardised functional outcome measures determine rehabilitation progression and RTS. The single-limb hop tests measure neuromuscular ability and dynamic knee stability, and demonstrates good test-retest reliability (ICC) in normal young subjects (Noyes et al., 1991; Ross et al., 2002).
During ACL rehabilitation the hop tests measured with good reliability and validity (7.05% – 12.96%) (Reid et al., 2007).

Patient assessed health outcome

Various patient-assessed health instruments with varying validity, measures patients’ perception of the ACLR outcome.
The Knee Injury and Osteoarthritis Outcome Score(KOOS) measures symptoms and disability with responsiveness values (MDC95) to change: pain, symptoms, daily living activities, sport and recreational and knee specific quality of life, but lacked addressing mental health domains(Garratt et al., 2004; Wright, 2009; Logerstedt et al., 2010a).
International Knee Documentation Committee 2000 form(IKDC) is a joint-specific outcome that measures symptoms, function, and sports activity aimed at various knee ailments with good test-retest value especially in bigger groups (Collins et al., 2011; Logerstedt 2010a). However, Irrgang et al.(2006), demonstrated that due to higher MDC95- values, responsiveness may be compromised.
The Knee Outcome Survey-Activities of Daily Living Scale(KOS-ALDS) is responsive to knee functional assessment with good test-retest (ICC 0.97) and minimal detectable changed values for MDC95 (Irrgang et al., 1998).

KOOS, IKDC or KOS-ALDS, and Hop tests may be used to assess pain, disability, function and clinical presentation changes during rehabilitation. Effective communication between the patient and the MDT will optimise rehabilitation and outcome to RTS.

Rehabilitation Interventions

7. Cryotherapy

Cryotherapy is used for post-operative pain and swelling reduction and to promote knee ROM and drainage. Evidence confirmed the cryotherapeutic analgesic effect, however no change was shown for ROM or drainage (Raynor et al., 2005).

It is recommended that cryotherapy is used for pain relief immediate post-operative and ongoing during the first weeks of rehabilitation.

8. Therapeutic Exercise

Eccentric, concentric and NMT is used during rehabilitation to improve quadriceps contractions.
Eccentric rehabilitation is effective to improve quadriceps strength. NMT improves motor learning in addition to strength training. Eccentric training improves quadriceps strength better than concentric exercises (Gokeler et al., 2013).

Rehabilitation should be a combination of concentric, eccentric, and NMT.

9. Accelerated Versus Non-accelerated rehabilitation

Shelbourne & Nitz (1990), described accelerated rehabilitation by initially aiming to restore full weight bearing, knee extension and optimising quadriceps activity.
According to a study, 85% of participant with BPTB accelerated group (19-weeks) and non-accelerated BPTB group (32-weeks), showed almost equivalent anterior posterior laxity (1.3mm difference) after the first 3-months, postoperative. After the two year follow-up the outcome were again similar for both groups (Beynnon et al., 2011).

19-week accelerated rehabilitation is possible when using BPTB ACLR.

10. Open Kinetic (OKC) and Closed Kinetic Chain exercises (CKC)

OKC is performed while the foot is not planted, by performing leg extensor resistance training using ankle weights. OKC increases anterior tibial translation (Beynnon et al., 1997), which may result in increased graft stress causing knee laxity. However, OKC may increase quadriceps torque, resulting in accelerated rehabilitation and RTS.
During CKC the foot is supported by using a leg-press machine (Andersson et al., 2009). CKC promotes joint compression and knee stability (Beynnon et al., 1997).
Uncertainty exists in the quantity of quadriceps loading that can safely be applied to gain quadriceps strength improvements in HT graft rehabilitation. During the initial HT post-surgical phase, graft necrosis takes place causing optimum graft weakness at 6-8 weeks (Scheffler et al., 2008). HT graft stress would cause more instability and needs to be protected.
OKC for HT graft, from 90-45° knee flexion can be safely performed from 4-weeks post-operatively without stressing the HT graft, resulting in improved quadriceps strength (Fukuda et al., 2013). Further studies should assess the frequency and magnitude of quadriceps activation allowed.

OKC exercises to strengthen quadriceps are allowed for HT at 4-weeks but is limited to 90-45° as it places stress on the graft, while CKC places less stress on the graft.

11. Neuromuscular training (NMT)

NMT is the facilitation of movement training progressions from single plane low intensity training to multi-planar complex power training, resulting in improved joint kinaesthesia, stability, acceleration and deceleration (Hewett et al., 2002). In addition, NMT reduces ACL re-injury (Johansson et al., 1991) and includes balance, proprioception and plyometrics.
A combination of NMT and strengthening produce better outcomes than only strength training exercises after 6 months (Risberg et al., 2007) and also confirmed during 2 and 4 year follow-ups (Risberg & Holm 2009). NMT improved global knee function and pain relief, while strengthening improved hamstring strength after two years post-operative.

Rehabilitation should combine NMT and strength training to increase knee stability and movement coordination during supervised physiotherapy.

12. Neuromuscular Electrical stimulation (NMES)

Postoperative quadriceps inhibition is caused by arthrogenic muscle inhibition (Palmieri et al., 2004).
Combining NMES and quadriceps exercises improves quadriceps contraction during the first 4 weeks post-operative (Kim et al., 2010).
NMES is not a substitute for muscle volitional exercises (Bax et al., 2005), but will promote quadriceps contraction initially.
NMES compared to a standard post-operative strength programme improved the quadriceps strength of the NMES group by an average of 29% after 6-month follow-up (Feil et al., 2011). Inconclusive evidence exists to show whether NMES has any effect on functional performance or patient-orientated outcomes.

NMES may contribute to quadriceps contraction in the first weeks postoperatively, but patient-orientated outcomes may not be influenced.

13. Knee Bracing

Post-surgical bracing (0-6 weeks) has no beneficial influence on ACLR outcome, pain or knee stability (Wright et al., 2008a, Andersson et al., 2009).
No evidence was found that functional bracing reduces re-injury in 100 patients during land-based exercise (McDevitt et al., 2004).
However, functional knee bracing may enhance the proprioceptive input during downhill ski (Nemeth et al., 1997). Functional bracing showed reduced ACL re-injury during 6 seasons. The non-braced skiers were 3.9 times more likely to re-injure than the braced skiers (Sterett et al., 2006).

Post-operative bracing has no role in ACLR. Functional bracing may be effective in downhill skiing.

14. Home–based rehabilitation versus supervised rehabilitation

The quality and cost of rehabilitation protocols are influenced by home-based versus supervised rehabilitation.
Evidence showed no difference between home- and clinic-based groups assessed by knee ROM, laxity, strength and function (six months to one year) (Andersson et al., 2009).

A combined supervised- and home-programme will be more beneficial and cost effective during rehabilitation.

15. ACL Injury prevention and performance enhancing

Avoidance of knee compression, hip abduction torque and tibial internal rotation is essential for ski prevention programmes. By strengthening the hip abductor, extensor and hamstrings may contribute to protecting the knee against forces (Bere et al., 2014).
Injuries may be reduced by NMT, educational tools and interventions (Gagnier et al., 2013). Awareness videos and training programmes reduce injuries in professional skiers (Ettlinger et al., 1995). These videos prevented injuries by teaching skiers to identify and respond correctly when at risk of sustaining injury.
NMT should be implemented during the training of young female adolescents. This will counteract the neuromuscular deficiencies that develop at a later adolescent developmental phase, resulting in altered mechanics and injuries (Myer et al., 2013).
Injury prevention is effective (Walden et al., 2012). Injury reduction of 64% was achieved (N=4564, between ages of 12-17). Injuries occurred at -0.07 (95% CI -0.13 to 0.001) per 1,000 playing hours in favour of the preventative group (Walden, 2012).
A preventative programme must be encouraged by all MDT members. The programme must have a duration of 10 to 20 minutes, thrice weekly during pre-season and once weekly during season (Grindstaff et al., 2006).
Inconclusive evidence for the effectiveness and type of male injury prevention programmes exist (Alentorn-Geli et al., 2014).
Numbers-needed-to-treat is between 108-120 training players to prevent one ACL injury (Sugimoto et al., 2012a). Further research to improve the screening process together with sport specific prophylactic programmes are required.
The correct ski binding should be used for the level of skier and be adjusted properly to reduce ACL injuries (Young et al., 1976).

Effective prevention programmes need to be sport specific. Preventative videos are effective to educate skiers.

References

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• Yoo, J.H., Lim, B.O., Ha, M., Lee, S.W., Oh, S.J., Lee, Y.S., & Kim, J.G. (2010). A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surgery, Sports Traumatology, Arthroscopy, 18(6): 824-830.
• Young, R., Aronsson, D., Johnson, R., Ettlinger, C., Shealy, J., (1976). The etiology of ski injuries: An eight year study of the skier and his equipment. The Orthopaedic clinics of North America, 7(1): 13-29.
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• Centre of Evidence based medicine Oxford United Kingdom (http://www.cebm.net) Accessed 16/2/2014.

Disclaimer

The contents of this article – Management of ACL Ruptures in Skiers, is aimed at medical professionals. It is provided here for informational purposes only and should not be treated as medical or health management advice. The materials herein are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, physiotherapist or other health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article or website. Reliance on any information provided herein is solely at your own risk.

Copyright

The content of this article – Management of ACL Ruptures in Skiers, is copyright © 2016 of Suegnet Meyer and Meyer & Associates. Transmission or reproduction of the contents, beyond that allowed by fair use as defined in the copyright laws requires the written permission of the copyright owners.

The post Management of ACL Ruptures in Skiers first appeared on Meyer Physio.

PFPS vs Pain

Hodges et al (2009) induced pain by injecting fat pads which did cause delayed VMO. With the increasing or aggravating the pain caused decrease in VM muscle activation. Furthermore swelling can also cause reduced VMO activity. Stokes et al., (1984) injected 10ml of fluid causing VM to inhibited while VL was inhibited only after injecting 40ml fluid. Swelling and Pain will inhibit VMO activation according to these studies and be a contributing factor to PFPS.

Influence of the hip & foot on PFPS?

In addition to my previous answer last week, weakness of the hip abductors and external rotators can cause PFPS as demonstrated by Souza & Powers (2009). Increased hip internal rotation ROM with weakness of hip abductor muscles were observed in females suffering from PFPS (in weight bearing). Powers (2003) also previously documented that since the patella is influenced by the interaction of proximal and distal segments that abnormal tibia and femur motion in the transverse and frontal planes have an effect on the PFJ. This highlights the importance of stability of the hip (strength training of hip abductors and external rotators) and the foot. This will also have a better long term effect and prevent further injury.

Rehabilitation of the VM / VMO to Optimise Patello-Femoral mechanics

Beside taking the hip Abductor strength and feet biomechanical factors as well as muscle lengths of gastrocs/soleus/hamstrings in consideration, rehab in closed chain kinematics :

Method

To make sure that the VMO is optimally rehabilitated, firstly educate the patient how to static contract the VM (pain free) by locating and palpating the VM or using EMG feedback. By using PF tape or ice brushing can facilitate VM contraction. The patient needs to train VM contraction regularly during the day. Since optimum contraction will be in a closed chain, persue weight bearing position but in a pain free ROM. By watching out for signs of fatigue, posture positioning of the foot and hip, and preferrebly in closed chain, get the patient to do this frequently during the day to promote the neuro-muscular pattern and try to facilitate the VM contraction and endurance. Progresssion for endurance and strength in larger range of motion can be achieved by using terminal extension with theraband. Assess what ROM gives them pain during function (stairs) and break the components down and strengthen the knee/hip in that spesific range but still be aware of pain as a contraindication and keep icing to reduce pain and inflammation. Taping may also help. Use a raised chair height or perhaps the side of a desk and let them train, controlling the VM while getting up from this elevated position instead of working through a full range of motion, causing pain that they are unable to tolerate anyway. If this is tollerated, progress mini squats supported to single leg squats with support, then without support, but ensuring no pain with good hip foot knee control and posture. Progressive weight training can then be introduced and sport specific exercises.

References

1. Bolgla, L. A., Malone, T.R. Umberger B.R., (2011). Comparison of hip and knee strength and neuromuscular activity in subjects with and without patella femoral pain syndrome. The International Journal of Sports Physical Therapy. 6(4) : 285-296.
2. Cagnie B, Elliott JM, O’Leary S, D’hooge R, Dickx N, Danneels LA (2011). Muscle functional MRI as an imaging tool to evaluate muscle activity. Journal of Orthopaedic & Sports Physical Therapy; 41 (11): 896–903.
3. Hodges PW., Mellor R., Crossley K., Bennell K. (2009). Pain induce by injecting hypertonic saline into the infra patellar fat pad an effect on coordination of the quadriceps muscle. Arthritir Rheum 61); 70-77.
4. O’Leary S, Cagnie B, Reeve A, Jull G, Elliott JM (2011). Is there altered activity of the extensor muscles in chronic mechanical neck pain? A functional magnetic resonance imaging study. Arch Phys Med Rehabil. 2011; 92 (6): 929–34.
5. Pattyn, E., Verdonker, P., Adelheid. S., Van Tiggelen, D., (2013). Muscle functional MRI to evaluate quadriceps dysfunction in patella femoral pain. Medicine and science in sports and exercise: 45 (6) 1023-1030.
6. Powers, CM., (2003). The influence of altered lower extremity kinematics on patellofemoral joint dysfunction : a theoretical perspective. Journal of Orthopaedic Sports Physical Therapy. 33(11):639-646.
7. Souza RB, Powers CM. (2009). Differences in hip kinematics, muscle strength and muscle activation between subjects with and without patella femoral pain. Journal of Orthopaedic Sports Physical Therapy 39(1) 12-19.
8. Stokes M., Young A., (1984). The contribution of reflex inhibition to arthrogenous muscle weakness. Clinical Science. 67: 7-14.

Disclaimer

The contents of this article – Quadriceps Dysfunction in Patello Femoral Pain Syndrome, is aimed at Physiotherapists and other medical professionals. It is provided here for informational purposes only and should not be treated as medical or health management advice. The materials herein are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, physiotherapist or other health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article or website. Reliance on any information provided herein is solely at your own risk.

Copyright

The content of this article – Quadriceps Dysfunction in Patello Femoral Pain Syndrome, is copyright © 2016 of Suegnet Meyer and Meyer & Associates. Transmission or reproduction of the contents, beyond that allowed by fair use as defined in the copyright laws requires the written permission of the copyright owners.

The post Quadriceps Dysfunction in Patello Femoral Pain Syndrome first appeared on Meyer Physio.