J Orthop Sports Phys Ther 1982;3(4):171-177.

The treatment of focal full thickness articular defects in the knee has continued to present a challenge, with no traditional treatment method providing consistent acceptable long-term clinical results. Patients with significant chondral defects frequently have persistent joint line pain, swelling, and catching in the knee. In contrast to marrow stimulation treatment techniques, such as abrasion arthroplasty, drilling, or microfracture, which populate the defect with pluripotential stem cells, the use of cultured autologous chondrocytes fills the defect with cells of a committed pathway to develop hyaline-like cartilage. This hyaline-like cartilage more closely recreates the wear characteristics and durability of normal hyaline cartilage than the fibrous or fibrocartilage repair tissue formed by pluripotential stem cells. The purpose of this paper is to review the efficacy of available treatment options as well as the basic science rationale, indications, technique, postoperative rehabilitation, and clinical results of using cultured autologous chondrocytes in the treatment of focal full thickness chondral defects of the knee.

J Orthop Sports Phys Ther. 1998;28(4):241-251.

Key Words: articular cartilage surgery, knee joint disease, autologous chondrocyte, cell transplantation

Knee joint effusion has been shown to cause a reflex inhibition of the quadriceps musculature. However, the effect of effusion on knee joint proprioception has not been thoroughly investigated. This issue is further clouded by the debate surrounding the role of the muscle spindle and joint mechanoreceptors in providing afferent feedback to the central nervous system. This case study examines the effects of a chronic effusion on knee joint proprioception. Possible suggestions for the results are discussed, and areas for further study are offered.

J Orthop Sports Phys Ther. 1997;25(3):208-212.

Key Words: effusion, proprioception, mechanoreceptors, knee

Current concepts in postoperative anterior cruciate ligament (ACL) reconstruction management include participation in an "accelerated" rehabilitation program. There are no published reports examining the effects of accelerated or conservative rehabilitation on subjects with generalized ligamentous hyperelasticity. The purpose of this case study was to examine the effects of a conservative or "decelerated" rehabilitation program on the functional outcome of a hyperelastic female adolescent athlete following ACL reconstruction. The subject was a 15-year-old female basketball player who sustained a unilateral ACL tear and underwent subsequent ACL reconstruction using a patellar tendon autograft. The subject immediately began participation in a "decelerated" rehabilitation program in which the intensity and rate of progression was decelerated, emphasizing a prolonged period of maximum graft protection. Progress was objectively quantified with a battery of diagnosis-specific tests at scheduled intervals. Results at 52 weeks postoperative revealed normal range of motion, proprioception, balance, knee stability, quadriceps strength, hamstring strength, and subjective assessment values, and only a 4.0% deficit in functional scores. Our results suggest a "decelerated" rehabilitation program may be appropriate for the population with generalized ligamentous hyperelasticity by yielding excellent functional results without compromising the integrity of the graft and, ultimately, knee stability.

J Orthop Sports Phys Ther. 1997;26(1):29-34.

Key Words: anterior cruciate ligament reconstruction, rehabilitation, hyperelasticity

It is hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. The purpose of this study was to determine what effect shoulder muscle fatigue has on glenohumeral proprioception and to examine the relationship between arm dominance and shoulder proprioception. Eighty subjects without a history of glenohumeral pathology participated. Each was seated on an isokinetic dynamometer with a randomly selected shoulder positioned in 90° of abduction and elbow flexion. With vision blinded, the arm was passively positioned in 75° of external rotation for 10 seconds, then passively returned to the neutral starting position. Three trials each of active and passive repositioning (2°/sec) were recorded. Following a fatigue protocol, both active and passive repositioning were reassessed. Testing order was randomized. A significant difference was detected between pre- and post-fatigue scores. No significant difference was detected between dominant and nondominant extremities. No relationship between arm dominance and shoulder proprioception was established. It is concluded that shoulder proprioception is diminished in the presence of shoulder muscle fatigue, suggesting clinical rehabilitation protocols must emphasize increasing muscular endurance.

J Orthop Sports Phys Ther. 1996;23(6):348-352.

Key Words: proprioception, fatigue, dominance, shoulder