CLINICAL PLACEMENT 3
(DPCP 43210)
NAME: AFIQUL RASHYED BIN OSMAN
MATRIX NO: 4242211002
COHORT: DPY 37
HOSP. PLACEMENT: KPJ DAMANSARA
SPECIALIST HOSPITAL
D.O. PLACEMENT: APRIL 29, 2024 – JULY 7,
2024
CONTENT OF EACH CASE STUDY:
0. Introduction
I. Pathophysiology of diseases
II. Clinical features / sign and symptoms
III. Dr’s management
IV. Assessment & SOAPIER
*No i-iv needs supporting evidence
*Font – Arial,11
CASE STUDY & ASSESSMENT
CASE STUDY: HYALOFAST SURGERY ON RIGHT KNEE
INTRODUCTION
A significant part of tissue restoration is played by hyalofast. By effectively trapping
mesenchymal stem cells in the cartilage lesion to rebuild the tissue, it essentially aids in the
body's self-healing process and promotes the regeneration of cartilage tissue. By means of
the MSCs that have colonised the scaffold, hyalofast facilitates cartilage tissue repair and
helps to steer tissue remodelling. Arthroscopy, also known as mini-arthrotomy, is used to
apply hyalofast in the cartilage defect.
PATHOPHYSIOLOGY
The goal of hyalofast surgery is to help restore cartilage in the knee joint by
implanting a biomaterial scaffold called hyalofast into the cartilage lesion. The
pathophysiology of hyalofast surgery revolves around several key mechanisms such as
trauma to the knee joint can lead to cartilage defect formation or wear and tear on the knee
joint also can lead to the breakdown of cartilage tissue.
CLINICAL FEATURES
Clinical elements of hyalofast surgery include those components of the procedure
and its results that can be observed and measured. From pre-operative assessment to post-
operative recuperation, these sections cover a wide range of topics. The clinical outcomes of
hyalofast surgery are pain relief, improve function of the knee joint, and improve ROM.
DOCTOR MX
Hyalofast surgery involves a procedure designed to treat cartilage defects in the knee
joint using biomaterial called Hyalofast. Hyalofast is a type of scaffold made from hyaluronic
acid, which is a substance naturally found in the body, particularly in joint fluid and cartilage.
The scaffold is biodegradable & porous, designed to mimic the natural environment of
cartilage tissue & support the growth of new cartilage cells & extracellular matrix. Before
surgery, imaging such as MRI or arthroscopy may be used to assess the extent & location of
the cartilage defect in the knee joint. Hyalofast surgery is typically performed
arthroscopically, which involves making small incisions around the knee joint & inserting an
arthroscope to visualize the inside of the joint.
ASSESSMENT
PATIENT DETAILS: -
Name: Mrs. S
MRN: 00248XXX
Age: 45 y/o
Gender: female
Race: malay
D.O. Admission: May 25, 2024
D.O. Operation: May 27, 2024
D.O. Ax: May 29, 2024
Dr. diagnosis: Hyalofast surgery on Right knee
Dr. Mx: operative, proceed to physio for further tx
SUBJECTIVE AX: -
pt c/o: feel sharp pain & tightness when bending the right knee.
Current hx : ankle twisted when walk at house on 1/52 ago.
: proceed to Thompson Hosp. for check up
: after 3/7, proceed to KPJDSH for further tx when pt feels more pain &
numbness.
: pt decided to do an operation.
Past hx: NIL
Surgical hx: NIL
Medical hx: hypothyroid
Medication hx: thyroxin (4 years +)
Social hx : status – married, 3 children
: occupation – housewife
: nature of work – prolonged standing (2h +)
: housing – triple story
: stairs – yes
: toileting – sitting
: hobby – brisk walk (10k step/day)
INVESTIGATION: -
MRI: May 26, 2024 at KPJDSH
Imp : strain lateral collateral ligament.
: G2 – G3 chondral injury medial & lateral femoral condyles.
: G2 – G3 chondral injury with blistering & fissuring of medial & lateral facets.
Body chart: -
Anterior Posterior
NRS: 8/10
Area of pain: right knee
Type of pain: sharp & pulling
Nature of pain: intermittent
Irritability: high
Aggravating factor: knee flexion
Ease factor: straight leg with hip ext. rotation
24h behaviour : AM – 3/10
: PM – 7/10
: Night – not disturbing sleep d/t painkiller
OBJECTIVE AX: -
General observation: a female pt with mesomorph body build came to rehab dept. by
wheelchair accompanied by therapist.
Local observation: -
1. 2 post op patches on right knee
2. no redness
3. no scar d/t post op patches
4. quads contraction – poor
On palpation: -
1. swelling present at right knee
2. warmness present at right knee
3. tenderness: G2 on right knee
ON EXAMINATION: -
1. joint circumference (knee): -
Base: Right (42cm) Left (37cm) Differences (5cm)
Middle: Right (40cm) Left (37.5cm) Differences (2.5cm)
Apex: Right (37cm) Left (35cm) Differences (2cm)
Imp: swelling noted at right knee d/t inflammatory process.
2. ROM (knee)
Flexion (prone lying): Right (active 0°-15°) Left (active 0°-135°)
Extension (supine lying): Right (active Lag 5°) Left (active 0°)
Imp: limited ROM on right knee d/t pain.
3. joint clearance: -
Hip : flexion (supine ly) – Right (0°-15°) Left (0°-120°)
: extension (prone ly) – Right (0°-20°) Left (0°-30°)
: abduction (side ly) - Right (0°-50°) Left (0°-55°)
: adduction (side ly) - Right & Left (0°)
: ext. Rotation (high sitting) - Right (0°-40°) Left (0°-45°)
: int. Rotation (high sitting) - Right (0°-25°) Left (0°-35°)
Ankle : plantarflex (high sitting) - Right & Left (0°-45°)
: dorsiflex (high sitting) - Right & Left (0°-20°)
: inversion (high sitting) - Right (0°-40°) Left (0°-45°)
: eversion (high sitting) - Right & Left (0°-15°)
Imp: Limited ROM on right leg d/t weakness.
4. MMT (lower limb): -
Knee : flexion (hamstring) - Right 2/5 Left 5/5
: extension (quadriceps) - Right 2/5 Left 5/5
Hip : flexion (ilopsoas major) - Right 2/5 Left 5/5
: extension (gluteus maximus) - Right 2/5 Left 5/5
: abduction (gluteus medius) - Right 2/5 Left 5/5
: adduction (adductors) - Right 3/5 Left 5/5
Ankle : plantarflex (gastrocnemius) - Right 4/5 Left 5/5
: dorsiflex (tibialis anterior) - Right 4/5 Left 5/5
: inversion (tibialis posterior) - Right 4/5 Left 5/5
: eversion (peroneus longus & brevis) - Right 4/5 Left 5/5
Imp: reduce muscle power at right leg d/t weakness
5. Muscle girth
Superior of patella from base : 5cm (VMO) - Right (40cm) Left (39cm) Difference (1cm)
: 10cm (rectus femoris) - Right (45.5cm) Left (44cm) Difference
(1.5cm)
: 15cm (hamstring) - Right (48cm) Left (49.5cm) Difference
(1.5cm)
Inferior of patella from apex : 5cm (gastrocnemius) - Right (35cm) Left (37cm) Difference
(2cm)
: 10cm (tibialis anterior) - Right (37.5cm) Left (38.5cm)
Difference (1cm)
: 15cm (soleus) - Right (34cm) Left (35cm) Difference (1cm)
Imp: decrease in muscle bulk at right leg d/t lack of activity.
ANALYSIS: -
1. Swelling noted at right knee d/t inflammatory process
2. Limited ROM on right knee d/t pain.
3. Limited ROM on right leg d/t weakness.
4. Reduce muscle power at right leg d/t weakness.
5. Decrease in muscle bulk at right leg d/t lack of activity.
SHORT TERM GOALS: -
1. Reduce swelling within 1/52
2. Reduce pain within 1/52
3. Improve ROM within 1/52
4. Increase muscle bulk within 1/52
5. Increase muscle power within 1/12
LONG TERM GOALS: -
1. Improve ADL function within 2/12
2. To prevent secondary complications such as stiffness
PLAN OF TX: -
1. Stretching exs
2. Strengthening exs
3. Pain mx
4. Home education
INTERVENTION: -
1. Stretching exs (to improve muscle flexibility): hamstring & ITB stretching using stretch
band, 20 reps, 5 sec hold each.
2. Strengthening exs (to strengthen the muscle): SLR 4-planes (assisted by therapist), SQE,
20 reps, 5 sec hold each.
3. Pain mx (to reduce pain): ice compression, 20 mins
4. Home education : teach pt how to walk in partial weight bearing, flat surface and stairs
properly using axillary crutches
: advised pt to do ice application for 20 mins each, 2-3x/day
: teach pt how to correct the leg positioning
EVALUATION: -
pt feel much better to move but still complain of tiredness & pain at right knee.
REVIEW: -
Need to be review on NRS, ROM, & MMT on next session.
