title: Rehabilitation and functional outcomes after extensive surgical debridement of a knee infected by fusobacterium necrophorum: a case report.
abstract: OBJECTIVE
  Joint infection is a rare but serious complication after knee injury that should be part of a physical therapist's differential diagnosis. This case report presents the care of a 17 year-old female athlete with septic arthritis from a Fusobacterium infection after sustaining a right lateral meniscus tear. Joint pathology combined with the aggressive infectious agent led to arthrofibrosis of her knee joint and resultant activity limitations and participation restrictions. The purpose of this case report is to highlight a rare and unique pathology, the serious effects that a joint infection can have on musculoskeletal function, and the challenges encountered during the rehabilitation process.
  
  
  METHODS
  The subject was a 17 year-old volleyball player who injured her right knee while playing volleyball. Within 7 days, the subject developed a severe joint infection that spread into surrounding gluteal, quadriceps, and gastrocnemius musculature. The infection was surgically debrided eight times during a 10-week inpatient hospital stay. A manipulation under anesthesia was performed to restore range of motion in her knee joint. Outpatient physical therapy was initiated 4 days later in order to restore musculoskeletal function.
  
  
  RESULTS
  Over eight months of physical therapy services were utilized to address the impairments and activity limitations caused by her joint dysfunction. She met her physical therapy goals and made significant improvements on the Knee Outcome Survey and the Lower Extremity Functional Scale. Success in physical therapy and completion of additional strength training exercise allowed this subject to return to competitive softball at the club level during her freshman year of college.
  
  
  CONCLUSIONS
  Though rare after musculoskeletal injury, joint infection can lead to soft tissue damage, partial or complete degradation of articular cartilage, and arthrofibrosis causing significant disability. Physical therapists must incorporate evidence-based treatment principles including eccentric exercise, core stability, and lower extremity strength training along with sports-specific rehabilitation into the treatment plan in order to address activity limitations and meet physical therapy goals.
  
  
  METHODS
  Level 4-Single Case report.
authors.affiliation: Beacon Orthopaedics and Sports Medicine, Cincinnati, OH, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Naylor
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Briggs
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Kegelmeyer
authors.forename: Anne D
authors.initials: AD
authors.lastname: Kloos
keywords: Fusobacterium necrophorum infection; knee; rehabilitation