2a-c] Knee Part 1 + ACL Flashcards
Laxity is a
Sign
Instability is a
Symptom
Ligament strength
MCL > PCL > ACL > LCL
MOI for ACL
Non-contact Deceleration with twist Valgus collapse IR or IR+hyperextension Cutting maneuver- unhappy triad
Signs and Sx for ACL
Acute hemarthrosis
“Pop” with effusion
Can’t continue playing
Special tests for ACL
Lachman
Anterior drawer
Macintosh lateral pivot shift
Which lig is twice as strong as ACL?
PCL
MOI for PCL
Flex knee with PF
Hyperextension (ACL goes first)
Posterior rotation force
Valgus/varus rotation (collateral goes first)
Physical exam for PCL
Swollen knee, tender calf, loss of tibial plateau prominence
Special tests for PCL
Posterior drawer
Godfrey “sag” sign
MOI for MCL injury
Valgus force (0-90)
Signs and symptoms for MCL
Local swelling
Tender
Pain with valgus stress
What sign does MCL injury NOT have
It doesnt have hemiarthrosis
Why is there no hemiarthrosis in MCL?
MCL is extraarticular
Special tests for MCL
Valgus stress tests
Signs and symptoms for MCL injury
Usually walk with flexed knee
Tender at tibial insertion
Tender at adductor tubercle
Swelling
MOI for LCL
Varus force; usually associated with ACL or PCL
Signs and Sx of LCL injury
Local swelling
Tender
Pain with varus stress
NO hemiarthrosis (extraarticular)
Special tests for LCL
Varus stress test
ACL rehab: NM training, aggressive quad strengthening
Pre-operative
ACL rehab: BPTB or hamstring autograft or soft tissue allograft
Surgical intervention
ACL rehab: ACLR rehab guidelines
Post operative
Days 1-7 for ACL rehab
Control swelling
Full active knee extension (patellar mobility)
Quad strength
Gait training
Exercises according to article
NMES with knees in 60 flex. Wall squat with more bend and weight on impaired knee. Prone hang Single leg balance Single leg cone pick up
When does running start?
3-5 months
When can level II sports start?
6-9 months
When can level I sports start?
6-12 months
Level 1 return to play?
4 months to NEVER.
But average is 9 months.
Outcomes for allografts
5 more likely to require revision
Outcomes for ipsilateral re-tear
Men 3x more likely. Hamstring autograft Young Graft angle 3.9 xCutting sports
Contralateral tear outcomes
Women 6x more likely
BPTB older
5x cutting sports
ACL injury is more likely to happen to who and what age?
Women and younger than 18
You risk of re-injury of ACL is higher?
If you go back sooner, if youre younger,
Males (ipsi)
Females (contra)
ACL deficient athletes are at risk of?
Re-injury
Meniscus tearing
Articulation cartilage damage
What is a true coper?
No giving way episodes following injury
Classification criteria for coping.
Non coppers= fail ATLEAST ONE criteria.
Less than or = to 1 giving way episode
6 meter timed hop > = 80% LSI
KOS-ADLS >= 80%
GRS >= 60%
Perturbation training does what?
Improves knee function
Variable response to rehab
Goals of perturbation training
Break up rigid co-contraction
Promote fast, selective muscle responses
