5] Posterolateral Corner and 6] Articular Cartilage Injuries Flashcards
6 deep layers of PLC
FCL Arcuate lig PFL FFL (fabulous fib lig) Popliteus muscle and tendon Joint capsule
Attachment of Fibular collateral lig
Proximal femoral condyle to styloid
Force to failure for FCL
750 N
Attachments of popliteofibular lig
83 deg to popliteus to styloid
Force to failure for PFL
400 N
Attachments of popliteus
Lateral femur to medial tibia
Attachments of arcuate lig
Lateral capsule to posterior fibular head
Main cause of injury to PLC
Trauma
MOI (3) for PLC
Hyper extension
Hyperext with varus or ER
Hyperext with ER and knee flexed
What do plain films show for PLC
Wide joint spaces
Arcuate Fx
Gerry tubercle avulsion Fx
Second Fx
Best imaging view for PLC
MRI: coronal oblique T2
Acute complaints for PLC
Lateral knee pain
Peroneal nerve injury
Chronic complaints for PLC
Med/lat/post knee pain
Unstable
Neuro Sx
Functional limitations
5 instability tests for PLC
Posterolateral drawer Dial test (tibial ER) ER recurvatum Reverse pivot shift test Varus at 0 and 30
Grade 1 PLC
Minimal tearing with no weird joint motion
Grade 2 PLC
Partial tear with slight-mod abnormal joint motion
Grade 3 PLC
Rupture with marked abnormal joint motion
Protected phase of non op txt
Immobilized for 2-3 weeks in hinged branch
WBAT gait training
Therex
Relative contraindications for protected phase
Control varus and tibial ER moments
Indications for surgery for PLC
Grade 3 sprain
Combined injury
Athlete
Post op rehab protective phase
Weeks 0-6
Protected WB locked in full ext with brace
30-110 deg
Isometric quad sets
Funcitonal phase of post op rehab for PLC
Weeks 7-12
0-120 deg at week 8
0-135 deg at week 12
CKC and balance exercises (NM trg)
When do you start OKC hamstrings
Week 16 return to activity
Running for PLC
4-6 months
Return to sport for PLC
9-12 months
Most common articular cartilage injury
Meniscus
MOI for Chandra’s injuries
Acute trauma with hemarthrosis
Insidious onset with repetition
Small lesion size
Less than 1.5 cm
Preferred surgery for small lesion
Microfracture
Medium lesion size
1.5 to 2.5
Surgery for medium lesion
Osteochondral autogenous transfer (OATS)
Large lesion size
2.5 to 4
Surgery for large lesion
ACI (autogenous cartilage implantation)
Failed microfracture/OCD Large lesion More than 6mm bone loss 15-55 years old Normal alignment Stable BMI less than 40 No swelling Not sensitive to bovine serum
Indications for ACI surgery
Athletes age
Slower cartilage repair with increased age
BMI
More gradual rehab progression with BMI more than 30
Type of sport
Higher demand on tissue in impact sports
Repair technique
More rapid progression wit restorative technique
Defect location
Immediate WB for PF defect (locked in full extension)
Cartilage quality
Slower rehab progress with general joint chondropenia
Meniscus status
Slower rehab progress after meniscectomy (esp lateral meniscus)
Overload principle
Decreased GAG concentration
Improves knee joint levels
Decreases cartilage thickness
Milestones of protection and joint activation phase
Full PROM Minimal to no pain (VAS < 3) Trace to no effusion Recovery of muscle activation Normal gait
Milestones of progressive joint loading/functional restoration
Full PROM VAS less than 3 Less than 1+ edema Quad strength less than 10% diff Hop performance less than 10% diff PROs more than 90% Jog at 8 km/hour (5 mph) > 10 min?
Effusion spontaneously returns to medial side after upstroke
2+
Not possible to move effusion
3+
Large bulge on medial side with downstroke
1+
Small wave on medial side with downstroke
Trace
Sore during warmup that continues
2 days off
Drop 1 level down
Sore durign warmup that goes away
Stay
Sore durign warm up that goes away but comes back during session
2 days off
Drop down 1 level
Sore the day after lifting
1 day off
Don’t advance
No soreness
Advance 1 level/week as instructed by healthcare professhhh
