acl Flashcards
Origin insertion of ACL
A
runs Posterioly
inserts in External (lateral) condyle of femur
function of ACL
resist anterior translation of tib on femur
resist rotation of femur on tib
resist valgus
assist in screw home mechanism
mechanism of ACL injruy
70% non contact
between 0-30 deg flexion
can ACL injury happen from excessive hyper flexion and extention
yes
T/f ACL is most frequent totally disrupted ligament in KNEE
true
Why higher in females
intrinsic
Extrinsic factors
Extrinsic factors
ligament dominance,
supporting mm don’t absorb GRF,
quad dominant,
stiff landing posture
leg dominance
intrinsic
anatomy
limb posture
joint laxity
size of indracondyal notch
which leg at greater risk for ACL
the unfavoured leg
diagnosing ACL
history
observation
special tests
what in history makes you think ACL
pain
unable to play on
swelling, when and how much
instability
condition that accompany an ACL
mensical damage
capsular damage
secondary ligament
fracture
Is surgery best
we don’t know whats best long term
first thing after ACL
get quad strength pre op
increase load
open chain
name 2 types of ACL surgeries
semitendinosus - gracillis
bone-patellar tendon - bone
sequences of events in graft healing
avascular necrosis
cellular infiltration
vascular invasion
remodelling (1-3 years)
potential ACL surgery complications
pain/swelling loss of ROM laxity nerve injury infection DVT
two elements of proprioception
joint position sense
sense of limb movement
what provides proprioception
mechaoreceptors
nociceptors
mm afferents
t/F acl has proprioceptive properties and is a mechanical stabilizer
t
whats a major factor in ACL injury / re injury risk
poor control of dynamic movements
t/f deficits in uninjured leg post op has similar deficits
t
goal of ACL patients
inc unconscious motor response
improve nervous systems optimal mm firing for stability
unlearn some movements
if ACL left untreated what are some deficits
mm weakness
impaired neurological control
how to increase demand in ACL exercises
add internal and external perturbation
stages in post op ACL
pre op immediate post op (1week) early rehab (2-4) inter rehab (4-10) advanced activity (10-16) Return to activity (16-22)
do isometric hamstring exercise >60 degs endanger the graft
no
which exercise results in more axial orientated forces and mm co contraction
closed k chain
when is graft week
6-12 weeks
goals in pre op phase
reduce swelling pain
ROM
mm activity
eduation
immediate post op goals
extention swelling / pain flexion quad control ind ambulating hamstring strength to 8-%
when should ACL have 90 deg flexion by
day 5
and 100 by 7
goal of early post op
ext swelling pain flexion proprioception patellar mobility hamstring back to full
which phase should hamstring be back to full strength
early post op week 2-4
intermediate post op goals
ROM LE strength proprioception, banche, control mm endurance limb confidence
is there a role for open chain quad strengthening
yes - more quad stretch and RTS but no difference in lax
how to avoid undue stress on healing graft
limit knee rom from 90-45 deg for any NWB exercise
progress to 90-10 deg by week 12
advanced activity phase
LE prop, balance power , endruace sport specific hop test
where should the hop test bee by week 12
> 85%
Return to activity phase
unrestricted in sport
progress training
why do we care if the meniscus was repaired
more post op restriction
i.e. limited in ROM in WB
