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Ortho > ACL and Osteotomy > Flashcards

ACL and Osteotomy Flashcards

1
Q

What are the mechanisms of injury for an ACL sprain?

A
  1. rotational forceful hyperextension

2. Valgus force- can be part of terrible triad

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2
Q

What are the mechanisms of injury for an PCL sprain?

A
  1. forceful blow to the anterior tibia while knee flexed (dashboard knee)
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3
Q

What are the mechanisms of injury for an MCL sprain?

A
  1. Valgus force
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4
Q

What are the mechanisms of injury for an LCL sprain?

A
  1. traumatic varus force across the knee
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5
Q

What are the coronary ligaments?

A

connect meniscus to tibia

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6
Q

What are the 3 degrees of sprains

A

1- mild- overstreched fibers no tears but pain with stretch usually at end ranges, no instability
2-moderate- some fibers torn; some instability; pain with stretch
3- severe- full tear, joint instability, pain with injury but not after

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7
Q

What are functional limitation after ligament sprain?

A
  1. gait
  2. stairs
  3. sitting on toilet
  4. ADL’s
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8
Q

What are disabilities after ligament sprain?

A
  1. work activities

2. recreational activities

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9
Q

What are treatment guideline for ligament sprain in acute phase?

A
  1. Pt education
    - transfers, motions to avoid
  2. PRICE
    - crutches WBAT
    - bracing depending on what they have done
  3. TherEX
    - PROM in pain free ranges
    - Muscle setting quads, HS, gastroc-soleus
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10
Q

What are treatment guideline for ligament sprain in subacute phase?

A
  1. TherEx
    - AROM- ball, rocking chair, supine wall slides
    - begin stretching
    - patellar mobs
    - Strength: initiate with CC, multi angle iso, 4-way SLR (supine or standing)
    - Endurance- bike, pool, walk, UE ergometer
    - Balance- toe raises, slingle leg stance, foam
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11
Q

What are treatment guideline for ligament sprain in chronic phase?

A
  • Exercise should avoid excessive stress on ligament
    1. TherEx
  • lunges
  • plyometrics
  • sport specific- eccentric
  • braiding
  • side stepping
  • add speed to exercises
  • isokinetics if you have equipment
  • Balance bord, bosu- get full range
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12
Q

What is important to remember about an ACL reconstruction with a patellar graft?

A
  • graft site is vulnerable for 4-6 weeks

- at 8-10 wks graft should be revascularized

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13
Q

Describe Maximum protection phase for ACL recontruction

A
  1. PRICE:
    - brace use varies among physicians
    - usually pt PWB/WBAT with crutches for about 1 wk
  2. ROM:
    - Want full PASSIVE knee EXTENSION in 1-2 weeks
    - PROM- pain free ranges, supine gravity assisted flexion
  3. Strength:
    - Isometrics quad, HS, adductors
    - Ankle pumps
    - 4-way SLR assisted
    - CC squats (watch form)
    - heel toe raises
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14
Q

Describe Moderate protection phase for ACL recontruction

A
  1. ROM
    - want 110-125 flexion
    - want extension 0 but still want it passive during 4-8 wks
    - start active TKE about 10 wks
    - prone stretching with weight
  2. Strength
    - multi angle isos
    - Bilateral CC progress to single leg stance
    - bridging
    - wall slides
    - partial squats
    - step up/down
  3. Muscular Endurance
    - bike
    - walk if gait normalized
  4. Balance/coordination
    - unstable surfaces
  5. Cardio endurance/fitness
    - bike
    - pool
    - elliptical
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15
Q

Describe Minimum protection phase for ACL recontruction

A
  • Full speed activities: jog, spring, run
  • agility drills
  • initiate plyometric
  • continue stretching
  • stand on half foam rolls for balance
  • some pts may still use brace during high demand activities
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16
Q

What is the time frame for minimum protection phase for ACL reconstruction

A

20-24 weeks

- done with therapy

17
Q

What is an osteotomy?

A
  • surgical cutting of bone primarily for realignment
  • may do to postpone a TKA
  • may do to fix deformity
18
Q

How long is an osteotmy typically immoblized and protected WB followed?

A

8-12 weeks

some sources say 6-8

19
Q

Desrcribe maximum protection phase for osteotomy

A
  1. ROM:
    - PROM
    - Focus Associated areas because of immoblized knee
    - breathing
    - ankle pumps
    - muscle setting- glutes and HS
    - SLR
20
Q

Describe moderate- minimum protection phase for ostotomy

A
  • bracing based on surgeon
    1. ROM
  • knee flexion 0-135 desired unless non-operative knee flexion less
  • supine wall slides
  • watch ROM during exercises
  • Autogenic and Reciprocal stretching
  • stationary bike
    2: Strength:
  • low impact OC and CC
  • watch ROM during exercises
  • total gym- can grade body weight
  • LAQ/SAQ
  • 4 way SLR
    3. M. Endurance & balance
  • ALWAYS LOW IMPACT
    4. Cardio enduracne/fitness
  • bike
  • rowing if experienced
  • walk treadmill
  • pool
  • NO running, jumping, plyos

Ortho (17 decks)

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