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DPT MSK Fall 22' - Spring 23' > ACL - exam 3 > Flashcards

ACL - exam 3 Flashcards

1
Q

ACL:
attaches:
runs:

A

attaches centrally and anteriorly on the tibial plateau and attaches to the lateral aspect of the intercondylar fossa
runs superior, posterior, and laterally

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2
Q

ACL
primary restraint:
secondary restraint:

A

excessive anterior tibial glide
tibial IR

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3
Q

ACL makes up ____% of knee injuries
mostly in ______ and ______ females

A

20
younger and active

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4
Q

what are non-modifiable risk factors for a non contact ACL injury?

A

female
2 weeks following start of menstrual period (ligamentous laxity)
bony morphology
–> people can have different shaped bones

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5
Q

what are modifiable risk factors for a non contact ACL injury?

A

high shoe surface interaction/friction (wearing the wrong shoe for the activity)
high BMI

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6
Q

does bracing help prevent ACL injuries?

A

helps prevent hyperext.
so yes helps ACL but other surrounding things too

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7
Q

Modifiable RF: Muscle Strength
__________ overall w/ ACL tears
ham to quad ratio strength:
–> lower in _____
–> predicts _______
hamstrings prevent _____

A

lower
–> lower in females
–> predicts LE control
ant movement of tibia

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8
Q

modifiable RF: altered loading patterns
impaired LE control:
–> increased knee ______ and hip _____
–> good ability to visually identify high knee ______ with _______ test
____ and nearly 2x ____
decreased knee _____ with _____ landing

A

valgus and add
valgus with vertical drop
earlier; faster
flexion; harder

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9
Q

poor control creates significant ______ movement.
knee is ______ to foot

A

valgus
medial

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10
Q

reduced control creates some ______ movement.
knee NOT entirely _____ to foot

A

valgus
medial

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11
Q

good control = no _____ movement
knee is _____ with toes

A

valgus
vertical

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12
Q

modifiable RF: impaired trunk proprioception and kinesthesia
– greater trunk ______ and ______ toward support limb

A

lean and rotation

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13
Q

modifiable RF:
greater activation of ____-_____ strategy vs sensory-motor strategy
this means ?

A

visual-motor
someone with impaired LE control uses their vision more (tries to use their eyes to balance)

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14
Q

what is a risk factor for having a second ACL injury?

A

like primary ACL injury plus excessive femoral IR

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15
Q

true or false. most ACL injuries occur from contact

A

false - non-contact (50-70%)

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16
Q

symptoms of an ACL injury:

A

consistent with any ligament injury plus:
effusion, popping and giving way following trauma (high likelihood)
WBing activities limited with likely giving way

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17
Q

signs of ACL injury:
- ROM:
- end feels:

A

limited and painful particularly into hyperext and IR
empty, soft, late end feels if acute

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18
Q

what is the most useful special test for ACL injury?

A

anterior drawer

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19
Q

will the pt feel pain if there is a complete rupture?

A

most likely not
nerves are torn

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20
Q

what are 3 possible ways that could block the anterior glide causing possible false negatives of ACL special tests?

A

severe swelling tightens capsule
hamstring guarding
meniscal tear

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21
Q

with an ACL injury, you would see arthrogenic muscle inhibition of quads. This could be due to:
NOT due to:

A

pain
effusion (joint swelling)
– involved knee inhibition (42%)
– uninvolved knee inhibition (21-33%)
– amount of swelling not always correlated with the amount of muscle inhibition
joint laxity or giving away
muscle weakness/incoordination

NOT due to denervation (no damage to nerve)

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22
Q

with an ACL injury, you would see arthrogenic muscle inhibition of quads. This could lead to:

A

atrophy and more inhibition/weakness
– deficits common out to 2-4 years post op and even in both LE
determined by observation, palpation, muscle testing

23
Q

true or false. MOST can return to lower risk activity without surgery and with good outcomes

A

true

24
Q

what is the primary goal of Rx for ACL injury?
- immediate mobilization for ____, _____, & ____
- full ext no later than ______

A

full to nearly full ROM, esp ext
- ROM, P!, and minimizing immobilization effects
- 4 weeks; predicts ext at 12 weeks & contributes to lower risk of OA

25
Q

what is the 2nd goal of Rx for ACL injury?

A

minimal to no swelling

26
Q

what is the 3rd goal of Rx for ACL injury?

A

quads activation/endurance/coordination
- SLR without ext lag
- quad set > 90% of uninvolved side

27
Q

what must you be careful of when comparing the injured side to the noninvolved side?

A

can get inhibition to both sides and you could be comparing an inhibited side to another inhibited side without knowing

28
Q

PT Rx for ACL injury:

A
  • early WBing in both sides
  • POLICED - weak support for cryotherapy
  • functional bracing
    —> more beneficial than not with ACL deficiency. conflicting support with ACL reconstruction
  • MT - initiate post op
29
Q

what modality is effective when combined with MET?
- significant increase in _____ strength
- NO significant changes with ______
- ______ @ varying angles
- discontinue once quad index is ______ of ______ side

A

Neuromuscular Electrical Stimulation (NMES) for activation/coordination/strength
- quad
- function
- isometrics
- > 80% of uninvolved

30
Q

what should you focus on with MET for ACL Rx?

A

assumptions must be made about arthrogenic muscle inhibition
intense resistive training without inducing P! must eventually be performed
emphasize both concentric and eccentric training

31
Q

what are general exercise guidelines for ACL loading?
- greater with ______ exercises
- _____ or _____ activities less of a concern
- greatest loads _______
- squatting, lunging, leg press:
- walking:

A

greater with non-WBing exercises
– isolated load on quads. In CC other muscles around the knee are working
Non-WBing or OC activities less of a concern
greatest loads within 50 deg of full ext with both
squatting, lunging, and leg press
– increased with knee beyond toes
– decreased with forward trunk lean
walking
– as much load as non-WBing knee ext due to repetitive terminal knee ext
– several times greater than other WBing activities

32
Q

to just work the quads, what could you have your patient do?

A

leg ext - start 90-45 deg
squat - start 0-45 deg

33
Q

overall, what kind of activities are good to do early and often for someone with an ACL injury?

A

OC and CC, esp if they are walking and using correct trunk and LE control

34
Q

MET Rx:
emphasize _______ strength and coordination
goals:
- males
-females
if quads remain inhibited, __________

A

hamstring
- hams > 66% of quad activity
- hams > 75% of quad activity
hamstrings will look like they’re strong enough but may not be

35
Q

MET Rx: Neuromuscular training
- _____ strength DOES NOT EQUAL proper _______ or _____ control
- trunk _____ and ______ minimize lean and twist
** emphasize _____ activities

A

normal; neuromuscular or LE
proprioception and kinesthesia
balance

36
Q

MET Rx: Neuromuscular training
LE proprioception and kinesthesia
- minimize _____ and _______ plane motion
- promote sagittal plane knee and trunk _____
- decrease GRF with _______ landing
- progressive _____ and ______
- emphasis on jump _____ and _______

A

frontal; transverse
flexion
softer
speed and difficulty
landing and balance

37
Q

MET needs to be at least _______/week for _____ months

A

2-3x
6-10

38
Q

should you exercise the involved AND uninvolved side?

A

yes

39
Q

what does blood flow restriction do for ACL healing?
- similar
- increased
- decreased

A

similar strength and hypertrophy as high intensity training
increased growth hormone, myogenic stem cells
decreased myostatin which would limit m. growth

40
Q

when you start the healing process you start with internal focus which is:

A

focusing on the movement itself
learning pace is slower
less carryover
more feedback

41
Q

external focus is progress so you’re focusing on:

A

effect of movement
faster learning pace
more carryover
less feedback

42
Q

what are examples of motor learning with external focus?

A

improved balance
higher vertical jump
more force production
greater knee flexion
softer landing
improved coordination

43
Q

what are other ways you can further add motor learning with observation?

A

with others by competition
post and real time feedback

44
Q

what are ways to add plyometrics to Rx for an ACL injury?

A

vertical drop jump
increased loading with rate of deceleration

45
Q

what percentage of ACL injuries occur with meniscal tears?

A

22-86%

46
Q

how would you change your Rx for an ACL injury with a meniscal repair?

A

slower progressions due to slower healing process because PT can’t touch until meniscus is healed due to greater protection needed
makes achieving ROM more difficult

47
Q

____ % of ACL injuries also occur with a bone bruise

A

80%

48
Q

on average, how long does it take to heal a bone bruise with ACL/PCL and meniscal injuries?

A

3.2 months

49
Q

how does a bone bruise with ACL injury with PCL and/or meniscal injury affect healing?

A

delaying factor that leads to more difficulty reaching full ext and proper quad function

50
Q

are MCL tears surgically repaired most often?

A

no
some will not repair ACL until MCL is healed

51
Q

what are precautions for a MCL tear?

A

only sagittal plane activity for 4-6 weeks
limit tibial ER and valgus stresses

52
Q

____% have an articular cartilage defect with an ACL injury

A

36%

53
Q

if articular cartilage gets repaired, will it delay ACL rehab?

A

most likely
OATS outcomes > ACI > Microfx

DPT MSK Fall 22' - Spring 23' (29 decks)

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