ACL Injury Management

Question 1

What are pre-op considerations for the ACL

Answer 1

Pain
Effusion
ROM
Muscle function
Extension lag
Gait
How “angry” is it?

Question 2

What are Post-Op Considerations for the ACL

Answer 2

Initial graft strength
Graft type
Healing and maturing of graft

Question 3

Pros of an autograft?

Answer 3

Faster incorporation and healing
Better outcomes in young, active patients

Question 4

Pros of an allograft?

Answer 4

Less acute pain

Question 5

BPTB Autograft precautions?

Answer 5

Avoid early heavy eccentrics
Modify squats to minimize PF
compression forces

Question 6

BPTB Autograft cons?

Answer 6

Higher incidence of PFP
Persistent quad weakness

Question 7

Hamstring Autograft precautions?

Answer 7

Less aggressive early on
No isolated hamstring
strengthening unCl pow 8

Question 8

Week 1-2 Post-OP Goal?

Answer 8

full passive extension

Question 9

Week 2-3 Post-OP Goal?

Answer 9

Knee flexion 100°

Question 10

Week 3-4 Post-OP Goal?

Answer 10

full active extension

Question 11

Week 4-6 Post-OP Goal?

Answer 11

full knee flexion

Question 12

Why is lack of extension early post-op troublesome?

Answer 12

Potential development of Cyclops Lesion

Question 13

Ways to restore ROM?

Answer 13

Wall slides > assisted heel slides
LLLD heel prop > prone hangs
Frequent extension mob > aggressive

Question 14

Which rehabilitation exercise creates the most peak strain on the ACL?

Answer 14

Seated, Isometric knee
extension at 15°

Question 15

Which gender is 6x more likely tear their ipsilateral ACL with 24
months after surgery?

Answer 15

Female

Question 16

(T/F) There is no clear evidence that ACL reconstruction reduces
the rate of OA development

Answer 16

TRUE

Question 17

What percentage of patients return to their pre-injury level of participation

Answer 17

63%

Question 18

What percentage of patients return to competitive sports percentage?

Answer 18

44%

Question 19

What are characteristics of a coper?

Answer 19

• Joint stability
• Fewer episodes of
  giving way
• “Normal” knee ROM
  and forces during
  functional activities

Question 20

What are characteristics of a non-coper?

Answer 20

• increased joint laxity
• Reduced knee ROM
  during hop testing

-Reduced knee
compression and shear
forces during gait

Question 21

What is an appropriate timeline for a therapist to test if a patient is a coper or non-coper?

Answer 21

After approximately 10 sessions of PT
- >60 days
- <6 months