ACL MD Rx & Special Tests - exam 3

Question 1

up to ____% ACLs surgically repaired

Answer 1

65%
few return to high risk activity without sx due to continual instability

Question 2

your patient participates in pre op PT before ACL surgery. should you expect that they will have better outcomes after sx? why or why not?

Answer 2

yes
the better you are entering surgery the better you are likely to come out

Question 3

what is a BPTB autograft?

Answer 3

incision over patellar tendon
remove middle 1/3 of bone of patella, patellar tendon, and bone of tibial tuberosity

Question 4

what is a downfall to doing an autograft?

Answer 4

up to 1/3 develop anterior knee pain
- there is less supply and it takes time for patellar tendon to fill in/heal

Question 5

describe the timeline for graft strength after autograft:
- 1st 4 weeks:
- 6-8 weeks:
- 8-12 weeks:

Answer 5

initial weakening within 1st 4 weeks - vascularity is taken away at first
incorporation of graft into bone at 6-8 weeks
dense fibrous tissue at 8-12 weeks

Question 6

what is a BPTB allograft?

Answer 6

graft from donor

Question 7

what are pros and cons to getting an allograft?

Answer 7

pro: symptoms improve faster than graft incorporates. won’t have anterior knee pain. pre-pubescent population

con: patient feels like they can do more than they should. potentially takes 2x longer to heal. longer rehab

Question 8

describe the timeline for graft strength after allograft:
- 8-12 weeks:

Answer 8

incorporation of graft into bone 8-12 weeks
dense fibrous tissue 8-12 weeks

Question 9

what are advantages to a STG graft? (semitendinosus with/without gracilis)

Answer 9

prepubescent youth to avoid epiphyseal plate complications
also avoids anterior knee P!

Question 10

PURE strengthening of hamstrings following a STG graft may start at ______
you should delay heavy strengthening of hamstrings for ______

Answer 10

6-8 weeks
12 weeks

Question 11

what is the prognosis for an ACL surgery?

Answer 11

18-24 months
muscle weakness and impaired neuromuscular control remain. Things are still healing out to 2 years

Question 12

inhibition, atrophy, and weakness are common out to ____ to ____
explain why it’s not uncommon to see someone retear their ACL

Answer 12

2-4 years
all grafts and bone show continued healing on imaging this long which means pt returns to play before everything is fully healed

Question 13

____% of 2nd tears occur between 18-24 months

Answer 13

75%

Question 14

how long should you have your pt wait to return to play following an ACL surgery to reduce injury rate?

Answer 14

at least 9 months

Question 15

Which of the following ACL special test(s) is being described:

stabilize foot with 90 deg flex in supine. sit on pt foot. glide tibia ant
- best test for ACL we have

Answer 15

anterior drawer test

Question 16

Which of the following ACL special test(s) is being described:

in supine, stabilize femur @ 15 deg flexion; glide tibia ant

Answer 16

Lachman’s

Question 17

Which of the following ACL special test(s) is being described:

in supine, hold tibial IR with valgus stress from 90 deg flexion to full ext slowly
- (+) = palpable thud/clunk as it relocates into ER
- tests rotational stability

Answer 17

Pivot shift test