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Sports > ACL Tear > Flashcards

ACL Tear Flashcards

1
Q

What factor contributes to higher ACL tear rate in females?

A

Neuromuscular

Females have higher valgus moment with landing and relatively weaker hamstrings compared to quads

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2
Q

A genotype within the COL5A1 gene is associated with a reduced risk of which of the following injuries in women?

A

ACL tear

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3
Q

What is the function of the ACL?

A

Primary: resist anterior translation of the tibia
Secondary: varus/valgus and rotational restraint

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4
Q

What are the two bundles of the ACL?

A

Anteromedial: tight in flexion, longer than PM bundle
Posterolateral: tight in extension; rotational stability

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5
Q

Following ACL reconstruction, which of the following tests most closely correlates with patient satisfaction with their reconstructed knee?

A

Pivot shift test

From flexion to extension; as knee is brought into 20-30 flexion the tibia reduces posteiorly

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6
Q

In an ACL rupture what is the pathognominc bone bruising seen on MRI?

A

Posterolateral tibia and middle 1/3 of the LFC

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7
Q

What are indications for ACL reconstruction?

A

1) young, active
2) children
3) prior ACL failure
4) Older highly active pts; >40yo is not contraindication

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8
Q

What is the treatment algorithm for a patient with an ACL and MCL tear?

A

Allow the MCL to heal, then perform the ACL reconstruction; varus/valgus instability can jeopardize the graft

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9
Q

What is the treatment algorithm for a patient with an ACL and meniscal tear?

A

Repair the meniscus at time of ACL reconstruction

Better outcomes with meniscal repair when done in conjunction with ACL reconstruction

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10
Q

What is the treatment algorithm for a patient with an ACL and PLC injury?

A

Reconstruct at the same time as ACL

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11
Q

Where is the correct femoral tunnel placement of an ACL graft?

A

1) with 1-2mm of posterior rim bone

2) 9-10 o’clock (right knee) or 2-3 o’clock (left knee) in the LFC

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12
Q

Where is the correct tibial tunnel placement of an ACL graft?

A

10-11mm in front of anterior border of PCL insertion

Start tibial tunnel halfway btw tibial tubercle and postromedial edge of tibia

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13
Q

What are complications of BTB ACL reconstruction?

A

1) patellar tendon rupture
2) anterior knee pain (10-30%)
3) patellar fx *8-12wks post op)

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14
Q

In biomechanical testing, which ACL graft has the highest maximum load to failure?

A

Quadruple semitendinosus and gracilis

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15
Q

What is the best predictor of remaining skeletal growth in females?

A

Onset of menarche; usually 1.5-2yrs of growth remaining

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16
Q

What are factors increase physeal injury in children with ACL tears?

A

1) oblique tunnel position
2) interference screw fixation
3) high-speed tunnel reaming
4) increasing tunnel diameter (>8mm)

Transphyseal technique rarely leads to growth disturbance

17
Q

What exercises should be avoided during ACL rehab in the early post-operative period?

A

1) Open chain quad exercises

2) isokinetic quads from (15-30 degrees)

18
Q

What exercises are encouraged in the early post-operative period in ACL reconstruction?

A

1) isometric hamstrings at any angle (least stress)
2) isometric quads or simultaneous quad and hamstrings
3) active knee ROM from 35-90 degrees

19
Q

In which patient population has ACL bracing been shown to be beneficial?

A

Skiers

also fall training in skiers has shown to reduce ACL tear incidence

20
Q

What is the most common cause of ACL failure?

A

Improper graft tunnel placement (70%)

21
Q

What is the physical exam findings in a patient with a vertical femoral tunnel on ACL?

A

Positive pivot shift test and instability with cutting activities due to failure to reconstruct the posterolateral bundle of the AC

22
Q

What happens to the knee when femoral tunnel is malpositioned during ACL reconstruction?

A

Too anterior: tight in flexion, loose in extension

Too posterior: tight in extension, loose in flexion

23
Q

What happens to the knee when tibial tunnel is malpositioned during ACL reconstruction?

A

Too anterior: tight in flexion, impinges during extension

Too posterior: ACL will impinge on PCL

24
Q

In a patient with traumatic knee injury and ACL reconstruction, what can lead to continued instability and graft failure?

A

Unrecognized PLC injury

25
Q

What two things can help prevent arthrofibrosis in ACL reconstruction?

A

1) “pre-hab”; initial rehab to regain FROM

2) Delay surgery past initial inflammatory phase

26
Q

Increased ACL injury rates in women athletes compared to male athletes may be due to muscular imbalance and relative weakness of what muscle group?

A

Hamstrings

27
Q

At what range of motion do seated leg extension exercises place the greatest amount of stress on the anterior cruciate ligament?

A

0-30 degrees

28
Q

Most surgeons prefer to avoid or limit which of the following exercises in the initial post-operative rehabilitation following ACL reconstruction?

A

Seated leg extensions

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