Anterior Cruciate Ligament Flashcards
ACL
What attaches centrally and anteriorly on the tibial plateau?
ACL
ACL runs?
superior, posterior and laterally
ACL also attaches
to lateral aspect of the intercondylar fossa
what excessive tibial motions will the ACL limits?
anterior tibial glid e
the Primary restraint to excessive anterior tibial glide and secondary restraints to tibial IR/hyperextension is
ACL
What is the prevalence of the ACL
20% of all knee injuries
most in younger and active biological females
what are non modifiable risk factors for non contact injuries for biological sex(acl)
-females tears>male tears; two weeks following start of menstrual period
what are non modifiable risk factors for non contact injuries for bony morphology? (acl)
narrow intercondylar femoral notch
posterior tibial lope and hyperextension both correlated with non contact ACL injuries
what are non modifiable risk factors for non contact injuries
congenital joint hypermobility
what are risk factors primary acl injury that are modifiable?
-high shoe surface interaction and friction
-BMI
-bracing inconsistent benefit
muscle strength; lower overall with ACL tears
ham to quad ratio strength
lower in biological females vs males
quads pull tiba forward
hamstrings pull tibial posterior
why are the hamstring important to the ACL?
helps prevent anterior tibial translation
Risk factors primary ACL injuries that are modifiable
altered loading patterns
w/ increased dynamic knee valgus and hip add
- earlier and nearly 2x faster with impaired LE control
-very good ability to visually identify high knee valgus angles with vertical drop jump
-decreased knee flexion with larger ground reaction forces or harder landing
*ACL
poor control ( with a squat)
significant valgus movement knee medial to foot
ACL
reduced control(with squat)
some valgus movement kness NOt entirely medial to foot
ACL (with squat) good control
no valgus mvement and knee vertical with toes
Rick factors primary ACL injuries
modifiable
-impaired trunk proprioception and kinesthesia
-greater trunk lean toward support limb
-greater trunk rotation toward support limb
-greater activation of visual motor strategy vs sensory and motor strategy
Risk factors for a second ACL injuries
like primary ACL injury plus excessive femoral IR momnet
which muscle needs addressed more? ER
What are causes/ etiology of ACL tears?
NOn contact 70%
Contact 30%
What are the symptoms of anterior cruciate ligament?
-consistent with any sprain plus
-effusion, popping, and giving away following trauma
-wbing activities limited giving away
what are signs of ACL
signs; consistent with any sprain plus
ROM limited and painful, particularly into hyperextension and IR( tibia wants to glide anterior)
Sings of ACL( special test)
Anterior Drawer
if popping, effusion, and giving away after trauma
torn acl
signs of acl (special test)
Lachmans
possible false negative due to blocking of the anterior glide; severe swelling tightens capsule hamstring guarding and meniscal tear
+ pivot shift hugh spec
What leads to muscle inhibition
swelling, pain, joint laxity, and disuse
signs of MMT/M activity arthrogenic muscle inhibition of quads due to?
-pain
-effusing(joint swelling); involves knee inhibition, the uninvolved knee inhibition, amount of swelling not always correlated with amount of muscle inhibition
-joint laxity or giving away
-muscle weakness or incoordination
signs of MMT/M activity arthrogenic muscle inhibition of quads lead to?
Atrophy and more inhibition and weakness-deficits common out to 2-4 years post op and even in both LE’s
Determined by observation, palpation , and muscle testing
PT RX for ACL
most can return to lower risk activity without SX and with good outcomes
what are the three primary and early goals of PT RX?
full to nearly full ROM especially ext.
*immediate mobilization for ROM, Pain, and minimizing immobilization effects for moderate support
*ideally full extension no longer than 4 weeks.
predicts extension at 12 weeks
contributes to lower risk of OA
what are the three primary and early goals of PT RX?
- minimal to no swelling
- quads activation endurance, and coordination; best with full extension
SLR without extension lag
-Quad set 90% of the uninvolved side
PT RX for ACL with earl weight bearing?
without detrimental effects if symmetrical and leads to better outcome
PT RX for ACL Policed
Weak support for cryotherapy
weak support for continuos passive motion CPM devices
PT RX for Acl
Manual therapy needed post-op
MET for ACL
Neuromuscular electrical stimulations NMES for activation coordination and strength;
*significant increased in quad strength;
*no change in function
*isometric abd varying based upon symptoms and commorbidities
*discontinus once quad index is > 80% of uninvolved side
PT RX: MET for ACL
-assumptions must be made about atherogenic muscle inhibition
-gradually progress to intense resistive training without inducing
-emphasize both concentric and eccentric training
PT RX; MET for ACL
general exercises guidelines for initial ACL loading
Non weight bearing vs weight bearing
normally greater with non weight bearing extension. NON weight bearing or OKC activities less of a concern then in past.
* greatest load is within 50 degress of full extension
PT RX; MET for ACL
squatting lunging and leg press;
increased with knee beyond knee
decreased with forward trunk lean
PT RX; MET for ACL
general exercise guidelines for ACL loading and walking: as much load as non weight bearing knee extension due to repetitive terminal knee ext
*several times greater than other weight-bearing activities
SN: OKC and CKC activities earl and often especially if they are walking and using correct trunk and LE control carefully and progressively work towards end rang ext
with PT RX what MET should emphasize on?
hamstring strength and coordination
*hams> 66% of quad activity for males
*hams> 75% of quad activity for females
predicts LE control
PT RX; MET for ACL neuromuscular training
NOrmal strength and proper neuromuscular or LE control
trun proprioception and kinesthesia minimal lean and twist
PT RX; MET for ACL neuromuscular training
LE control based on limited evidence
*minimize excessive frontal and transverse plan motion
*promote sagittal plan knee and trunk flexion
*decreased ground reaction force with soft landing
*progressive speed and difficulty
*emphasis balance
PT RX; MET for ACL
needs to be at least 2-3 weeks for 6-10 months
be sure to also work each LE individually as well as bilaterally for cross education less deficit compared to only exercising involved knee
PT RX for ACL; blood flow restriction
*similar strength and hypertrophy as high-intensity training
*good alternative if high intensity cant be done otherwise
*motor learning for improved movement patterns
PT RX for ACL; motor learning with external focus
*improved balance(central pressures)
*higher vertical jump
*more force production
*greater knee flexion
*softer landing decreased ground reaction force
* improve circulation
PT RX for ACL with functional bracing
more beneficial than not with ACL deficiency
*conflicting support with ACL reconstruction
*Further motor learning with observation added to practice
-with other by competition, motivation, and responsibility
-post and real time feedback including in slow motion
PT RX for ACL plyometrics
vertical drop jump similar loading to NON weight bearing extension ‘
increased loading with rating of deceleration
