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PHTH 517 - Ortho Midterm LE > Collateral Ligaments - KaNee > Flashcards

Collateral Ligaments - KaNee Flashcards

1
Q

What is the main way the ACL gets injured?

A

Through non-contact injuries
- usually a combination of hyperextension and valgus

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2
Q

What is the function of the ACL?

A

as the primary stopper to anterior movement of the tibia on the femur

secondary stopper of IR and ER of a NWB knee

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3
Q

What are the subjective findings regarding ACL injuries?

A
  • women are 2-8x more at risk (!!)
  • twisting or hyperextion as a mechanism of injury
  • that popping or giving out feeling
  • pain and onset dysfunction
  • instability of the affected knee and can’t walk w/o assistance
  • swelling right away (acute hemarthosis)
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4
Q

What is seen in the objective findings for ACL?

A
  • increased swelling
  • pain
  • (+) anterior stability tests
  • other knee structures are affected
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5
Q

What are the special tests conducted for ACLs?

A

Anterior drawer (Sn = 0.41 / Sp = 0.95)
Lachman (Sn = 0.82 / Sp = 0.97)
Pivot shift (Sn = 0.82 / Sp = 0.98)
Lelli’s

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6
Q

What is the gold standard for ACL special test?

A

The lachman’s test with the most sensitivity for acute ACL rupture
- (+) in 80% of nonanesthetized pts and 100% in anesthetized

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7
Q

What is the difference between an intact vs sprained ligament?

A

intact = abrupt and firm end-feel

sprained = soft or distinct end feel depending on the injury

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8
Q

What is the typical prognosis of an ACL tear?

A

Usually has other structures that are affected
- a post-op = 8-12 months for return to activity

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9
Q

What is the process of ACL reconstruction surgery?

A

It doesn’t fix the damanged/torn ligament but creates a new ligament using other tissues in the leg

can use their autograft or allograft

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10
Q

What is an autograft?

A

using own tissue which is usually, patellar tendon, hammies and quad tendon

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11
Q

What is an allograft?

A

using a tissue from a cadaver

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12
Q

What are the pros of allografts?

A
  • lack of harvest morbidity
  • less trauma and quicker surgery (due to less cutting)
  • decreased post-op pain
  • easier and early rehab
  • sizing limits
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13
Q

What are the cons for allographs?

A

slower rate of biologic adaptation
longer inflammatory response
be able to “stretch”
slower revascularization and recellularization

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14
Q

What is the biggest problem for allographs?

A

HIGH fail rate (~ 25%) in youth

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15
Q

What are the usually load failures for native and autographs for ACL reconstruction?

A

Native = 1725 to 2160 N
Hammies = 2640 N
Patellar = 1580 N
Quads = 2185 N

Patellar -> Quads -> Hammies (strongest)

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16
Q

What is the overall graft failure rate?

A

11%
- the graft choice has no effect on the failure rate

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17
Q

What is the contralateral ACL injury rate?

A

13%
- possible compensations and just the worse luck ever

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18
Q

What are the major goals of rehab for ACL-injuries?

A

get good functional stability
bring back muscle swoleness
return to functional level
↓ the possibility for re-injury

using proper techniques like closed and open chain for proper rehab and progression

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19
Q

What is the most important movement
factors for ACL recovery?

A

getting full knee extension and good quad activation

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20
Q

What is the “general” time frame for ACL?

A

most people agree on a minimum of 6 months before getting back out there

the assumption is around 7-10 months with around a year recovery

4-5 months is jogging :)

21
Q

What is the concern for return to sports for ACL injuries?

A

81% = return to some sport
65% = pre-injury level
55% = back to competitive sports

the risk of the second ACL is GREATER in both knees BUT more likely to happen on the opposite side :0

22
Q

What is the main characteristic that differentiates the PCL from the ACL?

A

THAT BIH STRONG AS HELL
- the strongest and largest intra-articular ligament in the human knee
- it usually is either a stretch or complete rupture

23
Q

What is the function of the PCL?

A

Primary stopper for posterior translation of the tibia onto the femur

24
Q

How prevalent is a PCL injury?

A

less common than ACLs
- 3% of OP knee injuries
- 38% of acute traumatic knee hemarthroses
- 95% happens with other injuries (how bad the causes are for this thang)

25
Q

What is the mechanism of injury for PCL?

A

“dashboard injury” = force towards posterior on the anterior surface of the tibia with knees flexed
or
blow to anterior tibia or fall onto the knee w/ PF

26
Q

What sport has the highest incidence of PCL tears?

A

Football (Lamar Jackson)
Soccer
Rugby
Skiing

27
Q

What are the clinical sx seen for PCL injuries?

A

effusion in 24hrs
limited ROm (10-20deg of restriction = pain)
Pain and instability w/ WB

28
Q

What are the special tests for the PCL?

A

Posterior drawer (most sensitive)
Sag sign

29
Q

What is the Sag sign?

A

No injury = the tibial plateau woll be 1cm in front of the femoral condyles

with the sag sign, that thang is DROPPY
- the tibia will be in a posterior position

30
Q

What is the treatment for PCL injuries?

A

Most need surgical reconstruction
- most return to sports in ~9-12 months

31
Q

What is more commonly injured between the LCL and MCL?

A

MCL is more commonly injured
- usually by itself or can have an added meniscus problem or even PCL issue

32
Q

What is the subjective findings found in collateral ligaments sprain?

A

localized swelling or stiffness
either medial or lateral pain and tenderness
most are able to walk after an injury

33
Q

What are the objective findings of an MCL?

A

tender along the entire course
- specific tenderness at the most proximal or distal attachment of the MCL = avulsion

can palpate quite clearly in knee flexion

34
Q

What are the objective findings of an LCL?

A

anywhere where it runs along its attachment and origin

Can palpate quite clearly in a figure four position

35
Q

What is the special test for the LCL?

A

Varus stress test
1. test at full extension
2. 30 deg of flexion

30 deg of flexion helps to relax the cruciate ligaments and posterior capsule

36
Q

What is the special test for MCL?

A

Valgus stress test
1. test at full extension
2. 30 deg of flexion

37
Q

What does a laxity in full extension in both MCL and PCL stress test indicate?

A

Shows a more extensive injury that might have ACL and/or PCL injuries :0

38
Q

What is the function of the MCL?

A

prevents valgus (UwU) movement

39
Q

What is the mechanism of injury for MCL injuries?

A

Since its common in contact sports:
- hit on the outside of the knee with the foot planted
- associated injuries are common which is also dependent on how bad it is

40
Q

What are the sx for MCL injuries?

A
  • pain over medial knee
  • gets worse in flexion/extension of the knee
  • pain can be constant or present during moving only
  • feeling of unstable
  • soft tissue swelling
41
Q

What is indicated for a grade 1 MCL?

A
  • tenderness on the medial femoral condyle or medial plateu
  • min swelling
  • pain but no laxity on valgus stress test @ 30 deg
42
Q

What is indicated by a grade 2 MCL injury?

A
  • specific tenderness @ the MCL
  • mild to mod swelling and pain
  • laxity on valgus stress test

for just MCL, knee should be stable during full extension stress test

43
Q

What is indicated by a grade 3 MCL injury?

A
  • tender over MCL
  • LOTS of laxity on valgus stress w/o a stop
  • if its that bad - usually has laxity in full extension as well
  • ↓ pain = damange to nociceptive fibers
44
Q

What structure is associated with a grade 3 MCL?

A

rarely includes the medial meniscus but instead - LCL because of the mechanism
= creating a compressing and shear of lateral compartment

45
Q

What is indicated in the imaging for MCL?

A

ruling out fractures
MRI will show other involved structures or ensure the dx

46
Q

What is the prognosis for a grade 1 MCL injury?

A

around 10 days

47
Q

What is the prognosis for a grade 2 MCL injury?

A

around 3 to 4 weeks for a low end

48
Q

What is the prognosis for a grade 3 MCL injury?

A

around 6-8 weeks

49
Q

What is the assumed treatment theme for MCL recovery?

A
  • because of the great blood supply, recovery for grade 3s can be nonsurgical
  • intially, will focus on controlling that knee edema while ↑ ROM and quad strength
  • area of injury on the MCL = determines where to start exercises
  • Fast implementation of the stationary bike

PHTH 517 - Ortho Midterm LE (10 decks)

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