Knee and Ankle Flashcards
ACL Risk factors
Female
Young age
Earlier, more intense and more frequent participation in sport
Variations in bone morphology
Neuromuscular control
Genetic
Hormonal
KANON: Surgery or conservative management of ACL
Rehab + early reconstruction not superior to rehab + optional delayed ACL reconstruction
No difference between knees surgically reconstructed early or late and those treated with rehab alone
COMPARE surgery or conservative management of ACL
statistically significant difference but not clinically meaningful between groups
Surgery for those with ongoing instability
Surgery better option
ACL recovery options
Rehab alone –> reconstruct if functional instability develops
Reconstruct then do postoperative rehab
Pre-op rehab followed by reconstruction then post op rehab
ACL surgery types
Autograft: tissue from own body. more cost effective
Allograft: tissue from donour
Autograft ACL
Hamstring
- easier surgery to perform
- no concern of PFP
- may have hamstring weakness
- faster recovery
Quadriceps
- increased post op knee pain
- risk of PFP
Allograft ACL
No pain from autograft
Increased risk of infection and failure rate
more expensive
Types of meniscus injury and presentation
acute and traumatic
chronic and degenerative
Presents: pain, stiff, catching/locking/ROM restriction, instability
Types of meniscus surgery
Arthroscopy: camera to look with knee joint
Arthroscopy + meniscectomy: damaged cartilage is trimmed away
Arthroscopy + Meniscus repair: sutured together. longer recovery
What happens if you trim too much cartilage in a meniscectomy
risk of OA
Meniscus surgery rehab: weeks 1-2
WBAT
Goal: FWB after 5 days
reduce pain/swelling
Exercises: SLR, hip adduction and abduction, 1/4 and 1/2 squats, hamstring curls
AAROM emphasising full knee extension –> heel slides and supine wall slides
Meniscus surgery rehab weeks 2-4
Isometric quad exercise
Short arc quad exercise
Long arc quad exercise
High seat stationary bike –> reduce seat height and/or increase loading
Meniscus surgery rehab 4-8 weeks
increase resistance and range for exercises
running program initiated
goals: restore muscle strength and endurance, return to functional activities and running
Meniscus surgery rehab weeks 8-12
Start agility and sport specific drills once patient can run 4-5km
Return to competitive sport = 8 weeks
Meniscus surgery for chronic and degenerative
no difference in meniscectomy and sham surgery after 12 months
Weber Classifications
Weber A: fib # below syndesmosis, RTS in 3-4 weeks
Weber B: fib # in line with syndesmosis, usually in CAM boot and WBAT for 6 weeks, syndesmosis may or may not be injured
Weber C: fib # above syndesmosis, syndesmosis ruptured
How can you tell Weber C fracture/ruptured syndesmosis on MRI
larger gap between tib and fib indicating rupture of syndesmosis
Weber A management
no cast
ankle orthoses
early movement and WBAT
ROM exercises as tolerated
Non type A Weber management
CAM boot, 6 weeks WBAT
orthosis on at night
ROM exercises as tolerated
Ankle surgery rehab management 0-6 weeks
goals: NWB or PWB, DF to neutral at 6 weeks, control swelling
exercises
- 0-2 weeks: NWB
- 2-4 weeks: WBAT with crutches
- AROM for ankle and foot within pain. Ankle pumps, inv/ev, toe crunches, alphabet
- towel stretch in DF
Ankle surgery rehab management 6-8 weeks
GOALS
WBAT
>50% AROM all planes
control swelling
minimise complications
exercises
- bike
- grade 1-2 mobs
- PROM
- DF stretches
- theraband DF/PF/Ev/inv
- seated heel raise
- manual resistance
- leg ext/curls/press
Ankle surgery rehab management weeks 8+
full ankle AROM, flexibility
restore on gait on all surfaces
full return to function
Achilles tendon repair risk factors
30-40 y/o
M>F (5x more likely)
recreational sports
sports involving sudden acceleration/deceleration
steroid injections - reduces pain and inflammation and weakens nearby tendons
Conservative vs surgical management Achilles rupture
reduced re-rupture for surgery
higher risk of infection from surgical intervention
conservative is cheaper
