Knee and Ankle

Question 1

ACL Risk factors

Answer 1

Female
Young age
Earlier, more intense and more frequent participation in sport

Variations in bone morphology
Neuromuscular control
Genetic
Hormonal

Question 2

KANON: Surgery or conservative management of ACL

Answer 2

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

Question 3

COMPARE surgery or conservative management of ACL

Answer 3

statistically significant difference but not clinically meaningful between groups

Question 4

Surgery for those with ongoing instability

Answer 4

Surgery better option

Question 5

ACL recovery options

Answer 5

Rehab alone –> reconstruct if functional instability develops

Reconstruct then do postoperative rehab

Pre-op rehab followed by reconstruction then post op rehab

Question 6

ACL surgery types

Answer 6

Autograft: tissue from own body. more cost effective

Allograft: tissue from donour

Question 7

Autograft ACL

Answer 7

Hamstring
- easier surgery to perform
- no concern of PFP
- may have hamstring weakness
- faster recovery

Quadriceps
- increased post op knee pain
- risk of PFP

Question 8

Allograft ACL

Answer 8

No pain from autograft
Increased risk of infection and failure rate
more expensive

Question 9

Types of meniscus injury and presentation

Answer 9

acute and traumatic
chronic and degenerative

Presents: pain, stiff, catching/locking/ROM restriction, instability

Question 10

Types of meniscus surgery

Answer 10

Arthroscopy: camera to look with knee joint

Arthroscopy + meniscectomy: damaged cartilage is trimmed away

Arthroscopy + Meniscus repair: sutured together. longer recovery

Question 11

What happens if you trim too much cartilage in a meniscectomy

Answer 11

risk of OA

Question 12

Meniscus surgery rehab: weeks 1-2

Answer 12

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

Question 13

Meniscus surgery rehab weeks 2-4

Answer 13

Isometric quad exercise

Short arc quad exercise

Long arc quad exercise

High seat stationary bike –> reduce seat height and/or increase loading

Question 14

Meniscus surgery rehab 4-8 weeks

Answer 14

increase resistance and range for exercises

running program initiated

goals: restore muscle strength and endurance, return to functional activities and running

Question 15

Meniscus surgery rehab weeks 8-12

Answer 15

Start agility and sport specific drills once patient can run 4-5km

Return to competitive sport = 8 weeks

Question 16

Meniscus surgery for chronic and degenerative

Answer 16

no difference in meniscectomy and sham surgery after 12 months

Question 17

Weber Classifications

Answer 17

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

Question 18

How can you tell Weber C fracture/ruptured syndesmosis on MRI

Answer 18

larger gap between tib and fib indicating rupture of syndesmosis

Question 19

Weber A management

Answer 19

no cast
ankle orthoses
early movement and WBAT
ROM exercises as tolerated

Question 20

Non type A Weber management

Answer 20

CAM boot, 6 weeks WBAT
orthosis on at night
ROM exercises as tolerated

Question 21

Ankle surgery rehab management 0-6 weeks

Answer 21

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

Question 22

Ankle surgery rehab management 6-8 weeks

Answer 22

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

Question 23

Ankle surgery rehab management weeks 8+

Answer 23

full ankle AROM, flexibility
restore on gait on all surfaces
full return to function

Question 24

Achilles tendon repair risk factors

Answer 24

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

Question 25

Conservative vs surgical management Achilles rupture

Answer 25

reduced re-rupture for surgery
higher risk of infection from surgical intervention
conservative is cheaper