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MM I > Knee Intervention > Flashcards

Knee Intervention Flashcards

1
Q

Identify and describe the 3 categorical names for pt response to ACL injury

A
  1. Copers: able to function w/ an ACL-deficient knee AND return to injury levels of sports
  2. Adapters: able to cope by reducing activity demands
  3. Non-copers: unable to cope w/o surgery

Note: ID as coper or non-coper is better after a 5-week rehab program rather than immediately after injury

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2
Q

T or F: not everyone who tears their ACL needs a reconstruction!

A

True.

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3
Q

What are the 6 predictors of a coper?

A
  1. Age (older = better)
  2. Lower sport demands
  3. stronger quads
  4. better performance on functional tests
  5. fewer giving way episodes
  6. better self-reported function

Note: ID as coper or non-coper is better after a 5-week rehab program rather than immediately after injury

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4
Q

T or F: Identification as coper or non-coper is better after a 5-week rehab program rather than immediately after injury

A

True.

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5
Q

A rehab brace is often used after ACL reconstruction to keep knee ____ for the first ____ weeks and to be used with early ambulation.

A
  1. Straight
  2. 2
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6
Q

What are 8 rehab principles for post-ACL reconstruction?

A

(Order of priority)
1. Dec knee pn & swelling (icing, compression, elev)
2. Restore ext ROM: early = critical! (full ext in first 10 days!)
3. Restore quad recruitment: early = critical! (consider use of NMES if SLR w/ lag persists after first 2-3 days)
4. Restore patellar mob: prevent “infrapatellar contracture syndrome”
5. Restore normal gait pattern w/o AD and w/o brace (requires good quad function!)
6. Restore knee flex ROM
- 0-90 deg knee flex 7 days post-op
- 0-120 14 days
- Full ROM at 4 wks
7. Restore LE mm performance
8. Restore symmetric LE proprioception

Remember: don’t ignore the unaffected limb!!

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7
Q

What are the consequences of a pt not restoring full ext quickly after ACL reconstruction?

A

Not restoring full ext in first 6 weeks has been assoc w/ poorer outcomes:
- Inc risk of ant knee pn
- inc risk of dev OA
- inc risk of dev a permanent flex
contracture
- dec quad strength
- formation of cyclops lesion in
notch

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8
Q

Compare the difference in healing time between patellar tendon autograft and HS or Quad autograft

A

Patellar tendon (bone-on-bone): 8 weeks

HS or Quad (tendon-on-bone): 12 weeks

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9
Q

T or F: A pt’s rehab program following a HS or Quad autograft cannot be as aggressive as compared to if they had a patellar tendon autograft

A

True.

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10
Q

T or F: if a pt had an ACL reconstruction w/ a HS autograft, isolated maximal HS strengthening should be delayed (8-12 wks) to allow for healing of graft site

A

True.

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11
Q

According to Noehren 2020, OKC knee ext exercises are considered safe, critical to restoring quad strength, and key for assessing readiness to return to sport

A

True.

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12
Q

T or F: functional braces are NOT indicated in an ACL reconstructed knee

A

True.

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13
Q

What is the best indication for functional knee bracing?

A

stable ACL-deficient knee willing to modify activity level

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14
Q

Describe the risk of blot clots with BRF

A

NO increased risk as compared to non-occluded exercise

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15
Q

What are 8 contraindications for BFR?

A
  1. Hx of DVT
  2. Clotting disorder
  3. HTN
  4. PVD
  5. Varicose veins
  6. Pregnancy
  7. Cancer
  8. Contraceptive use (hormonal)
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16
Q

What range % for limb occlusion pressure when doing BFR?

A

40-80% (lower pressure in UE and in small limbs)

17
Q

What are 4 ways to determine limb occlusion pressure (LOP) for BRF?

A
  1. Doppler unit
  2. Pulse ox
  3. Palpation of distal artery
  4. BFR unit that provides this measurement (SmartCuff)
18
Q

What are goals of rehab following a meniscectomy? (nothing repaired-just removed)

A
  1. Dec pain/swelling
  2. Address: mobility, mm performance impairments, proprio
  3. Return to activity 4-6 wks
19
Q

T or F: meniscal injuries occur in 60-75% of ACL injuries

A

True.

20
Q

What are ACL rehab considerations following a meniscal repair too?

A
  1. PWB/WBAT (MD preference) for 2-4 wks
  2. HS strengthening limited for 8-10 wks to allow healing of repair
  3. No squatting past 60 for 8-12 wks (meniscus undergoes sig displacement w/ squatting >60)
  4. No squats w/ twisting motion for at least 16 wks
21
Q

How does choice of intervention change between a pt w/ osteochondritis dissecans w/ a STABLE fragment VS. a FREE fragment?

A

Stable fragment: non-surgical intervention
-Activity mod 3-6 mo

Free fragment: surgical intervention
- Fixation
- Microfracture (replaces hyaline
cartilage w/ fibrocartilage)
- Osteochondral graft (allograft or
mosaicplasty)
- Autologous chondrocyte
implantation
- Protocol driven!!

22
Q

What are interventions to address the 4 Patellofemoral Pain Classifications?

  1. Overuse/overload w/o other impairment
  2. Muscle performance deficits
  3. Movement coordination deficits
  4. Mobility impairments
A
  1. Overuse/overload w/o other impairment: taping, activity mod
  2. Muscle performance deficits: hip and quad strengthening
  3. Movement coordination deficits: gait and mvmt retraining
  4. Mobility impairments: foot orthoses or taping, muscle stretching
23
Q

List 4 surgical intervention options for PFPS after conservation care has been exhausted

A
  1. Arthroscopic patellar debridement/chondroplasty
  2. Lateral release
  3. MPFL reconstruction
  4. Distal realignment procedures (medialization of tibial tubercle)
24
Q

What are the 4 main goals of PT intervention for Knee OA?

A
  1. Dec pn
  2. Improve function & minimize disability
  3. ID & tx other pn generators
  4. Delay surgical intervention (total jts only last ~15-20 yrs)
25
Q

T or F: proprioceptive exercises are efficacious in the tx of knee OA

A

True.

26
Q

What are biomechanical interventions for knee OA?

A
  1. Unloader bracing: can delay need for TKA
  2. Wedge insole: lat or med depending on compartment
  3. Shock absorbing foot insoles
  4. Use of AS to unload (cane, crutches)
27
Q

What is the relationship btwn knee OA and weight loss as an intervention?

A

Messier 2018: greater weight loss resulted in superior clinical and mechanistic outcomes

28
Q

What are 4 surgical intervention options for knee OA?

A
  1. Arthroscopic lavage and debridement
  2. high tibial osteotomy
  3. total knee replacement
  4. arthrodesis
29
Q

What are 4 indications for TKA (total knee arthroplasty)?

A
  1. Severe pn and/or functional loss
  2. knee jt destruction
  3. marked knee deformity: genu varum/valgum
  4. extreme limitation in knee ROM
30
Q

T or F: for a patient with a TKA, you CAN mobilize if they are have cruciate retaining prosthesis but you CANNOT mobilize a more constrained design.

A

True.

31
Q

T or F:

75% of TKA pts have difficulty descending stairs

40% of TKA pts require an AD for amb

A

True.

True.

32
Q

What are signs of wound of jt infection?

A
  1. swelling
  2. warmth and redness around wound
  3. wound drainage
  4. fevers, chills, night sweats
33
Q

Recognizing possible arthrofibrosis asap following TKA is important! What 4 signs indication possible arthrofibrosis?

A
  1. Pn steadily inc after surgery
  2. ongoing knee swelling
  3. weak quads
  4. prolonged knee inflammation (2-3 wks post-surgery)
34
Q

T or F: For a pt recovering from TKA, if by 3 mo their flex contracture is > 15 deg, then they will not naturally recover.

A

True

35
Q

Following TKA, the goal is to have 8-100 deg ROM by 6 weeks. If this is not accomplished, what intervention should you consider?

A

Dynamic splinting or
Static progressive splinting

36
Q

T or F: Following TKA, current rehab programs involving PROM, AROM, low level functional exercise have been shown to be INEFFECTIVE at restoring long-term strength & function

A

True.

37
Q

According to the 2020 TKA CPG, PTs should or should NOT use CPMs (continuous passive motion device) for pts who have undergone primary, uncomplicated TKA

A

should NOT!

38
Q

T or F: According to the 2020 TKA CPG, PTs should prescribe high-intensity strength training and exercise programs during the EARLY post-acute period (within 7 days after surgery) to improve function, strength, and ROM

A

True.

MM I (9 decks)

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