Knee Intervention Flashcards
Identify and describe the 3 categorical names for pt response to ACL injury
- Copers: able to function w/ an ACL-deficient knee AND return to injury levels of sports
- Adapters: able to cope by reducing activity demands
- 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
T or F: not everyone who tears their ACL needs a reconstruction!
True.
What are the 6 predictors of a coper?
- Age (older = better)
- Lower sport demands
- stronger quads
- better performance on functional tests
- fewer giving way episodes
- better self-reported function
Note: ID as coper or non-coper is better after a 5-week rehab program rather than immediately after injury
T or F: Identification as coper or non-coper is better after a 5-week rehab program rather than immediately after injury
True.
A rehab brace is often used after ACL reconstruction to keep knee ____ for the first ____ weeks and to be used with early ambulation.
- Straight
- 2
What are 8 rehab principles for post-ACL reconstruction?
(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!!
What are the consequences of a pt not restoring full ext quickly after ACL reconstruction?
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
Compare the difference in healing time between patellar tendon autograft and HS or Quad autograft
Patellar tendon (bone-on-bone): 8 weeks
HS or Quad (tendon-on-bone): 12 weeks
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
True.
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
True.
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
True.
T or F: functional braces are NOT indicated in an ACL reconstructed knee
True.
What is the best indication for functional knee bracing?
stable ACL-deficient knee willing to modify activity level
Describe the risk of blot clots with BRF
NO increased risk as compared to non-occluded exercise
What are 8 contraindications for BFR?
- Hx of DVT
- Clotting disorder
- HTN
- PVD
- Varicose veins
- Pregnancy
- Cancer
- Contraceptive use (hormonal)
What range % for limb occlusion pressure when doing BFR?
40-80% (lower pressure in UE and in small limbs)
What are 4 ways to determine limb occlusion pressure (LOP) for BRF?
- Doppler unit
- Pulse ox
- Palpation of distal artery
- BFR unit that provides this measurement (SmartCuff)
What are goals of rehab following a meniscectomy? (nothing repaired-just removed)
- Dec pain/swelling
- Address: mobility, mm performance impairments, proprio
- Return to activity 4-6 wks
T or F: meniscal injuries occur in 60-75% of ACL injuries
True.
What are ACL rehab considerations following a meniscal repair too?
- PWB/WBAT (MD preference) for 2-4 wks
- HS strengthening limited for 8-10 wks to allow healing of repair
- No squatting past 60 for 8-12 wks (meniscus undergoes sig displacement w/ squatting >60)
- No squats w/ twisting motion for at least 16 wks
How does choice of intervention change between a pt w/ osteochondritis dissecans w/ a STABLE fragment VS. a FREE fragment?
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!!
What are interventions to address the 4 Patellofemoral Pain Classifications?
- Overuse/overload w/o other impairment
- Muscle performance deficits
- Movement coordination deficits
- Mobility impairments
- Overuse/overload w/o other impairment: taping, activity mod
- Muscle performance deficits: hip and quad strengthening
- Movement coordination deficits: gait and mvmt retraining
- Mobility impairments: foot orthoses or taping, muscle stretching
List 4 surgical intervention options for PFPS after conservation care has been exhausted
- Arthroscopic patellar debridement/chondroplasty
- Lateral release
- MPFL reconstruction
- Distal realignment procedures (medialization of tibial tubercle)
What are the 4 main goals of PT intervention for Knee OA?
- Dec pn
- Improve function & minimize disability
- ID & tx other pn generators
- Delay surgical intervention (total jts only last ~15-20 yrs)
T or F: proprioceptive exercises are efficacious in the tx of knee OA
True.
What are biomechanical interventions for knee OA?
- Unloader bracing: can delay need for TKA
- Wedge insole: lat or med depending on compartment
- Shock absorbing foot insoles
- Use of AS to unload (cane, crutches)
What is the relationship btwn knee OA and weight loss as an intervention?
Messier 2018: greater weight loss resulted in superior clinical and mechanistic outcomes
What are 4 surgical intervention options for knee OA?
- Arthroscopic lavage and debridement
- high tibial osteotomy
- total knee replacement
- arthrodesis
What are 4 indications for TKA (total knee arthroplasty)?
- Severe pn and/or functional loss
- knee jt destruction
- marked knee deformity: genu varum/valgum
- extreme limitation in knee ROM
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.
True.
T or F:
75% of TKA pts have difficulty descending stairs
40% of TKA pts require an AD for amb
True.
True.
What are signs of wound of jt infection?
- swelling
- warmth and redness around wound
- wound drainage
- fevers, chills, night sweats
Recognizing possible arthrofibrosis asap following TKA is important! What 4 signs indication possible arthrofibrosis?
- Pn steadily inc after surgery
- ongoing knee swelling
- weak quads
- prolonged knee inflammation (2-3 wks post-surgery)
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.
True
Following TKA, the goal is to have 8-100 deg ROM by 6 weeks. If this is not accomplished, what intervention should you consider?
Dynamic splinting or
Static progressive splinting
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
True.
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
should NOT!
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
True.
