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Ortho Knee > Knee Ligament Injuries > Flashcards

Knee Ligament Injuries Flashcards

1
Q

Explain knee flexion biomechanics. CKC

A

femur rolls posteriorly
femur glides anteriorly
ACL guides condyles anteriorly
menisci move posteriorly

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2
Q

Explain knee extension biomechanics. CKC

A

femur rolls anteriorly
femur glides posteriorly
PCL pulls condyles posteriorly
menisci move anteriorly

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3
Q

Common LE Position for ACL rupture

A 
IR of tibia 
knee in 10-20 degrees of flexion
foot planted
deceleration force
>valgus collaps
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4
Q

What individuals are more likely to get ACL injuries?

A

athletes
15-30 years old
60% males/ 40& females (but female athletes more than male)

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5
Q

Why might females be more likely to get ACL injury?

A

wider pelvis, small femoral notch, hormonal factors.

males athletes tend to be hamstring dominant and females quad dominant

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6
Q

Injury prevention programs?

A

Sportsmetrics
PEP Program
FIFA F-Mark

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7
Q

ACL History

A 
MOI: ER with foot planted 
ER with foot planted with valgus force
Internal rotation 
hyperextension
cutting or changing direction
landing from a jump

Immediate hemarthrosis
popping
feeling of instability
inability to continue playing

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8
Q

In what type of injuries will you see and not see hemarthrosis?

A

Hemarthrosis: intraarticular injuries like ACL & PCL, patella tendon rupture, patellar dislocation

No hemarthrosis: extra- articular injuries like MCL/LCL

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9
Q

ACL X ray

A

Segond Fx: almost always indicative of ACL injury

small avulsion fracture of lateral tibial condyle just below joint line

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10
Q

ACL MRI

A 
normal = black
injured= gray colored
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11
Q

Will ACL present with a capsular pattern?

A

YES because of swelling

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12
Q

Who should get ACL reconstruction surgery?

A

Competative athlete with “best possibe knee” = surgery

Recreational athlete = consideration

non athlete (limit activities/non-op Rx)

influenced by knee instability, secondary injury, reduced activity level, post traumatic OA.
some individuals can return to high demand activities after ACL injury without surgery.
long term functional outcomes may be similar for surgical vs non surgical interventions

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13
Q

ACL deficient knee risk of what?

A

meniscus tears years later
bone bruises later
most will get signs of OA 10-20 years later

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14
Q

Intensive Rehab Program should include what?

A 
LE Muscle strengthening
Cardiovascular endurance training
agility training
balance perterbation training
sport-specific skill training

PreOp training is very improtant!

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15
Q

ACL Injury Interventions

A

1) CryotherapyElectrical stimulation
2) Strengthening- quads, hamstrings, hip abductors, open chain vs closed chain
3) Joint ROM/ stretching
4) Proprioception Training - progress to balance/perturbation training
5) Gait Training- possible AD– walking to stairs to jogggin to running
6) functional bracing- limited benefit

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16
Q

ACL Rehab
Phase I
Goal

A

weeks 0-3
- immediate post-injury phase

Goals

  • reduce swelling and inflammation (compression wrap, cryotherapy, HVGS)
  • normalize knee motion (want full AROM by weeks 2-3)
  • voluntary activation of quads (early WB, weight shifting, EMS, quad sets, SLR, 1/4 Squats, develop quand and hamstring co-contraction)
  • partial weight bearing with crutches
  • immediate stimulation of mechano receptors.
17
Q

ACL Rehab
Phase II
Goal

A

weeks 4-6
Dynamic stabilization phase

Goals:

  • maintain normal knee ROM
  • normalize unilateral muscle ratio
  • enhance proximal/distal stabilization
  • improve proprioception and neuromuscular control

leg press 0-100 degrees, leg extension 100-40 degrees, wall squats 0-70 degrees , lateral step-ups, front step-downs, hamstring curls, D/C crutches

18
Q

ACL Rehab
Phase III
Goal

A

weeks 7-10
Neuromuscular Activity Phase

Goals:

  • gradual increase in strength
  • promote endurance
  • improve core instability
  • enhance neuromuscular control
  • gradually increase applied loads

*leg extension 100-0 degrees, 20-45 minutes of stationary bicycle, elliptical pool program, perturbation training drills, progression in plyo jumping drills (leg press, foam, floor, boxes), pool running

19
Q

ACL Rehab
Phase IV
Goal

A

weeks 11-16
Return to Activity Phase

Goals

  • gradual return to sports/activities
  • continue strengthening/endurance program
  • continue neuromuscular program
  • backward>lateral shuffles, lateral shuffles >forward running, jogging>jog/stops>running/stops>suicides, cutting drills, 30-45 minutes of cardio
20
Q

ACL reconstructions

A

grafts:

extraarticular: ITB
intraarticular: BPTB autographs and allografts, single/double/quad stranded semitendinosus autographs, semitendinosus/ gracilis autografts

21
Q

Criteria for return to sport after ACL surgery

A 
Full ROM
Quad Strength = 85% of other leg
Hamstring strength = 100%
Hamstring to quad ratio = >70%
Functional Testing >85 of uninvolved side
no effusion
no pain
22
Q

PCL MOI

A

hyperflexoin, direct blow to anterior tibia, hyperextension, rotation

23
Q

PCL Injury Signs and Symptoms

A
  • pain (posterior when kneeling), may radiate into calf
  • mild swelling
  • may be ROM limitation
  • popping
  • infrequent instability
  • feelings of giving way
24
Q

Goals of Non operative PCL Rx

A

correct neurmuscular deficiences
develop quad-dominant knee
educate pt as to lig deficiency and future signs and symptoms
exercize in safe zone to avoid PF arthritis
modify lifestyle by avoiding high risk activities
brace to protect abnormal motion

25
Q

Non operative PCL management

A

grade III: PROM CMP, brace locked into extension

Grades I/II: prom, careful arom, resisted rom limited to 0-60 degrees flexion(brace)

26
Q

PCL Muscle training

A 
QUAD STRENGTHENING!
avoid early hamstring strenghening. 
3 way SLR in a brace
CKC 0-45 degrees 
terminal extension only
no squats!
no downhill walking
27
Q

Post surgical

A

protected WB
progressive PROM

Strengthening:
quads
CKC 0-60 degrees
isokinetics 0-60 degrees, full range by month 3, no hi-speed until 5-6 months

28
Q

Posterolateral Corner MOI

A

posterolaterally directed blow to the anteromedial proximal tibia
noncontact hyperextension and ER twisting injury
direct blow to a flexed thigh
high energy trauma

return to work/athletics 10-12 months post op

29
Q

Medial collateral MOI

A

direct trauma to the lateral knee creating a valgus force

30
Q

MCL physical exam

A 
tenderness along MCL
minimal effusion (extra articular)
increased laxity

at 25 degrees flexion, MCL provides 80% of valgus restraint. at full extension, less than 60% of valgus restraint

31
Q

Differential Diagnosis:
Medial knee contusion
Medial meniscal tear
patellar dislocation

A

Medial knee contusion:
no laxity noted

Medial meniscal tear:
joint line tenderness, valgus laxity with MCL, difficulty differentiating grade I MCL and MM tear, resolving tenderness with MCL

Patellar Dislocation:
tenderness near the adductor tubercle, (+) patellar apprehension sign

32
Q

MCL surgical choices

A

tib anterior allografts

semitendonosis and gracilis autografts

33
Q

combined rotational injury

ACL/MCL/MM

A

Follow ACL protocol
protect MCL
consider MM repair
menisectomy

Ortho Knee (6 decks)

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