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Knee CPGs > Knee Stability and Movement- Ligament Sprain 2010 and 2017 > Flashcards

Knee Stability and Movement- Ligament Sprain 2010 and 2017 Flashcards

1
Q

What outcome measures should you use to assess knee symptoms and function associated with Knee ligament Sprains?

A

IKDC 2000- International Knee Documentation Committee 2000
KOOS- Knee Injury and OA Outcome Score
Lysholm

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2
Q

What combination of outcome measures should you use to assess activity level with knee ligament sprains?

A

Tegner or Marx Activity Scales

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3
Q

What outcome measure would you use to assess psychological factors for knee ligament sprains?

A

ACL- RSI- Anterior Cruciate Ligament Return to Sport After Injury

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4
Q

What physical performance measures can you use for examining baseline and assess readiness for return to activities?

A

Single leg hop tests:

  1. Single hop for distance
  2. Crossover hop for distance
  3. Triple Hop For distance
  4. 6 meter timed hop
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5
Q

What physical impairment measures should you assess for knee ligament sprains?

A 
Knee laxity/ stability 
Lower limb movement Coordination 
Thigh Muscle Strength 
Knee Effusion 
Knee joint ROM
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6
Q

What can be said about CPM after ACL reconstruction?

A

C (weak) evidence- can use to decrease post op pain

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7
Q

What can be said about early WB after ACL reconstruction?

A

C (weak) evidence- WBAT within 1 week after surgery
B (moderate) evidence- WBAT within 1 week to help increase joint ROM, decrease joint pain, reduce adverse response to surrounding soft tissue

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8
Q

What can be said about knee bracing for ACL deficiency? After ACL surgery? For other ligament injuries?

A

C (weak) evidence- May use for ACL deficiency
D (conflicting) evidence- elicit and document patient preferences- there is evidence for and against
F (expert opinion)- can use for PCL, MCL, or PLC injuries

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9
Q

What can you advise about cryotherapy after ACL

A

B- moderate evidence promotes use to decrease pain

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10
Q

What type of exercises can you recommend post ACL reconstruction?

A

A- strong evidence for WB and NWB concentric/ eccentric exercises implemented within 4-6 weeks, 2-3X/ week for 6-10 months

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11
Q

What recommendations can be made for neuro e-stim after ACL reconstruction?

A

A- strong evidence- in favor of use for 6-8 weeks to augment muscle strengthening in quads and increase short term functional outcomes

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12
Q

What recommendations can be made for neuro re-ed in those with knee stability and movement impairments?

A

A- strong evidence- should be incorporated with strengthening exercises

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13
Q

What is the % breakdown for ACL injuries for contact versus non- contact?

A

70% are non- contact

30% are contact

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14
Q

Female versus male- who is at higher risk for ACL injury?

A

Female, and are 4.5X more likely to sustain second injury in ipsilateral and contralateral side

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15
Q

Is it more likely that you will tear same side or contralateral side after returning to high risk sport?

A

Contralateral- risk is 4.9 fold versus 3.9 fold of ipsilateral

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16
Q

What age range is highest for incidence of ACL injuries?

A

III- case study level for 21-30; but peak incidence for women was age 14-18

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17
Q

Which two groups are most likely to sustain ACL injury?

A

Military and Professional athletes, then amateur athletes

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18
Q

What are the two most common multi- ligament knee injuries?

A

MCL and ACL

PLC (posterolateral corner) and ACL/ PCL

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19
Q

Describe most likely scenario/ mechanism for sustaining an ACL injury

A

Usually during acceleration/ deceleration with excessive quad contraction with reduced hamstring co-contraction at or near full knee extension

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20
Q

When is ACL load the highest

A

quad forces combined with knee IR
valgus load combined with knee IR
valgus load with deceleration

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21
Q

What is the most common mechanism (s) for PCL (posterior collateral ligament) injury

A
  1. “dashboard” or anterior tibial blow
  2. fall on flexed knee with foot in plantar flexion
  3. sudden, violent hyperextension off knee
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22
Q

What is the mechanism of injury for MCL injury

A

Valgus torque to the knee- direct hit to lateral aspect of knee

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23
Q

What is the role of the LCL

A

resists varus forces, especially in initial 0-30 deg of knee flexion.
Also with role in limiting ER of flexed knee

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24
Q

What is the mechanism for isolated injury to the PLC (posterolateral corner)

A

Posterolateral force to tibia at or near full knee extension, forcing knee into hyperextension and varus

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25
Q

What is the mechanism for combined PLC (posterolateral corner) injuries?

A

Knee hyperextension, ER and varus rotation, complete dislocation, flexed and ER knee + posterior force to tibia

26
Q

What sport accounts for 1/3 of ACL reconstructions

A

Soccor

27
Q

What other activity/ sport has a high likelihood of isolated ACL injuries?

A

Skiing- 1.13X likelihood of isolated ACL injuries
2X likelihood of PCL
2X likelihood of MCL and multiligament injuries

28
Q

Is there a difference between early ACL reconstruction versus structured rehab with option for later rreconstruction?

A

Similar mean change on KOOS and in 5 year f/up there was no difference between groups in PROs or radiographs

29
Q

What are the findings comparing autografts for ACL?

A

ligament stability and PROs (patient- related outcomes) were similar among quad tendon, hamstring tendon, and bone- patella bone tendon

30
Q

Describe incidence for copers and non- copers for return to activity c/o ACL reconstruction

A

58% of non- copers- failed the screening and are not rehab candidates for return to activity thru non-operative management
42% of copers- returned to pre- injury levels without ACL reconstruction
72% of copers + neuro re-ed returned to high- level activities

31
Q

What type of autograft had more laxity in women after ACL reconstruction

A

hamstring compared to bone patella bone, and also compared to men with either autograft

32
Q

How long can strength deficits persist after ACL reconstruction?

A

Quad and hamstring for up to 6 months after surgery and quad deficits up to 5 years after

33
Q

What are the effects on balance and proprioception after ACL reconstruction?

A

Static postural control (SL balance with EO/EC) moderately impaired
Dynamic postural control is moderately magnified (EO on unstable surfaces with perturbations)

34
Q

What are some psychological factors that can impact return to sport after ACL reconstruction?

A 
fear of movement/ reinjury 
Athletic confidence 
Self- efficacy and emotions 
Motivation 
Internal Locus of control 
Positive coping strategies- modeling, imagery, relaxation
35
Q

What are some environmental risk factors for non- contact ACL injuries?

A

Dry weather and Artificial turf

36
Q

What are some intrinsic risk factors for non- contact ACL injuries?

A 
Female 
Narrow intercondylar notch 
lesser concavity depth of medial tibial plateau 
Greater ATFL (or PTFL) joint laxity 
prior ACL reconstruction 
familial predisposition
37
Q

What are the diagnostic criteria for ACL sprain and associated clinical findings?

A

-Mechanism of deceleration and acceleration motions with non-contact valgus load at or near full extension
- hearing/ feeling a “pop” at time of injury
- hemarthrosis 0-12 hours after injury
- h/o giving way
+ lachman with “soft” end feel/ increased anterior tibial translation
+ pivot shift test

38
Q

What are the diagnostics for knee stability and movement coordination impairments for ACL sprains?

A

6 meter SL timed hop test < 80% of uninvolved limb
Max voluntary quad strength index < 80%
Giving way with 2 or more of daily activities

39
Q

What clinical findings are seen with PCL regarding knee stability and movement coordination impairments?

A
  • Dashboard/ anterior tibial blow injury, fall on flexed knee, sudden hyperextension of knee joint
  • localized posterior knee pain with kneeling or decelerating
  • Positive posterior drawer test at 90 deg with non- discrete end feel/ increased posterior tibial translation
  • Posterior sag (subluxation) of proximal tibia relative to anterior aspect of femoral condyles
40
Q

What clinical findings are seen with MCL regarding knee stability and movement coordination impairments?

A
  • trauma by force applied to lateral aspect of lower extremity
  • rotational trauma
  • medial knee pain with valgus stress test performed at 30 deg knee flexion
  • increased separation between femur and tibia with valgus stress test performed at 30 deg knee flexion
  • TTP over MCL
41
Q

What clinical findings are seen with LCL regarding knee stability and movement coordination impairments?

A
  • Varus trauma
  • localized swelling over LCL
  • TTP over LCL
  • lateral knee pain with varus stress test performed at 0 deg and 30 deg knee flexion
  • Increased separation between tibia and femur with varus test at 0 and 30 flexion
42
Q

What are the Ottowa Knee Rules- to determine when to order radiographs with acute knee injury?

A
  1. 55 or older
  2. Isolated tenderness of patella
  3. TTP to head of fibula
  4. Inability to flex to 90
  5. Inability to bear weight immediately and in emergency department for 4 steps regardless of limping
43
Q

What findings have been made regarding clinical exam versus MRI

A

Clinical exam by WELL TRAINED clinicians are as accurate as MRI, and they may be reserved for complicated cases or to assist Orthopedic Surgeon aiding in pre-op planning

44
Q

When performing hop testing- what can you recommend for bracing?

A

Recommended for all patients post- injury or < 1 year post- surgery

45
Q

With hop testing- do you measure where toe or heel lands?

A

Heel

46
Q

How many trials/recordings are done with hop testing

A

2 trials, then 2 recorded

47
Q

Describe the method for the modified stroke test

A

Performed supine and in full extension. Starting at medial joint line- stroke upward 2-3X toward suprapatellar pouch . Then stroke downward on the distal lateral thigh superior to the suprapatellar pouch toward the lateral joint line

48
Q

Describe the grading for the modified stroke test

A

0- no production
Trace- small wave
1+ larger bulge of fluid medial to knee
2+ effusion fills medial knee sulcus with downward stroke or returns to medial knee without downward stroke
3+ inability to move effusion out of knee

49
Q

What is the bulge sign

A

amount of fluid measured by visual inspection

50
Q

What is the measurement method

A

hand superior to patella, pushes tissues and possibly fluid towards patella. keep hand in position, push medial aspect posterior to patella and then quickly along lateral opposite aspect observing for wave of fluid medially

51
Q

Describe the measurement method of Lachman test

A

Patient supine, knee in 20-30 deg flexion, stabilize femur and hand posterior on tibia applies an anterior force. Increased anterior translation/ soft end point is + for ACL

52
Q

Describe the units of measurement of Lachman test

A

Normal- 1 to 2 mm
Nearly normal- 3-5 mm
Abnormal- 6-10 mm
Severely abnormal- > 10mm

53
Q

What is the sensitivity and Specificity of the Lachman test- can it be used to rule in/ out ACL tear?

A

Sensitivity- 85%
Specificity- 94%
can be used to rule in

54
Q

Describe the measurement method of the pivot shift test

A

Patient supine, knee extended. Pick up limp from ankle, IR and flex the knee while applying valgus stress with CL hand on lateral aspect of tibia. + test is as its moved into flexion, a sudden reduction (at about 20 deg flexion) of the anteriorly subluxed lateral tibial plateau and indicates a ACL disruption

55
Q

What is the sensitivity/ specificity for pivot shift?

A

Sensitivity- 24%
Specificity- 98%
+ can rule it in

56
Q

Describe the measurement method for the posterior drawer test

A

Supine with knee flexed to 90. Examiner at the foot. Both hands to anterior proximal tibia and posterior force applied. Positive is increased posterior translation with soft end point + for PCL

57
Q

What is the sensitivity and specificity of the posterior drawer test?

A

Sensitivity-90%
Specificity- 99%
Can rule out of negative and rule in if positive

58
Q

Describe the measurement method for the posterior sag test

A

Supine, examiner holds heels of both limbs. Flexes knees and hips to 90. Examine the position of the tibia compared to uninvolved side + for PCL

59
Q

What is the sensitivity and specificity of the posterior sag test

A

Sensitivity-79%
Specificity- 100%
Can rule in if positive

60
Q

What is the description of the valgus stress test at 30 deg?

A

Separation of tibia and femur at MCL during the test

61
Q

What is the sensitivity and specificity for valgus stress test at 30? is it the same for the test done to evaluate pain?

A

Sensitivity- 91%
Specificity- 49%
Negative test can rule out
Not same for pain- poor sensitivity and specificity ( < 78%)

62
Q

What is the test for the LCL

A

Varus test at 0 and 30 deg knee flexion

Knee CPGs (4 decks)

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