Knee: Treatment 1 Flashcards
Primary goals for general knee rehab:
- avoid arthrofibrosis
- restore knee extension ASAP
- increase quad strength
Primary goals for general knee rehab:
pain and swelling are signs of
progressing too quickly
ACL tears: females (#)x more likely to tear ACL
4-8x more likely
ACL tears: occurs with these types of movements
pivoting/cutting
typically noncontact
ACL tears: At 1 year post-surgery, only (%) of pts attempted some type of athletics
67%
ACL tears: prevention programs
(%) reduction in risk with strengthening and proximal control exercises
> 65%
ACL tears: nonsurgical
goals
- restore joint mobility
- increase quad strength/endurance
- agility training
- protective bracing
- activity modification
ACL tears: “copers”
nonsurgical
To be considered for screening, must have
- no knee effusion
- full ROM
- isolated ACL tear
- > 70% involved/uninvolved quad ratio
- hop on injured leg without pain
ACL tears: nonsurgical
rehab candidate if score (%) on Noyes hop tests
80% involved/uninvolved
ACL tears: nonsurgical
rehab candidate if score (%) on KOS
> 80%
ACL tears: nonsurgical
rehab candidate if score (%) on global rating of knee function
> 60%
ACL tears: nonsurgical
rehab candidate if (#) of episodes of giving way
≤ 1 episode
ACL tears: surgical graft options (surgeon dictated)
- bone - patella tendon - bone
- hamstring graft
- various allografts
ACL tears: surgical
BTB - increased incidence of (pain)
anterior knee pain
ACL tears: surgical
BTB - potential for increased risk of (patella)
patellar fx
ACL tears: surgical
hamstring (muscles used)
semitendinosus
gracilis
ACL tears: surgical
hamstring - increased risk of this during rehab
hamstring strain
ACL tears: surgical
allografts - eliminates problems with
harvest sites
ACL tears: surgical
(double/single) bundle to more exactly match pre-injury anatomy
double bundle
ACL tears: surgical
ROM after reconstruction can be affected by
- surgical technique
- graft placement
ACL tears: surgical
WB
immediate WBAT
ACL tears: surgical
ROM
- focus on early full PROM extension
- pre-op “calm knee” has better ROM outcomes
ACL tears: surgical
most stress on ACL graft in this position
last 30˚ of NWB knee ext
ACL tears: surgical
Both WB and NWB exercises should be incorporated and you should also incorporate this modality
NMES
ACL tears: surgical
concomitant injuries
What should you use to dictate rehab guidelines and progression?
use the most limiting factor
ACL tears: surgical
concomitant pathologies
These types of injuries supersede ACL rehab guidelines
meniscal
cartilage
ACL tears: surgical
concomitant pathologies
Chondral damage or chondroplasty: WB
WB restrictions x 4 weeks
ACL tears: surgical
concomitant pathologies
MCL injury and ACL-R
ACL-R provides stability for even a grade 3 MCL sprain to heal
ACL tears: surgical
concomitant pathologies
PCL injury
PCL guidelines supersede ACL
ACL tears: surgical
concomitant pathologies
ACL revision: WB
PWB x 2 weeks
ACL tears: surgical
concomitant pathologies
ACL revision - return to run
delayed
