Knee Unit-ACL surgical Flashcards
What grades will have surgery for and ACL with Knee instability?
grades 1-2 or grade 3 injury
what is the most common procedure for ACL
arthroscopically assisted or endoscopic procedure using an autograft
What is an autograft?
-Own body tissue used to replace injured tissue
The central 3rd of patellar tendon along with a segment of bone from the patella and the tibia or hamstring graft are used
-most common
What happens 4-9 months after autograft
grafted tendon revascularized and adopts the properties and function of old ligament and can achieve tensile strength of the original ACL
What is an Allograft
Donor tissue or cadaver to replace the injured tissue of the client
> 60-75% success
Important Rehab Considerations: Precautions ACL
important!
-Avoid resisted open chain terminal knee extension
>especially 20-0 degrees
-Avoid closed chain extension between 60-90 degrees of flexion
Why is it important to avoid Closed chain extension between 60-90 degrees of flexion?
Contraction of the quadriceps in these positions and ranges causes the greatest anterior tibial translation and can create potentially excessive stress to the graft
Postop management
-Immobilization and protective bracing
>Surgeon’s determination
>Controlled motion brace initially locked in extension or 5-10 degrees of flexion to prevent inadvertent hyperextension
Postop management: Weight bearing
25-50% the first week
-progressed during the next 2-3 weeks based on the patient’s symptoms
When is full WB and ambulation without crutches possible while wearing a brace still?
usually possible by 3-4 weeks if wtb is pain free and patient has full active knee extension and sufficient strength of the quadriceps to control the knee
Brace with allowing how many degrees? is worn for what? and how long?
0-125 degrees, may need to be worn for ambulation and wtb activities for 2-3 months
Goals of maximum protection phase: ACL
IMPORTANT
- Prevent reflex inhibition and atrophy of lower extremity musculature
- Regain mobility within a protected range and prevent contractures of the knee
- Begin to restore dynamic control of knee musculature
Goals of controlled mobility phase: ACL
When does it begin? Includes what?
IMPORTANT
Begins week 4-5 or at the point when pain and joint swelling are well controlled
- regain full ROM of knee
- Increase strength, control, and endurance in lower extremities
- Improve proprioception and balance
- Regain cardiovascular fitness
Goals of return to function phase: ACL
When does it begin?
IMPORTANT
- Generally begins at 10-24 weeks
- Emphasis is on incorporating progressively demanding functional activities
- By 24 weeks should be at pre-injury level
What is the mechanism of the Unhappy Triad?
- ACL, MCL, medial meniscus
- Occurs with planted foot and twisting of the knee (internal rotation)
