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KNES 372 > Lecture 6 Ligament and joint injuries > Flashcards

Lecture 6 Ligament and joint injuries Flashcards

1
Q

Ligaments (article): structure

A
  • Dense bands of collagen tissue
  • Collagen, elastin, proteoglycan, and other proteins
  • Vary in size, shape, orientation and location
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2
Q

Ligaments(article) function

A
  • Connect one bone to another → Passive stabilization of the joints
  • Ligaments can creep
  • Serve important proprioceptive function
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3
Q

Ligaments(article): response to injury

A
  • Healing follows the constant pattern
  • Ligament scars have inferior creep
    properties
  • Ligament injury → decreased
    proprioception
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4
Q

Joint stability

A
  • depends on the interaction between the passive, active and neural subsystems
  • passive subsystem consists of non-contractile connective tissues, ligaments, cartilage, second category of soft tissue unable to contract and relax
  • active subsystem is controlled by the neural subsystem to provide dynamic joint stability
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5
Q

Types of ligaments

A

intre-articular ligaments, extra-articular ligaments, capsular ligaments
- all have different healing capacities

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6
Q

Intra-articular ligaments

A

Primary stabilizer of the joint, acl, pcl, in the joint
e.g., cruciate ligaments of the knee

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7
Q

Extra-articular ligaments

A

-support joint
e.g., calcaneofibular ligament

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8
Q

Capsular ligaments

A
  • Thickening of joint, higher blood, higher healing
    e.g., anterior talofibular ligament
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9
Q

Adaption to training

A
  1. adapt slowly to increased loading, but weaken very rapidly as a result of immobilization
  2. adapt to loading by increasing the cross-sectional area
  3. normal everyday activity is sufficient to maintain mechanical properties
  4. systematic training can increase ligament strength by 10-20%
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10
Q

Stress-strain curve

A
  • If force causes more than a 4% change of length the collagen fibres will start to rupture
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11
Q

Ligament injuries

A
  • typically injured because of acute trauma
  • single identifiable event of injury, mid-tearing couple fibres to complete tear
  • mechanism: sudden overload-> ligament is stretched (joint in an extreme position)
  • repetitive injuries rare, but can occur as the ligament is gradually stretched out
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12
Q

Grade 1 ligament injury

A

-mild
- structural damage on the microscopic level
- no instability

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13
Q

grade 2 ligament injury

A
  • moderate
    -partial tear
    -swelling and pain
  • no/limited instability
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14
Q

Grage 3 ligament injury

A
  • severe
  • full rupture
  • significant swelling
  • instability
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15
Q

Mechanism of injury

A
  1. Felt my knee-cap go out- Patellar dislocation/subluxation
  2. Hit from lateral side - valgus- MCL +/- ACL
  3. Valgus/external rotation - with or
    without contact- ACL +/- MCL +/- lateral meniscus +/- bone bruise
  4. Direct blow to anterior tibia- PCL
  5. Hyperextension injury- ACL
  6. Minor twist in older individual- Degenerative Meniscal tear
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16
Q

Knee or knee cap?

A

MPFL

17
Q

Valgus mechanism of injury

A
  • ACL injury
  • MCL sprain
  • Lateral dislocation of patella
  • Meniscus injury
  • Lateral tibial plateau fracture or bone bruise
18
Q

Hemarthrosis

A
  • bleeding into the joint
  • injuries that cause hemarthrosis: acl tear; peripheral meniscus tear; osteochondral injuries; fractures
  • injuries that not usually cause hemarthrosis: mcl tear; central meniscus tear; pcl tear; cartilage injury
19
Q

Anterior cruciate ligament injury

A
  • ACL – 2 bundles
  • Anteromedial bundle resists
    tibial anterior translation
  • Posterolateral bundle resists tibial rotation
  • No pain fibers, but has proprioceptive fibers
20
Q

ACL complications

A
  • osteochondral injury
  • acl injury and meniscus tear
  • osteoarthritis în 15-20 years
  • unhappy triad
21
Q

ACL treatment- goals

A
  • Goal is to prevent recurrent giving way: to prevent subsequent injuries, such as osteochondral injuries and meniscus injuries
22
Q

ACL treatment- options

A

Three options( as for any unstable joint):
* Modification of activity (no twisting activity)
* Bracing for light twisting activity
* ACL reconstruction (although functional – never normal)

23
Q

ACL reconstruction

A
  • The graft is weakest at 3 to 6 months!
  • High re-injury rates over 2 years after
    reconstruction
24
Q

ACL injury

A
  • anatomical factors
  • biomechanical factors
  • neuromuscular factors
  • hormonal factors
  • training related factors
25
Q

Prevention of ACL injuries

A
  • Modifiable risk factors
  • Weak hip abductors an external
    rotators
  • Increased knee abduction moments during cutting and landing
  • Knee Control training program
  • Adolescent female soccer players
    (n=4600)
  • 64% reduction in the rate of ACL injury was seen in the intervention group
26
Q

ACL injuries on the rise

A
  • Although current ACL injury prevention training programs have been successful in reducing injuries in controlled research settings, the real- world ACL injury rate remains high, and even continues to increase
  • The ACL injury rate for girls/women has not changed in over 20 years, and they remain up to 6 times more likely to experience injury compared with boys/men
  • In addition, as many as 40% sustain a recurrent ACL injury in the same knee or new ACL injury in the contralateral knee
27
Q

Shoulder dislocation and sublixation

A
  • common injuries in contact sports
28
Q

Dislocation

A

complete separation of articulating bones

29
Q

Subluxation

A

partial dislocation of articulating bones

30
Q

typical mechanism

A
  • direct blow to the posterior aspect of the shoulder
  • landing on outstretched arm
  • anterior dislocation, fracture dislocation
31
Q

Diagnosis and treatment

A
  • History and physical exmination
  • imaging
  • reduction of the shoulder (after confirmed diagnosis)
  • protection from re-injury
  • rehabilitation period prior return to sport
32
Q

High risk of recurrence

A

-50-90% depending the type of sport and shoulder dominance
- surgical management (in high-risk population)
- rehabilitation of the shoulder is critical to long-term function

33
Q

Prevention of shoulder dislocations and subluxations?

A
  • strength
    -proper technique
  • neuromuscular training
  • joint position sense

KNES 372 (10 decks)

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