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U1 PBT LGS > LGS 3 > Flashcards

LGS 3 Flashcards

1
Q

An ACL injury is a ______ sprain.

A

An ACL injury is a LIGAMENT sprain.

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2
Q

Majority of ACL tears are incomplete. True or False?

A

False.

5-15% are partial, most are full

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3
Q

What are the connection points of the ACL?

A

Anterolateral part of tibial plateau –> lateral femoral epicondyle

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4
Q

What are the main ways to differentiate muscle strains vs ligament sprains?

A

Muscle spasm –> ligament sprain has NONE
Pain on contraction –> ligament sprain has NONE

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5
Q

What is the function of the ACL?

A
  • Prevents anterior tibial translation

“X” from ACL & PCL also prevents some rotational forces

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6
Q

What is the incidence of ACL injuries in the US?

A

1 in 3,500 people

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7
Q

ACL is the most commonly injured ligament in the knee. True or False?

A

True.

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8
Q

Why are females at a greater risk of ACL injuries than males?

A
  • Muscle imbalance: weaker hamstrings, preferential use of quads while decelerating
  • Increased valgus angulation of the knee
  • Increased circulating estrogen (controversial)
  • Different genetic expression (upregulation of aggrecan and fibromodulin and downregulation of WISP2)
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9
Q

Females are 2-100x at greater risk than males to get an ACL injury. True or False?

A

False.
there is a 2-10x greater risk.

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10
Q

ACL injuries typically occur in what populations?

A
  • Young (peak age of 17yrs)
  • Active individuals
  • Participate in sport
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11
Q

What is the etiology of ACL tears?

A
  • Most commonly, non-contact mechanisms
    (Decelerating and rotational forces)
  • Sudden changes in direction, rapid stopping, jumping and landing abnormally, direct blow to lateral aspect of the knee (valgus force)
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12
Q

What athletes/ sports are at highest risk for ACL injuries?

A

Skiers, soccer players, basketball players, football players

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13
Q

What are some risk factors for ACL injuries?

A
  • Female
  • Patella Alta
  • Increased tibial slope
  • Small notch width index (NWI)
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14
Q

What are some common differential diagnoses for ACL injuries?

A
  • Epiphyseal fracture of femur or tibia
  • Medial collateral knee ligament injury
  • Meniscal tear
  • Osteochondral fracture
  • Patellar dislocation
  • Posterior cruciate ligament injury
  • Tibial spine fracture
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15
Q

What are some ways to diagnose ACL injuries in the clinic?

A
  • Observation,
  • ROM,
  • Muscle strength testing
  • Special tests:
  • Anterior Drawer
  • Pivot Shift
  • Lachman’s test
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16
Q

What are some ways to diagnose ACL tears outside of the clinic?

A
  1. MRI (primary modality)
    - High Sn (86%) & Sp (95%)
  2. Knee arthroscopy
    - To differentiate between partial & complete tears
  3. Arthrography
    - Gold standard (92-100% Sn & 95-100% Sp) however rarely used
17
Q

What is the typical natural history for a complete ACL tear?

A

Large majority will have surgical repair/ligament reconstruction
(Allograft or autograft)

18
Q

What are the medium-term (3 months-2 years) risk of instability, meniscal lesion, and osteoarthritis for complete ACL tears?

A
  • secondary instability: 15 -66%
  • secondary meniscal lesion: 15 -86%
  • osteoarthritis: 30%-100%
19
Q

What is the natural history of partial ACL tears?

A
  • Good short- & medium-term functional results
  • Especially when patients limit their sports activities
  • Residual pain is frequent (especially on effort) in patients without subjective instability
  • Laxity seems to progress with time
  • Low level demand: functional management is indicated
  • High level demand: may consider ligament reconstruction
20
Q

What are some signs & symptoms of ACL tears?

A
  • Hear and / or feel a sudden pop
  • Feeling of knee giving way at the time / after injury
  • Tenderness along the joint line
  • General knee pain
  • General knee swelling
  • Decreased range of knee motion
  • Difficulty walking
21
Q

Overall, there is a high level of satisfaction with treatment/ surgery of ACL tears. True or False?

A

True.

22
Q

When do most patients demonstrate near complete revolution of pain and range of motion limitation after ACL reconstruction?

A

around 12 weeks

23
Q

What percentage of patients maintain their preinjury level of play ability 4 years after surgery?

A

<50%

24
Q

What are some future risks for individuals who have ACL tears?

A
  • Instability
  • Meniscal injury
  • Osteoarthritis
25
Q

What are some poor prognostic factors for ACL injuries?

A
  1. Younger age
    - Adolescents are 2.5x more likely to undergo revision ACL reconstruction compared with a similar adult cohort
  2. Returning to cutting / pivoting sports:
    - Increases odds of graft rupture by 3.9 and contralateral rupture by 5.45
26
Q

Once an ACL injury & reconstruction has occurred, if a player returns to a pivoting sport, what are the odds of graft rupture? What bout contralateral rupture?

A

Increased odds of graft rupture: 3.9x
Contralateral rupture: 5.45x

U1 PBT LGS (3 decks)

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