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MS Test 3: Lower Quarter > Ligamentous Injuries of Knee > Flashcards

Ligamentous Injuries of Knee Flashcards

1
Q

What is the primary role of the ACL?

A

primary restraint to anterior tibial translation, greatest stress at 20-30 degrees flexion

secondary restraint to tibial ER

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2
Q

What is primary MOI for ACL?

A

fixation, rotation and valgus force and also deceleration and hyperextension

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3
Q

What percentage of ACL injuries also damage meniscus?

A

70%- usually with valgus stress

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4
Q

What is PP of ACL?

A

hearing or feeling a pop, acute onset of pain, sensation of giving way, delayed onset of swelling

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5
Q

What is the gold standard for ACL testing?

A

Lachman’s

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6
Q

When is a primary repair indicated?

A

true avulsion- teens, ligaments stronger than bones

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7
Q

What are two types of grafts for an ACL reconstruction?

A

allo- cadaver, possible longer healing time

auto- creates another morbidity in knee

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8
Q

How long does it take a patellar graft to be vascularized and innervated?

A

8 weeks- blood

innervation - 6 months

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9
Q

What is an important thing to remember about a patella tendon autograft?

A

donor site may need 6-8 weeks healing prior to tolerating quad load greater than 60 degrees

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10
Q

Which type of graft will have the strongest holding strength?

A

semitendinosous graft

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11
Q

What are advantages of a PT graft?

A

excellent strength, excellent long term results, allows for aggressive rehab (biological tissue healing as its bone to bone healing)

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12
Q

What are disadvantages of PT graft?

A

possible extensor weakness, may lead to patella fracture, tendon rupture, tendinitis, excessive scar tissue

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13
Q

Why is their a potential for excessive scar tissue for PT graft?

A

because they are doing two procedures there is going to be a lot of bleeding which leads to scar tisseu

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14
Q

What can be done to help prevent scar tissue?

A

soft tissue work and patella mobs

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15
Q

What are advantages of a HS graft?

A

much stronger than patella, extensor mechanism intact

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16
Q

What are disadvantages of a HS graft?

A

limited long term F/U studies, rehab is slower as its only soft tissue healing

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17
Q

What is rationale behind doing a double bundle ACL reconstruction?

A

single does not adequate restore mobility and may lead to OA sooner, double replicates natural ACL which has 2 bundles

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18
Q

What does the term ligamentization refer to?

A

graft is strongest on day its implanted but will decrease in strength and will be lowest at 3 months post op

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19
Q

Which kind of graft has a slower recovery time?

A

HS slower than patella but won’t affect outcome measures

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20
Q

What are the major success criteria for ACL rehab from a PT prospective?

A

restore LE strength and full ROM, normal gait, pain free activity, return to pre injury function

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21
Q

When is the ACL under most amount of strain?

A

stressed throughout all ROM but most when quad activity is between 40-0 degrees

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22
Q

What are major treatment principles for ACL?

A

increase weight bearing, knee complex strength, edema control, proprioceptive training, endurance training, agility activities

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23
Q

What are precautions for post op if pt also has a meniscal injury?

A

may not be WBAT, no deep squats, no isolated HS for 8 weeks

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24
Q

What should goals for pre-op rehab be before ACL reconstruction?

A
  • ROM should be equal to contralateral knee
  • volitional quad activation, no lag with SLR
  • minimal to absent joint swelling
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25
Q

What are goals for first week after surgery?

A

passive knee extension to 0 degrees

flexion to 90 degrees- patella mobs, bike with no resistence

26
Q

What are goals for week 2 of rehab?

A

full knee extension, SLR without lag, flexion greater then 110 for knee(unless meniscus involved), walking without crutches, reciprocal stair climbing

27
Q

What are sample interventions during week 2?

A

Patella mobs, prone hangs, wall squats, hip/calf strengthening, balance

28
Q

What are goals for weeks 3-5 post op ACL?

A

improve quad strength to 60% of uninvolved, flexion ROM within 10 degrees of opposite side, enhanced proprioception, improve endurance

29
Q

What are interventions weeks 3-5 post op ACL?

A

bike over 10 minutes, balance- perturbation, single leg work

30
Q

What are goals for weeks 6-8 post op ACL?

A

normal gait, symmetrical ROM, quad strength 80% of uninvolved

31
Q

When can a running program potentially begin?

A

for patella graft around 8-12 weeks must have little to no swelling, adequate strength, and must not have pain or swelling after run

32
Q

What are goals and interventions for weeks 9-12 post op ACL?

A

quad strength 80% opposite leg, hop tests 85 % (12 weeks)

sports specific and agility work

33
Q

When can return to activity work resume post op ACL?

A

16 weeks potentially need to have no swelling full ROM, completion of running program, 90% quad and hop test

34
Q

What are two areas for female athletes can PT control most in ACL prevention?

A

neuromuscular strength and coordination

35
Q

What are intrinsic risk factors for ACL injury in females?

A

age, strength, flexibility, joint geometry, joint laxity, anatomical alignment, hormones

36
Q

What are 4 major risk factor categories for ACL in females?

A
  1. environment
  2. anatomical
  3. hormonal
  4. neuromuscular
37
Q

What anatomical features in females lead to more ACL injuries?

A

larger Q angle, APT, wider pelvis, hip ante version , increased genu valgum, increased laxity and flexibility, less developed thigh muscles

38
Q

What is the main difference in femoral notch between males and females?

A

females is smaller which can lead to impingement on the ACL

39
Q

What two hormones are causes for higher ACL injury rate?

A

estrogen and relaxin

40
Q

What happens at distal leg that can lead to ACL injury in females?

A

limited dorsiflexion can lead to pronation as compensation which cause genu valgum

41
Q

What is difference in landing mechanics in males vs females?

A

males- Gastroc - hammys then quads fire

females- opposite meaning females land with less hip and knee flexion

42
Q

What planes do females use to decelerate?

A

frontal and transverse while men uses mostly saggital

43
Q

Why is endurance training for female athletes important for quad and hamstring?

A

when these muscles are fatigued then anterior tibial translation is increased by 33%

44
Q

What is typical MOI for PCL?

A

dash board, trauma usually a major knee injury with other structures involved

45
Q

What special tests are used for PCL?

A

posterior drawer, posterior sag

46
Q

What are treatment interventions for PCL?

A

edema and pain control, gait training, mobility and strength exercises, closed chain to promote stability

47
Q

What should be avoided during PCL rehab?

A

kneeling

48
Q

What special tests are used for MCL?

A

Valgus at 0 and 30 degrees

49
Q

What can results of special tests for MCL and LCL tell you?

A

if pain at 0 degrees it could be ligaments or capsule injury

if pain at 30 likely ligament injury

50
Q

Along with MCL what is usually also damaged?

A

ACL and meniscus

51
Q

What are special considerations for conservative rehab for MCL?

A

normalize quad function, avoid valgus stress, PRE with tibial IR, dynamic stabilization and HIP strength

52
Q

What is a common co morbidity with LCL injuries?

A

fibula head and peroneal nerve

same rehab as MCL except avoiding varus stress

53
Q

What are the main structures of the PLC?

A

LCL- stabilizes varus 0-30 and assists with control of tibial ER

Popliteus- dynamic stability against tibial ER

Popliteofibular ligament- similar functions

54
Q

What are other structures that could be consider part of PLC?

A

ITB, Bicep femoris, lateral gastroc, lateral joint capsule

55
Q

What is main role of PLC?

A

augments PCL and helps prevent hyperextension, tibial ER and varus angulation through static and dynamic stability

56
Q

What is typical MOI for PLC?

A

force to anteromedial knee, knee hyperextension, tibial ER with knee in flexion or hypertext.

57
Q

What is PP for PLC?

A

varus thrust due to instability, hyperextension, foot drop due to damage to peroneal nerve

58
Q

What are sensory and motor function for peroneal nerve?

A

sensory- 1st dorsal web space

motor- DF, EV, greta toe extension

59
Q

What are major tests for PLC injury?

A

PL drawer, Dial test, ER recurvartum, varus test

60
Q

What is ER recurvartum test used for?

A

suspected ACL and PLC injury

MS Test 3: Lower Quarter (10 decks)

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