op ligamental knee injuries

Question 1

compare rehabilitative and functional bracing

Answer 1

rehab - hinged and rage limiting; 1st 6 wks

functional - returning to sports

Question 2

discuss immob and bracing guidelines post op

Answer 2

ACL - 6 wks
PCL - 8 wks

unang 4-6 wks: 90-100° flexion lng muna until onti onti ext

locked in full ext for 24 hrs
removed during ROM ex
weaned of if full ext is achieved

Question 3

discuss WB considerations post op

Answer 3

ACL
- restricted WB for 2 wks to WABT c BAC
- FWB after 4 wks
- dpat pain free and full ext and good quads control

PCL
- PWB to NWB for 5 wks
- FWB s AD after 8-10 wks
- no pain or effusion, full AROM, 70% quads and no gait dev

Question 4

pre op exercise considerations for ACL

Answer 4

restore full ROM esp ext
prevent atrophy and weakness
improve hip and ankle stregnth and felx

Question 5

resistance training precuations for ACL

Answer 5

hamstring tendon graft - more gradual progresss

caution in strengthening of hams since dun nag harvest

avoid squatting beyond and CKC quad ex at 60-90° flexion

place resistance at distal thigh for OKC
- avoid short arc ext for 6-12 wks (45-30° to full ext)

Question 6

max prot phase

Answer 6

4-6 wks

mod

muscle sets c NMES
4 pos SLRs
heel slides - delay if hams graft

multiple angle isoms
- PCL: up to 25-30° flexion

PROM - AAROM
pat mob
pos stretch

weight shifting ex
stepping ang marching

amb training c AD and brace

Question 7

criteria to prog to mod prot

Answer 7

min pain and swelling
full active ext
100-110° flexion
50-60% quads
no joitn laxity

Question 8

mod prot phase

Answer 8

10-12 wks

mod

CKC - singe leg
OKC - within precatuions

low intenstiy end range stretching
gr 3 PJM

stationary bike, swimming and aquatic rehab

proprioception drills - stable to unstable

amb training s AD and brace

Question 9

criteria to prog to min prot

Answer 9

no pain and effusion
full AROM
75% STREGNTH
fucntional hop test > 70%
hams and quads ration > 65%

Question 10

min prot phase

Answer 10

6 mo.

PREs, eccentric and advanced CKC

advanced balance training - on ball, catching

agility drills and plyos

Question 11

criteria to progress from min

Answer 11

no pain and effusion
full AROM
85-90% quads
hams 100%
hams and quads ration > 70%
100% proprio
functional testing > 80%