Week 12 ACL Injuries Flashcards
T/F An ACL injury is not an isolated injury
True!
- Meniscus injury
- collateral ligament injury
- bone bruises
- bone marrow changes and cartilage thinning after 6 years following an ACL injury
T/F ACL injury effects muscle and NM control
True
- injury affects mechanoreceptors
What is a gait one may present with if they have an ACL tear?
Quadriceps avoidance gait
(Knee flexed gait)
What are some anatomic differences between males/ reasons why females may have more ACL injuries
- Wider pelvis
- Increased genu valgus
- narrower femoral notch
- Increased tibial torsion
- Less developed thigh musculature
- Increased flexibility
- Decreased knee flexion angles/ Q dominant knee
- Decreased cutting and landing from jumping
- lateral trunk displacement
- hormonal changes
What criteria do patients have to meet to be considered a “coper” and attempt to rehab nonoperatively
- have full isolated ACL tear (no meniscus or other ligaments injured)
- full pain free knee ROM without effusion
- affected quadricep MVIC 70% of unaffecte4d
- tolerate pain free single leg hopping
- No more than 1 episode of giving way since injury
- Hop test score >80%
- KOS ADL scale score >80
- Global knee rating >60%
What are the advantages of an Allograft tissue for ACL Surgery
- Cadaveric donor
- no donor site morbidity
- uniform graft size
- smaller incision
What are the disadvantages of an Allograft tissue for ACL Surgery
- sterilization/irradiation may effect tissue strength
- disease transmission and infection
- infection HIV 1:8/ Infection 26 million every year
- Slower graft incorporation
- some studies have shown more likelihood of graft failure
Autograph Comparison
1. Bone- Patella Bone
2. Hamstring
- Bone
- strongest at initial fixation
- return to athletics quicker
- increased risk for patellofemoral issues/patellar fx/tendinitis
- more painful
- Extra incision for graft harvest - Hamstring
- least pot op again
- quicker post op quad activation for harvest and fixation
- hamstring weakness
- return to athletics slower
- increased incidence of hamstring strains
Meniscus Surgery/Repair Do’s and Don’ts
- immediate passive motion
- full passive knee extension
- weight bearing with crutches
- NO ACTIVE knee flexion beyond 90
- NO hamstring strengthening 6-8 weeks
- NO deep flexion squatting 3 months
- return to sports at 5-7 months
What are some treatments/interventions for a Chondral Injury?
- immediate motion
- full knee extension
- reduce swelling
- weight bearing: microfracture = toe touch : Mosaicplasty= NWB for 2-4 weeks
- pool program
- No excessive loading for 3-4 months
What is the current ACL rehab approach
Immediate motion and early weight bearing
- immediate muscle exercises
- closed kinetic chain exercise
- early functional activities
- earlier return to sport
What are the stages of ACL repair
- pre-operative stage
- immediate post operative stage
- Intermediate phase
- Advanced stage
- return to activity stage
Immediate Post-Op Phase Goals
- restore full passive knee extension
- diminish welling and pain
- restore patellar mobility
- gradually improve knee flexion
- re-establish quadriceps control
- restore independent ambulation
Immediate Post-operative Phase Days 1-7
- brace in full extension /crutches
- full passive knee extension
- flexion progression : day 5 = 90 degrees: day 7= 100 degrees
- progressive exercises
ACL Rehab Range of motions =
week 1= 90 degrees
week 2= 105-110 degrees
week 3= 115-125 degrees
week4= 125 degrees or greater