Week 12 ACL Injuries Flashcards

1
Q

T/F An ACL injury is not an isolated injury

A

True!
- Meniscus injury
- collateral ligament injury
- bone bruises
- bone marrow changes and cartilage thinning after 6 years following an ACL injury

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2
Q

T/F ACL injury effects muscle and NM control

A

True
- injury affects mechanoreceptors

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3
Q

What is a gait one may present with if they have an ACL tear?

A

Quadriceps avoidance gait

(Knee flexed gait)

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4
Q

What are some anatomic differences between males/ reasons why females may have more ACL injuries

A
  • 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
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5
Q

What criteria do patients have to meet to be considered a “coper” and attempt to rehab nonoperatively

A
  • 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%
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6
Q

What are the advantages of an Allograft tissue for ACL Surgery

A
  • Cadaveric donor
  • no donor site morbidity
  • uniform graft size
  • smaller incision
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7
Q

What are the disadvantages of an Allograft tissue for ACL Surgery

A
  • 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
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8
Q

Autograph Comparison
1. Bone- Patella Bone
2. Hamstring

A
  1. Bone
    - strongest at initial fixation
    - return to athletics quicker
    - increased risk for patellofemoral issues/patellar fx/tendinitis
    - more painful
    - Extra incision for graft harvest
  2. 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
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9
Q

Meniscus Surgery/Repair Do’s and Don’ts

A
  • 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
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10
Q

What are some treatments/interventions for a Chondral Injury?

A
  • 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
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11
Q

What is the current ACL rehab approach

A

Immediate motion and early weight bearing
- immediate muscle exercises
- closed kinetic chain exercise
- early functional activities
- earlier return to sport

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12
Q

What are the stages of ACL repair

A
  1. pre-operative stage
  2. immediate post operative stage
  3. Intermediate phase
  4. Advanced stage
  5. return to activity stage
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13
Q

Immediate Post-Op Phase Goals

A
  • restore full passive knee extension
  • diminish welling and pain
  • restore patellar mobility
  • gradually improve knee flexion
  • re-establish quadriceps control
  • restore independent ambulation
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14
Q

Immediate Post-operative Phase Days 1-7

A
  • brace in full extension /crutches
  • full passive knee extension
  • flexion progression : day 5 = 90 degrees: day 7= 100 degrees
  • progressive exercises
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15
Q

ACL Rehab Range of motions =

A

week 1= 90 degrees
week 2= 105-110 degrees
week 3= 115-125 degrees
week4= 125 degrees or greater

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16
Q

Intermediate Rehab Goals

A
  • full passive knee extension
  • gradual improvement in knee flexion
  • muscle training
  • restoration of proprioception
  • reduce joint swelling/pain
  • independent ambulation
16
Q

Weightbearing Guidelines Accelerated vs. regular rehab

A

Accelerated
- brace 2 weeks
- crutches 7-10 days

Regular Rehab
- brace 4 weeks
- crutches 10-14 days

17
Q

What are some proprioception drills during ACL rehab

A

Level 1=
- joint reproduction, CKC drills, weight shift, weight distribution, knee sleeve

Level 2=
- squats
- balance drills
- single leg stance
- step-overs
- pool

18
Q

Advanced Activity Phase (weeks 10-16)

A
  • progress isotonic strengthening
  • Continue proprioception and NM control
  • Sport specific training : like side shuffles/backwards running
  • Progress endurance training
19
Q

Return to Activity Phase ( week 16-22)

A
  • KT results
  • isokinetic results
  • Hop test
  • outcome measures
20
Q

What are the advantages and disadvantages to an ACL brace

A

Advantages
- subjective reports “feels better”
- diminishes tibial translation
- Increased EMG quad, hamstring, gluteal
- improved proprioception-neoprene

Disadvantages
- higher forces/brace ineffective
- increased energy consumption
- alters kinematics (decreased ROM)
- False sense of security/stability
- cost

21
Q

What is the future of my ACL reconstructed knee?

A
  • 40-90% of ACL patients exhibit radiographic knee OA 7-12 years following surgery
  • 10x greater rate of OA in ACL injured knee
22
Q
A