Week 3 Soft tissue injury and knee SPP

Question 1

What are the common treatments for ligament tears?

Answer 1

1. ACL
   - nonoperative: brace and rehab
   - operative: for the <40 yo active patient. Use graft, then controlled rehab
2. PCL
   - less common, generally nonoperative
3. MCL
   - common and nonoperative: brace, PT
4. LCL
   - rare, usually associated with PCL injury or other

Question 2

How do you test for an ACL injury?

Answer 2

1. Lachman Test
   - leg fleet at 30 degrees, tibia pulled forward
2. Pivot Shift test
   - recreates injury, instability
   - tibia pops back in while flexing
   - very painful and usually not done unless sedated
3. Anterior Drawer
   - not as accurate as Lachman test

Question 3

What are signs of a ligament tear in acute hx?

Answer 3

• pop
• pain
• rapid onset
• unable to play sports
• unstable

Question 4

How do you test for PCL injury?

Answer 4

• Posterior drawer test

- flex leg at 90 degrees and push posterior

Question 5

How do you test for an MCL injury?

Answer 5

-Valgus stress test, pull leg laterally

Question 6

How do you test for an LCL injury?

Answer 6

-Varus stress test, pull leg medially

Question 7

How do you test for a meniscus injury?

Answer 7

1. Joint line tenderness

2. McMurray Test-listen for a pop or click or pain

Question 8

In the history, what does immediate knee swelling w/ difficulty walking vs. continued participation after injury indicate? (after a sports injury)

Answer 8

1. Immediate knee swelling, difficulty walking
   - ACL
   - Acute patella dislocation
   - tibial plateau fracture
2. continued participation after injury
   - Meniscus injury
   - patella subluxation
   - mild collateral ligament