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Musculoskeletal II > ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION > Flashcards

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Flashcards

1
Q

After a 2 week post op ACL reconstruction, if quadriceps control is achieved without a lag on SLR

A

discharge the brace and crutches by the end of week 2

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2
Q

p/o ACL recontruction, restore knee flexion to ______ on the _____ days following surgery

A
  1. 100° on the 10-14 days following Sx. SUPINE!
  2. 120 after 1 mo
  3. After weeks can be done in prone
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3
Q

Intervention to restore passive knee extension post ACL reconstruction.

Should the therapist restore hyper-ext to same ROM as the other side?

A
  • Low-load prolong stretch for at least a total of 60 minutes a day
  • Restore hyperextension to the other side if necessary:
    • after 6 weeks: at least 1/2 that of the other side (speak to the physician about this)
    • Ex. female with pre/op 15-0-150 knee flexion bilaterally.

​

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4
Q

Most common complication after ACL reconstruction

A

passive knee extension loss

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5
Q

Effusion (swelling), and pain in the knee increases autogenic inhibition of the

A

quads

“If you don’t get the inflammation out you will not restore quad function” Dr. M

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6
Q

Patella tendon autograft:

A
  • Gold standart
  • Bone to bone healing (best)
  • Higher risk of patellofemoral pain syndrome.
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7
Q

p/o ACL reconstruction knee ROM goal is:

A

Goal of 120° of knee flexion 1 month after surgery

Do not aggressively stretch into knee flexion with a large effusion

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8
Q

ACL + MCL injury

WB?

A
  • no valgus stresses
  • WB as tolerated
  • most MCL injuries heal on
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9
Q

post ACL reconstruction, ways to re-establish normal voluntary quadriceps control:

A
  • Neuromuscular electrical stimulation with a combination of quad sets and SLR (research for this)
  • OKC knee extension 90-40° when appropriate
    • Board exam: OKC is contraindicated
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10
Q

Patella tendon autograft can be rehabilitated more _________early on as compared to hamstring autograft

A

aggressively

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11
Q

ACL + articular cartilage injury

A
  • similar to meniscus:
    • WB limited for 6 weeks
    • then WB program
    • if effusion, back up!
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12
Q

After a ACL reconstruction, what will aide in discharging the brace and crutches by the end of week 2?

A
  1. Reduce post-operative inflammation: ice, ice, ice with elevation during the first week
  2. Restore volitional control of quads (10 SLR, descending stairs)
  3. if quadriceps control is achieved without a lag on SLR,
    1. Take brace first, leave crutches.
    2. Then one take one crutch
    3. The the other.
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13
Q

If you are going to use OKC exercise in the first 6 weeks post ACL reconstruction….

A
  • better be from 90 to 40
  • “better not to do any OKC” (Dr. M)
  • the goal at this point is to reduce inflammation, restore ROM, get rid of brace and crutches.
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14
Q

Bone-to-bone healing (patella tendon graft) faster:

A

8 weeks

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15
Q

post ACL reconstruction, proprioceptive training as early as week ____ based on quad control

A

2

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16
Q

ACL Allograft:

A
  • Used for older individuals or revisions ACL Sx.
    • greater risk of infection or graft failure

The transplant of an organ or tissue from one individual to another of the same species with a different genotype. For example, a transplant from one person to another, but not an identical twin, is an allograft. Allografts account for many human transplants, including those from cadaveric, living related, and living unrelated donors. Also known as an allogeneic graft or a homograft.

17
Q

it is imperative to reduce swelling, inflammation, and pain, restore normal ROM, normalize gait, and pre­vent muscle atrophy prior to _____

A

surgery

18
Q

ACL reconstruction, 2 clinical pearls:

A
  1. the strength of the surgical repair always should be much greater than the mechanical stress that is placed on the repaired tendon during rehabilitation (manual therapy, clinic exercises, HEP)
  2. it is imperative to reduce swelling, inflammation, and pain, restore normal ROM, normalize gait, and pre­vent muscle atrophy prior to surgery.
19
Q

Criteria for returning to play p/o ACL reconstruction

A
  1. Satisfactory clinical exam
  2. Symmetrical ROM without pain
  3. Greater than 90% quadriceps strength of the uninvolved leg
  4. Functional hop testing of at least 85% of the uninvolved leg
20
Q

Patella tendon autograft can be rehabilitated more ______early on compared to hamstring autograft

A

aggressively

(but may develop PFPS)

21
Q

A patient with an ACL reconstruction asks you when can they take the brace and crutches off. What is your answer?

A
  • “When you have restored volitional quad control as to walking and descending stairs knee does not buckle.”
  • When the pt can do a SLR without a lag 10 times.
  • Then: you can remove the brace.
  • Then the crutches
  • DO NOT say “consult your surgeon”
22
Q

Loss of patellar mobility can affect _____ gains and inhibit ________

A
  1. ROM
  2. quad function
23
Q

notes on restoring knee flexion post ACL reconstruction:

A
  • Supine: 100 in the fisrt 10-14 days
  • 120 in 1 mo
  • Prone: after 6 weeks
  • Flexion comes back as the inflammation goes away
24
Q

p/o ACL reconstruction, Bone-to-bone healing is __________ than soft tissue to bone healing (___)

A
  1. faster (8 weeks)
  2. 12 weeks
25
Q

Post ACL reconstruction, neuromuscular control progression exercises:

A
  1. Neuromuscular electrical stimulation with a combination of quad sets, SLR, and OKC knee extension 90-40° when appropriate
  2. Begin with bilateral WB weight-shifting exercises
  3. Progress to unilateral drills with perturbations over the next several weeks from stable to unstable surfaces

​

26
Q

ACL hamstring graft:

A
  • Takes longer to incorporate because is soft tissue to bone healing
  • No hamstrings exercises for ~8 weeks.
27
Q

Hamstring autograft no resisted hamstring exercises for the first _______

A

8 weeks

28
Q

ACL + meniscus tear:

A
  • menicus repair?
    • TTWB for 6 weeks
    • no knee flexion more than 60-90 fro 6 weeks
    • no resisted hamstring exercises
29
Q

soft tissue to bone healing (hamstring graft):

A

12 weeks

longer than patella graft.

No hamstring exercises for 6 weeks.

Musculoskeletal II (6 decks)

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