Managing Acute Knee Injuries

Question 1

Indications for surgery

Answer 1

Children/adolescents
Young active adults (18-35)
Desire to return to sports with pivoting and cutting
Concomitant injuries (meniscus, chondral, other ligament)

Question 2

Indications for conservative care

Answer 2

Older
Sedentary
Able to modify activity
Option of late reconstruction

Question 3

Stages of rehabilitation

Answer 3

Prehabilitation (0)
Immediate post op (1)
Functional strengthening; sport specific activities (2)
Return to play (3)

Question 4

Goals of prehabilitation

Answer 4

Decrease swelling and pain
Full ROM
Normal gait
Patient education

Question 5

4 Modifiable risk factors that make outcomes worse

Answer 5

Smoking
BMI > 30
Quads strength deficits
ROM deficits

Question 6

2 benefits of early surgery, 1 benefit of late

Answer 6

Earlier: decreased risk of meniscal and chondral injuries, decreased loss of muscle strength
Later: decreased risk of arthrofibrosis

Question 7

2 autografts for ACL reconstruction

Answer 7

Hamstrings
Patellar tendon (most)

Question 8

Meniscal injuries + ACL tears increase the risk of…

Answer 8

Osteoarthritis

Question 9

Closed kinetic chain

Answer 9

Distal segment is fixed in space and cannot move
Ex: squats, leg press, lunges, push ups, chin ups
Distributed force, more compression (less anterior force on the ACL)
Start with CKC

Question 10

Open kinetic chain

Answer 10

Distal segment is free to move
Ex: leg extension, leg curl, hip extension, biceps curl, bench press
Get more shearing of the joint and tugging on the ACL

Question 11

General time frame for return to play

Answer 11

6-12 months post surgery

Question 12

Criteria for return to play

Answer 12

No pain or swelling
Full knee flexion and extension ROM
Quads and hamstring strength > 85% vs contralateral side
Hop tests > 85% vs contralateral side
Movement quality
Psychological readiness