ACL Flashcards
Why is ACL prevention important
ACL injuries take a long time to recover. The recovery is typically 9-12 months during which time there is a large cost for surgery and rehabilitation + psychological burden.
This creates a large burden on both the athlete and the team.
35% of athletes will not return to their previous level of sport and can result in a sedentary lifestyle following injury.
24% of athlete will have a second ACL injury within the first 5 years after ACLR
1st function of ACL
Proprioception
So need to rehab well
When to consider early ACLR
- young
- athlete
- poor stability of knee
Typical concomitant procedures
- lat and med meniscus repair
- MCL surgery
- ant lat procedure
- post lat corner surgery
- chondral or osteochondral procedure
Why is pre-op rehabilitation important
- ensures better self report knee function after ACLR up to 2 year
- Knee extension deficit is a risk for extension deficit after ACLR
- more than 20% imbalance in quadriceps strength has significant negative effect on self reported outcomes 2 years after ACLR
Goals of pre-op rehabilitation
- Maintaining full knee ROM
- minimizing strength deficit (F and E)
Goals of early stage
- pain and swelling
- ROM (no flexion contracture after 1/2 weeks)
- strength
- walking gait
- avoid deconditioning
- psychology
Criteria for progression mid stage
- Pain ( 0-2)
- swelling (0- trace)
- Prom E ( 0 )
- Prom R ( > 120)
- quadriceps recruitment ( full quadriceps activation, no lag in SLR)
- walking without aids
Criteria good to have for progression mid stage
- 90 degree squat
- extension strength LSI >60%
- flexion strength LSI >60%
What is the criteria (–> midstage) for pain and why
- 0-2
- Pain affect joint proprioception and inhibit neuromuscular resulting in muscle atrophy and weakness
What is the criteria (–> midstage) for swelling and why
- 0- trace
- swelling prevent from full ROM, cause pain and indicate overload, prevent from full knee extension that might prevent from progression in resistance training
What is the criteria (–> midstage) for PROM Knee extension and flexion and why
- Extension : 0
- Flexion : >120
Restoring joint mobility important for recovering of optimal gait biomechanics
What is the criteria (–> midstage) for quandricepts recruitment and why
- Full quadriceps activation with no lag in SLR
Quadriceps inhibition can prevent from recovery quad muscle strength and if no achievement within 5 weeks, factors of quad weakness at 6 months
What is the criteria (–> midstage) for walking and why
- Walking without aids
Abnormal walking associated with joint weakness, deficit in functional performance and post-op complications
Soreness rules for progression
- soreness during warm-up that continues = 2 days off + drop down 1 level
- soreness during warm-up that goes away= stay same level
- soreness during warm-up that goes away but redev during session= 2 days off + drop down 1 level
- soreness the day after= 1 days off + stay same level
- no soreness= advance 1 level per week
Mid stage goal
- Full ROM recovery
- muscle strength normalization within 20%
- recovery of basic LL pattern and running gait
- Avoid effect of detraining
OKC
patient might not be able prior to 4weeks but start ASAP without resistance
CKC
improve eccentric control and reduce deficit in strength
Improve function
Goal late stage
- restore neuromuscular function marker within 10%
- restore high load movement quality
- full strength of knee and adjacent joint
- restore aerobic fitness
Limb symmetry index
- single hop
- trip hop
- triple cross-over hop
- 6m timed hop
Should be more than 90% at end of latest stage of rehab
Late stage recommandation from guidelines
- neuromuscular + strength training
- assess and monitor psychological factors
- progress linear running speed to 95% max speed (before injury)
Return to sport guidelines
- no time-basef decision making
- multidisciplinary decision
- global testing
- LSI > 90% and 100% for pivot and contact sports
Role of hamstring
Important dynamic stabilizer of knee joint
