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MSK Sprains > Anterior Cruciate Ligament > Flashcards

Anterior Cruciate Ligament Flashcards

ACL

1
Q

What attaches centrally and anteriorly on the tibial plateau?

A

ACL

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2
Q

ACL runs?

A

superior, posterior and laterally

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3
Q

ACL also attaches

A

to lateral aspect of the intercondylar fossa

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4
Q

what excessive tibial motions will the ACL limits?

A

anterior tibial glid e

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5
Q

the Primary restraint to excessive anterior tibial glide and secondary restraints to tibial IR/hyperextension is

A

ACL

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6
Q

What is the prevalence of the ACL

A

20% of all knee injuries
most in younger and active biological females

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7
Q

what are non modifiable risk factors for non contact injuries for biological sex(acl)

A

-females tears>male tears; two weeks following start of menstrual period

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8
Q

what are non modifiable risk factors for non contact injuries for bony morphology? (acl)

A

narrow intercondylar femoral notch
posterior tibial lope and hyperextension both correlated with non contact ACL injuries

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9
Q

what are non modifiable risk factors for non contact injuries

A

congenital joint hypermobility

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10
Q

what are risk factors primary acl injury that are modifiable?

A

-high shoe surface interaction and friction
-BMI
-bracing inconsistent benefit
muscle strength; lower overall with ACL tears
ham to quad ratio strength
lower in biological females vs males
quads pull tiba forward
hamstrings pull tibial posterior

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11
Q

why are the hamstring important to the ACL?

A

helps prevent anterior tibial translation

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12
Q

Risk factors primary ACL injuries that are modifiable

A

altered loading patterns
w/ increased dynamic knee valgus and hip add
- earlier and nearly 2x faster with impaired LE control
-very good ability to visually identify high knee valgus angles with vertical drop jump
-decreased knee flexion with larger ground reaction forces or harder landing

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13
Q

*ACL
poor control ( with a squat)

A

significant valgus movement knee medial to foot

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14
Q

ACL
reduced control(with squat)

A

some valgus movement kness NOt entirely medial to foot

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15
Q

ACL (with squat) good control

A

no valgus mvement and knee vertical with toes

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16
Q

Rick factors primary ACL injuries
modifiable

A

-impaired trunk proprioception and kinesthesia
-greater trunk lean toward support limb
-greater trunk rotation toward support limb
-greater activation of visual motor strategy vs sensory and motor strategy

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17
Q

Risk factors for a second ACL injuries

A

like primary ACL injury plus excessive femoral IR momnet

which muscle needs addressed more? ER

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18
Q

What are causes/ etiology of ACL tears?

A

NOn contact 70%
Contact 30%

19
Q

What are the symptoms of anterior cruciate ligament?

A

-consistent with any sprain plus
-effusion, popping, and giving away following trauma
-wbing activities limited giving away

20
Q

what are signs of ACL

A

signs; consistent with any sprain plus

ROM limited and painful, particularly into hyperextension and IR( tibia wants to glide anterior)

21
Q

Sings of ACL( special test)
Anterior Drawer

A

if popping, effusion, and giving away after trauma

torn acl

22
Q

signs of acl (special test)
Lachmans

A

possible false negative due to blocking of the anterior glide; severe swelling tightens capsule hamstring guarding and meniscal tear

+ pivot shift hugh spec

23
Q

What leads to muscle inhibition

A

swelling, pain, joint laxity, and disuse

24
Q

signs of MMT/M activity arthrogenic muscle inhibition of quads due to?

A

-pain
-effusing(joint swelling); involves knee inhibition, the uninvolved knee inhibition, amount of swelling not always correlated with amount of muscle inhibition
-joint laxity or giving away
-muscle weakness or incoordination

25
Q

signs of MMT/M activity arthrogenic muscle inhibition of quads lead to?

A

Atrophy and more inhibition and weakness-deficits common out to 2-4 years post op and even in both LE’s

Determined by observation, palpation , and muscle testing

26
Q

PT RX for ACL

A

most can return to lower risk activity without SX and with good outcomes

27
Q

what are the three primary and early goals of PT RX?

A

full to nearly full ROM especially ext.

*immediate mobilization for ROM, Pain, and minimizing immobilization effects for moderate support

*ideally full extension no longer than 4 weeks.
predicts extension at 12 weeks
contributes to lower risk of OA

28
Q

what are the three primary and early goals of PT RX?

A
  1. minimal to no swelling
  2. quads activation endurance, and coordination; best with full extension
    SLR without extension lag
    -Quad set 90% of the uninvolved side
29
Q

PT RX for ACL with earl weight bearing?

A

without detrimental effects if symmetrical and leads to better outcome

30
Q

PT RX for ACL Policed

A

Weak support for cryotherapy

weak support for continuos passive motion CPM devices

31
Q

PT RX for Acl

A

Manual therapy needed post-op

32
Q

MET for ACL

A

Neuromuscular electrical stimulations NMES for activation coordination and strength;
*significant increased in quad strength;
*no change in function
*isometric abd varying based upon symptoms and commorbidities
*discontinus once quad index is > 80% of uninvolved side

33
Q

PT RX: MET for ACL

A

-assumptions must be made about atherogenic muscle inhibition
-gradually progress to intense resistive training without inducing
-emphasize both concentric and eccentric training

34
Q

PT RX; MET for ACL

A

general exercises guidelines for initial ACL loading
Non weight bearing vs weight bearing
normally greater with non weight bearing extension. NON weight bearing or OKC activities less of a concern then in past.
* greatest load is within 50 degress of full extension

35
Q

PT RX; MET for ACL

A

squatting lunging and leg press;
increased with knee beyond knee
decreased with forward trunk lean

36
Q

PT RX; MET for ACL

A

general exercise guidelines for ACL loading and walking: as much load as non weight bearing knee extension due to repetitive terminal knee ext
*several times greater than other weight-bearing activities

SN: OKC and CKC activities earl and often especially if they are walking and using correct trunk and LE control carefully and progressively work towards end rang ext

37
Q

with PT RX what MET should emphasize on?

A

hamstring strength and coordination

*hams> 66% of quad activity for males
*hams> 75% of quad activity for females
predicts LE control

38
Q

PT RX; MET for ACL neuromuscular training

A

NOrmal strength and proper neuromuscular or LE control

trun proprioception and kinesthesia minimal lean and twist

39
Q

PT RX; MET for ACL neuromuscular training

A

LE control based on limited evidence
*minimize excessive frontal and transverse plan motion
*promote sagittal plan knee and trunk flexion
*decreased ground reaction force with soft landing
*progressive speed and difficulty
*emphasis balance

40
Q

PT RX; MET for ACL

A

needs to be at least 2-3 weeks for 6-10 months

be sure to also work each LE individually as well as bilaterally for cross education less deficit compared to only exercising involved knee

41
Q

PT RX for ACL; blood flow restriction

A

*similar strength and hypertrophy as high-intensity training
*good alternative if high intensity cant be done otherwise
*motor learning for improved movement patterns

42
Q

PT RX for ACL; motor learning with external focus

A

*improved balance(central pressures)
*higher vertical jump
*more force production
*greater knee flexion
*softer landing decreased ground reaction force
* improve circulation

43
Q

PT RX for ACL with functional bracing

A

more beneficial than not with ACL deficiency
*conflicting support with ACL reconstruction

*Further motor learning with observation added to practice
-with other by competition, motivation, and responsibility
-post and real time feedback including in slow motion

44
Q

PT RX for ACL plyometrics

A

vertical drop jump similar loading to NON weight bearing extension ‘
increased loading with rating of deceleration

MSK Sprains (8 decks)

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