Anterior Cruciate Ligament

Question 1

What attaches centrally and anteriorly on the tibial plateau?

Answer 1

ACL

Question 2

ACL runs?

Answer 2

superior, posterior and laterally

Question 3

ACL also attaches

Answer 3

to lateral aspect of the intercondylar fossa

Question 4

what excessive tibial motions will the ACL limits?

Answer 4

anterior tibial glid e

Question 5

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

Answer 5

ACL

Question 6

What is the prevalence of the ACL

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

what are non modifiable risk factors for non contact injuries

Answer 9

congenital joint hypermobility

Question 10

what are risk factors primary acl injury that are modifiable?

Answer 10

-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

Question 11

why are the hamstring important to the ACL?

Answer 11

helps prevent anterior tibial translation

Question 12

Risk factors primary ACL injuries that are modifiable

Answer 12

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

Question 13

*ACL
poor control ( with a squat)

Answer 13

significant valgus movement knee medial to foot

Question 14

ACL
reduced control(with squat)

Answer 14

some valgus movement kness NOt entirely medial to foot

Question 15

ACL (with squat) good control

Answer 15

no valgus mvement and knee vertical with toes

Question 16

Rick factors primary ACL injuries
modifiable

Answer 16

-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

Question 17

Risk factors for a second ACL injuries

Answer 17

like primary ACL injury plus excessive femoral IR momnet

which muscle needs addressed more? ER

Question 18

What are causes/ etiology of ACL tears?

Answer 18

NOn contact 70%
Contact 30%

Question 19

What are the symptoms of anterior cruciate ligament?

Answer 19

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

Question 20

what are signs of ACL

Answer 20

signs; consistent with any sprain plus

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

Question 21

Sings of ACL( special test)
Anterior Drawer

Answer 21

if popping, effusion, and giving away after trauma

torn acl

Question 22

signs of acl (special test)
Lachmans

Answer 22

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

+ pivot shift hugh spec

Question 23

What leads to muscle inhibition

Answer 23

swelling, pain, joint laxity, and disuse

Question 24

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

Answer 24

-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

Question 25

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

Answer 25

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

Question 26

PT RX for ACL

Answer 26

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

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

PT RX for ACL with earl weight bearing?

Answer 29

without detrimental effects if symmetrical and leads to better outcome

Question 30

PT RX for ACL Policed

Answer 30

Weak support for cryotherapy weak support for continuos passive motion CPM devices

Question 31

PT RX for Acl

Answer 31

Manual therapy needed post-op

Question 32

MET for ACL

Answer 32

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

Question 33

PT RX: MET for ACL

Answer 33

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

Question 34

PT RX; MET for ACL

Answer 34

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

Question 35

PT RX; MET for ACL

Answer 35

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

Question 36

PT RX; MET for ACL

Answer 36

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

Question 37

with PT RX what MET should emphasize on?

Answer 37

hamstring strength and coordination *hams> 66% of quad activity for males *hams> 75% of quad activity for females predicts LE control

Question 38

PT RX; MET for ACL neuromuscular training

Answer 38

NOrmal strength and proper neuromuscular or LE control trun proprioception and kinesthesia minimal lean and twist

Question 39

PT RX; MET for ACL neuromuscular training

Answer 39

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

Question 40

PT RX; MET for ACL

Answer 40

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

Question 41

PT RX for ACL; blood flow restriction

Answer 41

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

Question 42

PT RX for ACL; motor learning with external focus

Answer 42

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

Question 43

PT RX for ACL with functional bracing

Answer 43

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

Question 44

PT RX for ACL plyometrics

Answer 44

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