Knee 2 (test 3) Flashcards

Question

muscle inhibition of quads with ACL injury leads to

Answer 1

atrophy/more inhibition/weakness; deficits common 2-4 years after injury determined by observation, palpation, and muscle testing need to take seriously and communicate importance of staying on top of exercises to pt can also affect other side/knee as well

Answer 2

most can return to low risk activity without sx with good outcomes

Answer 3

full/near full ROM (especially ext) minimal to no swelling quad activation/endurance/coordination

Answer 4

immediate mobilization in PT for ROM, pain, and minimizing immobilization effects full ext should be obtained no later than 4 weeks (wont happen with everyone, especially if other structures like meniscus are involved) -predicts ext at 12 weeks and lower risk of OA

Answer 5

SLR without extension lag (bend in leg) quad set > 90% of uninvolved side (could be misleading if uninvolved side is also experiencing inhibition)

Answer 6

early WBing as symmetrical as possible w/o detrimental effects POLICED functional bracing (comes later); more beneficial with ACL deficiency, conflicting support with ACL reconstruction weak support for continuous passive motion devices

Answer 7

little accessory movements/translations can still occur within brace for ACL, outside of hyperext, brace wont prevent any other motions that could also cause pain

Answer 8

initiate post op

Answer 9

neuromusclular electrical stimulation (NMES) for activation/coordination/strength: significant increase in quad strength 'no significant changes with function isometrics at varying angles based upon symptoms discontinue once quad index > 80% uninvolved side

Answer 10

assumptions must be made about arthrogenic muscle inhibition intense resistive training without inducing pain must be performed eventually emphasize both concentric and eccentric training

Answer 11

load is generally greater with non WBing activities than WBing because open chain/non WBIng only activates quads but WBing will generally activate HS and other muscle groups as well to counteract the force of the quads and provide more symmetrical muscle activation across the joint non WBing or OKC activities are less of a concern than in the past greatest loads are found within 50 degrees of full ext with both WBing and non WBing (so i.e. you can do a knee ext from 90 to 45 only or with closed chain you dont want the pt to squat with knees over toes)

Answer 12

increases with knees beyond toes decreased with fwd trunk lean

Answer 13

with walking there is as much load as non WBing knee ext due to repetitive terminal knee ext this is several times greater than other WBing activities this means that both OC and CC knee activities early and often is OKAY...especially if they are walking and using correct trunk and LE control

Answer 14

males: hams > 66% of quad activity females: jams > 75% of quad activity in females this value could be skewed if there is quad inhibition present

Answer 15

normal strength does not equal proper neuromusclular or LE control trunk proprioception and kinesthesia to minimize lean and twist

Answer 16

minimize frontal and transverse plane motion promote sagittal plane knee and trunk flexion decrease GRF with softer landing progressive speed and difficulty emphasis on jump landing and balance

Answer 17

needs to be at least 2-3x/week for 6-10 months bilateral, for cross edu = less deficit compared to only exercising involved knee

Answer 18

no better than intensive exercise can increase growth hormone but can also decrease myostatin which would limit cell growth (cancels out)

Answer 19

important to improve movement patterns use language they can understand and help cue proper movement

Answer 20

improved balance/coordination higher vertical jump more force production greater knee flexion softer landing

Answer 21

competition with others (motivation/responsibility) real time feedback/post exercise feedback

Answer 22

increased loading with rate of deceleration (need to control descent with good movement patterns) vertical jump similar loading to NWB ext on ACL (with proper movement patterns)

Answer 23

if a partial meniscectomy there is no change if there is a meniscal repair performed = slower progressions due to greater protection required for meniscus healing may slow achievement of full ROM due to decreased WBing required for said protection

Answer 24

80% have bone bruise

Answer 25

if skeletally immature (young) healing = 2 weeks to 3 months skeletally mature healing = 1 month to 1 year average is 3.2 months overall bone bruise is a delaying factor that leads to more difficulty reaching full ext and proper quad function (inhibition)

Answer 26

MCL tears generally are not surgically repaired if ACL is torn then often surgeons will wait 10 weeks for MCL to heal before repairing ACL (better outcomes vs earlier sx)

Answer 27

only sagittal plane activity for 4-6 weeks limit tibial ER and valgus stresses

Answer 28

debridement (abrasion) = WBAT for 3-5 days and no delays to ACL rehab osteoarticular transport system (OATS) and autologous chondrocyte implantation (ACI) (cultured) = most conservative guidelines and greatest delays microfx of bone underneath to stimulate bleeding = NWB for 2-8 weeks; delay to ACL rehab ** dont need to know specifics; just know if articular cartilage is repaired then it will delay ACL timeline

Answer 29

OATS > ACI > Microfx

Answer 30

clotting repair is inhibited by synovial fluid few return to high risk activity without sx due to continual instability

Answer 31

bone patellar tendon bone (BPTB) grafts- have both autograft and allogract semitendinosus/gracilis (SGT) graft

Answer 32

allograft = cadaver autograft = from pt

Answer 33

the stronger you start the better you are likely to come out

Answer 34

incision over opposite patellar tendon remove middle 1/3 of: bone of patella, patellar tendon, and bone of tibial tuberosity

Answer 35

up to 1/3 develop anterior knee pain

Answer 36

initial weakining within 1st 4 weeks incorporation of graft into bone at 6-8 weeks dense fibrous tissue at 8-12 weeks

Answer 37

symptoms improve faster than the graft incoorporates into the body pt may feel like they can due more since they didn't have the extra trauma of an autograft but it actually takes longer for the donor graft to incorporate into the body than if it was their own tissue

Answer 38

incorporation if graft into bone at 8-12 weeks dense fibrous tissue at 8-12 weeks delayed timeline and longer rehab

Answer 39

if pediatric pt = dont want to interrupt growth plate if pt has already had multiple ACL repairs and no longer has viable tissue to donate can avoid anterior knee pain from graft being taken

Answer 40

prepubescent youth to avoid growth plate complications avoids anterior knee pain

Answer 41

may start pure strengthening of hamstrings at 6-8 weeks delay heavy strengthening with hams for 12 weeks

Answer 42

18-24 months post op muscle weakness and impaired neuromuscular control remain all grafts and bone show continued healing on imaging inhibition, atrophy, and weakness are common out to 2 years and 4 years post op (even in both LEs)

Answer 43

45% resumed pre injury level 29% returned to competitive sport

Answer 44

up to 30% 75% of 2nd tears occur between 18 and 24 months reduced injury rate by waiting at least 9 months to return to play *worse if meniscal or articular cartilage involvement or ext lag

Answer 45

thicker/stronger attaches central/posterior on tibial plateau runs superior/anterior attaches anteriorly on medial aspect of intercondylar fossa

Answer 46

excessive posterior tibial glide and IR

Answer 47

hyperflexion primarily but also some with hyperext

Answer 48

consistent with any ligament injury limited and painful ROM (least pain in ER) + PCL special tests

Answer 49

quads active post drawer post sag reverse pivot shift

Answer 50

ligament Rx plus emphasis on limiting posterior tibial gliding

Answer 51

flat broad ligament with 2 bands runs from medial condyles of femur and tibial

Answer 52

anterior band = limits flexion posterior band = limits hyperext

Answer 53

medial meniscus posterior capsule adj muscle and tendon units SO if you have a pt with MCL sprain you need to check other surrounding structures

Answer 54

excessive valgus and or ER stress and or hyper ext

Answer 55

general ligament S&S plus impaired ROM least limits with IR + MCL special tests adn possibly medial meniscus special tests TTP

Answer 56

valgus stress at 0 and 30 degrees more extended position tests other structures like cruciates and capsules

Answer 57

ligament RX plus early protection with valgus and ER stress and end ranges of flx/ext most wont need sx bc ligament is extraacrticualr and can scar/heal on blended capsule

Answer 58

round cordlike ligemetn attaches to lateral condyle of femur and fibular head no attachment to menisci primary restraint to excessive varus and ER stresses

Answer 59

string ligament so rarely injured

Answer 60

excessive varus and or ER stress and hyperext

Answer 61

consistent woth ligament injury plus ROM limited and painful especially in ext and ER + LCL special tests TTP

Answer 62

varus in 0 and 30

Answer 63

like ligament Rx plus early protection with varus and ER stress may need sx because ligament remains from the capsule even though its extraarticular

Answer 64

combo of supervised and HEP better than either alone combo of open and closed chain exercises coordination training

Knee 2 (test 3) Flashcards

(93 cards)