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MSK II - EXAM 3 KNEEEEEEE > Knee- ACL PT Rx thru LCL > Flashcards

Knee- ACL PT Rx thru LCL Flashcards

1
Q

Does the PT rx change from isolated ACL tear to consider additional tissue damage?

A

YES
- ACL
- MCL
- Medial meniscus

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2
Q

What percentage of ACL tears also have meniscal tears?

A

22-86%

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3
Q

What is a partial meniscectomy?

A
  • no change
  • take a tiny piece out NOT the whole thing, nothing changes from ACL protocol = no reconstruction to protect
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4
Q

What is a mensical repair?

A
  • stitched meniscus, NEED TO PROTECT
  • slower progressions due to greater protection needed for meniscal healing to occur
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5
Q

Why can a meniscal repair make achieving ROM more difficult and limit ACL prognosis?

A
  • takes longer to reach ROM goals, have to protect the meniscus to allow healing, cant be as aggressive
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6
Q

What percentage of ACL tears also occur with a bone bruise?

A

80%

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7
Q

What is considered skeletally immature in regards to bone bruise healing with ACL/PCL and meniscal injuries?

A

2 weeks - 3 months

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8
Q

What is considered skeletally mature in regards to bone bruise healing with ACL/PCL and meniscal injuries?

A

1month - 1 year

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9
Q

What is the average time to heal a bone bruise with ACL/PCL and meniscal injuries?

A

3.2 months

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10
Q

What does a bone bruise do to ROM with an ACL/PCL or meniscal injury?

A
  • delaying factor, leads to more difficulty reaching full ext and proper quad function bc of pain in extension due to CPP and bony approximation
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11
Q

Are MCL tears most often surgically repaired?

A

NO

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12
Q

How long do precautions last with MCL tears?

A

initial 4-6 weeks

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13
Q

What are precautions with MCL tears?

A
  • only sagittal plane activity
  • limit tibial ER and valgus stresses
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14
Q

When is there a better outcome with MCL tears along with an ACL tear?

A
  • with 10 weeks delay for ACL surgery than 3 weeks
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15
Q

What percentage of ACL tears also have an articular cartilage defect?

A

36%

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16
Q

What is a debridement?

A
  • “clean it up” fixing it and smoothing over tear
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17
Q

What are the precautions with debridement for an articular cartilage defect along with ACL tear?

A
  • WBAT 3-5 days
  • No delays to ACL rehab
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18
Q

What is Osterarticular Transport System (OATS) and AUtologous Chondrocyte Implantation (ACI) (cultured) doing for an articular cartilage defect with an ACL tear?

A
  • most conservative guidelines
  • greatest delays to ACL rehab for cartilage defects

** cartilage grown in petri dish, then put back in the body to protect

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19
Q

What is the benefit of a microfx for articular cartilage defect with ACL tears?

A
  • Cause bleeding, inflammation for repair
  • “fills in” articular cartilage’s spot
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20
Q

What are the precautions and outcomes with a microfx surgery for articular cartilage defects with ACL tears?

A
  • NWB 2-8 weeks
  • likely delay to ACL rehab
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21
Q

What is the progression of outcomes for articular cartilage defect interventions along with an ACL tear?

A

-OATS outcomes > ACI > Microfx

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22
Q

What is the clotting for repair of ACL inhibited by?

A

synovial fluid

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23
Q

Do many patients return to high risk activities post ACL tear without surgery?

A
  • few return to high-risk activity without surgery due to continual instability
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24
Q

What percentage of ACL tears are surgically repaired?

A

65%

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25
Q

What are some arthroscopic techniques to repair an ACL tear?

A
  • bone-patellar tendon-bone (BPTB) grafts (autograft or allograft)
  • semitendinosus/ gracilis (STG) graft
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26
Q

What is the difference between autograft and allograft with BPTB grafts?

A

autograft = from self
allograft = from donor

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27
Q

What do they ensure with arthroscopic techniques when sx is over after ACL repairement?

A

full ROM under anesthesia

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28
Q

What is related to poor outcomes with sx for ACL tears?

A

preoperative weakness

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29
Q

What is the benefit of pre-op PT for ACL tears?

A
  • preop progressive 5 wk program followed by 1 year post-op program
    > superior pre-op and post-op function out to 2 years
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30
Q

Where is the incision with a BPTB autograft?

A

over the patellar tendon

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31
Q

What is removed with a BPTB autograft?

A

middle 1/3 of:
- bone of patella
- patellar tendon
- bone of tibial tuberosity

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32
Q

Why do up to 1/3 develop anterior knee pain with a BPTB autograft?

A
  • supply to tendon is reduced due to the removal, so we have to be careful to settle down the inflammation and not create tendonistis on top of it
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33
Q

When is the graft strength with a BPTB autograft initially weakening?

A

within the 1st 4 weeks
- dig a plant up and put it somewhere else metaphor, supply is disrupted

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34
Q

When is the incorporation of the graft into the bone happening with a BPTB autograft?

A

6-8 weeks

35
Q

When is dense fibrous tissue filled in with a BPTB autograft?

A

8-12 weeks

36
Q

How is BPTB allograft different from a BPTB autograft?

A
  • same procedure
  • symptoms improve faster than graft incorporates so patient feels like they can do more than they should
37
Q

When does the allograft incorporate in to the bone with a BPTB allograft?

A

8-12 weeks

38
Q

When is there dense fibrous tissue with a allograft?

A

GREATER THAN 12 weeks

39
Q

What is the difference in rehab for allografts vs autografts with BPTB repairs?

A
  • allografts have a delayed timeline and longer rehab
40
Q

What are advantages of a BPTB allograft?

A
  • pre-pubescent population
  • avoids anterior knee pain associated with autograft
41
Q

What are advantages of a STG graft (semitendinosus with/wo gracilis)?

A
  • prepubescent youth to avoid epiphyseal plate complications
  • avoids anterior knee pain
42
Q

When can PURE strengthening for hamstrings start with a STG graft?

A
  • at 6-8 weeks
43
Q

When should heavy strengthening of the hamstrings be delayed to with a STG graft?

A

12 weeks

44
Q

What is the prognosis for post op with ACL repairs at 18-24 months?

A
  • muscle weakness and impaired neuromuscular control remain
  • all grafts and bone show continued healing on imaging
45
Q

What is common out to 2 years ( and 4 years) post op with ACL repairs?

A
  • inhibition, atrophy and weakness common out to 2 years and 4 years and even in both LEs
46
Q

What is the prognosis of BPTB grafts at 40 months? (percentages)

A
  • 45% resumed pre-injury level
  • 29% returned to competitive sport

LOW #s

47
Q

What is the failure rate of ACL repairs?

A

up to 30%

48
Q

When do 75% of the 2nd tears of the ACL occur?

A
  • between 18-24 months
49
Q

How can we reduce injury rate after ACL reapirs?

A

waiting at least 9 months to return to play

50
Q

When is prognosis of ACL repairs WORSE?

A
  • with meniscal or articular cartilage involvement or ext lag
51
Q

Which has a lower rate of radiological OA between STG vs. BPTB grafts?

A

stg graft - lower rate of radiological OA

52
Q

What are there NO differences between STG and BPTB grafts with?

A
  • clinical outcomes, laxity, return to play, ROM, quad size, PF crepitations
  • postoperative graft failure
53
Q

What tibial glides are limited by the PCL?

A
  • excessive posterior glide and IR
54
Q

Which is thicker and stronger the PCL or the ACL?

A

PCL

55
Q

Where does the PCL attach?

A
  • centrally and posterior on the tibial plateau
  • anteriorly on the medial aspect of the intercondylar fossa
56
Q

Where does the PCL run?

A
  • superior and anterior
57
Q

What is the prevalence of PCL injury?

A

least injured knee lig

58
Q

What is the etiology of PCL injuries?

A

hyperflexion primarily but also hyperextension

59
Q

What are S&S of PCL tears?

A
  • consistent with any lig injury plus:
  • ROM limited and painful, least in ER
  • Positive PCL special tests
60
Q

What are special tests for the PCL?

A
  • quads active
  • post drawer
  • post sag
61
Q

What is the PT rx for PCL?

A
  • ligament rx plus emphasis on limiting posterior tibial gliding
62
Q

What is the MCL?

A

a flat broad ligament with two bands

63
Q

Where does the MCL run?

A

from medial condyles of femur and tibia

64
Q

What excessive motions are limited by the MCL?

A

valgus and ER stresses

65
Q

What does the anterior band of the MCL limit?

A

flexion

66
Q

What does the posterior band of the MCL limit?

A

hyperextension

67
Q

What does the MCL attach to?

A
  • medial meniscus
  • posterior capsule
  • adjacent muscle/tendon units
68
Q

What is the prevalence of MCL injuries?

A

MOST injured knee ligament

69
Q

What is the etiology of MCL injuries?

A

excessive valgus and/or ER stress

70
Q

What are S&S of a MCL injury?

A

consistent with lig injury plus;
- ROM impaired and painful, least with IR
- positive MCL and possibly medial meniscus special tests
- palpation: TTP

71
Q

What are special tests for MCL injury?

A
  • valgus stress at 0 and 30 degrees
    > more extended postion tests other structures like cruciates and capsules
72
Q

What is the PT rx for MCL injuries?

A
  • early protection with valgus and ER stress
73
Q

Will MOST people with MCL tears need surgery?

A

NO - ligament is extraarticular and can scar/heal on blended capsule

74
Q

What is the LCL?

A

lateral collateral ligament: a round cordlike ligament

75
Q

Where does the LCL attach?

A

to the lateral condyle of the femur to the fibular head

76
Q

Does the LCL attach to the menisci?

A

NO

77
Q

What does the LCL limit?

A

excessive varus and ER stresses

78
Q

What is the prevalence of LCL injuries?

A

strong, seldom injured

79
Q

What is the etiology of LCL injuries?

A

excessive varus and/or ER stress and hyperextension

80
Q

What are S&S of LCL injury?

A

consistent with ligament injury plus:
- ROM limited and painful, particularly ext and ER
- positive LCL special tests
- Palpation: TTP

81
Q

What is a special test for the LCL?

A
  • varus stress at 0 and 30 degrees
82
Q

What is the PT rx for the LCL?

A

ligament rx plus emphasis on:
- early protection with varus and ER stress

83
Q

Does the LCL need surgery to be repaired?

A
  • may need surgery because ligament remains distant from the capsule even through it is extraarticular
84
Q

What should the MET for all sprains include?

A
  • combo of supervised and HEP better tha either alone
  • combo of open/closed chain exercises
  • coordination training

MSK II - EXAM 3 KNEEEEEEE (6 decks)

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