knee lig sprains CPG 2017

Question 1

Q: What is the primary classification label for patients with knee ligament sprains in these guidelines?

Answer 1

A: Knee stability and movement coordination impairments.

Question 2

Q: What key clinical findings support the classification of an acute ACL sprain?

Answer 2

A: Hearing or feeling a “pop,” immediate swelling, giving way, and a positive Lachman test.

Question 3

Q: How is a grade III MCL sprain commonly identified?

Answer 3

A: Excessive gapping with valgus stress at 30° knee flexion and localized medial pain/swelling.

Question 4

Q: What combination of tests is most accurate for diagnosing an ACL injury?

Answer 4

A: Lachman, anterior drawer, and pivot shift tests.

Question 5

Q: What clinical presentation is typical for posterior cruciate ligament (PCL) sprains?

Answer 5

A: Posterior knee pain, a positive posterior drawer test, and a “sag sign” on inspection.

Question 6

Q: What mechanism of injury often leads to ACL tears?

Answer 6

A: Non-contact deceleration, cutting, or pivoting maneuvers.

Question 7

Q: What timeframe defines the acute phase of a ligament injury?

Answer 7

A: Within 6 weeks of the initial trauma.

Question 8

Q: How are multi-ligament injuries typically identified?

Answer 8

A: Signs of instability in more than one direction, often following high-energy trauma.

Question 9

Q: What key finding suggests a chronic ACL injury with movement coordination deficits?

Answer 9

A: Complaints of knee instability or “giving way” during sport or activity.

Question 10

Q: How is knee hypermobility incorporated into the classification?

Answer 10

A: Considered when laxity exists without pain or trauma, distinguishing from ligament sprains.

Question 11

Q: How can a meniscal tear be differentiated from an MCL sprain?

Answer 11

A: Meniscal tears often present with joint line tenderness, locking, or clicking, while MCL sprains show medial pain with valgus stress and no mechanical symptoms.

Question 12

Q: What finding helps distinguish a PCL injury from an ACL tear?

Answer 12

A: A positive posterior drawer test and posterior sag sign suggest PCL injury, while a Lachman or pivot shift test indicates ACL involvement.

Question 13

Q: How does patellar subluxation differ from ACL injury?

Answer 13

A: Patellar subluxation involves lateral displacement and apprehension with lateral glide, not the instability and “pop” typical of ACL tears.

Question 14

Q: What symptom pattern suggests a tibial plateau fracture rather than a ligament sprain?

Answer 14

A: Acute swelling with inability to bear weight and bony tenderness may indicate fracture, confirmed by imaging.

Question 15

Q: How can clinicians differentiate pes anserine bursitis from MCL injury?

Answer 15

A: Pes anserine bursitis presents with tenderness distal to the joint line, not directly over the MCL.

Question 16

Q: What distinguishes a quadriceps tendon rupture from a ligament sprain?

Answer 16

A: Inability to extend the knee actively and a palpable defect above the patella suggest quadriceps rupture.

Question 17

Q: How does septic arthritis differ from ligamentous injury?

Answer 17

A: Septic arthritis presents with fever, joint warmth, and severe pain with passive motion—urgent referral is needed.

Question 18

Q: What clinical sign helps rule out patellar tendon rupture?

Answer 18

A: A high-riding patella (patella alta) and inability to perform a straight leg raise suggest tendon rupture.

Question 19

Q: How can referred hip pathology mimic knee ligament injury?

Answer 19

A: Hip conditions may cause anterior knee pain without local knee findings—hip ROM testing helps differentiate.

Question 20

Q: What distinguishes a chronic ACL-deficient knee from other causes of instability?

Answer 20

A: Recurrent giving way during cutting or pivoting activities without acute trauma suggests chronic ACL insufficiency.

Question 21

Q: How does shoe-surface interaction influence knee ligament injury risk?

Answer 21

A: High friction between footwear and playing surface can increase torsional forces, raising injury risk.

Question 22

Q: What anatomical feature is associated with increased ACL injury risk?

Answer 22

A: A narrow femoral notch width may predispose individuals to ACL tears.

Question 23

Q: How does increased joint laxity affect ligament injury risk?

Answer 23

A: Greater laxity can reduce passive stability, making ligaments more vulnerable to sprain.

Question 24

Q: What hormonal factor may influence ligament injury risk in females?

Answer 24

A: The pre-ovulatory (follicular) phase of the menstrual cycle may increase ligament laxity.

Question 25

Q: How does BMI relate to knee ligament injury risk?

Answer 25

A: Higher BMI increases joint loading and may elevate injury risk.

Question 26

Q: What neuromuscular pattern is linked to ACL injury risk?

Answer 26

A: Strong quadriceps activation during eccentric loading with limited knee flexion can increase strain on the ACL.

Question 27

Q: How does poor neuromuscular control contribute to injury risk?

Answer 27

A: Faulty movement patterns like valgus collapse during landing or cutting increase ligament stress.

Question 28

Q: What role does previous injury play in ligament sprain risk?

Answer 28

A: A history of knee ligament injury significantly increases the risk of future sprains.

Question 29

Q: How does sport type influence ligament injury risk?

Answer 29

A: Cutting and pivoting sports (e.g., soccer, basketball) carry higher risk due to rapid directional changes.

Question 30

Q: Why is fatigue considered a risk factor for ligament injury?

Answer 30

A: Fatigue impairs neuromuscular control, increasing the likelihood of poor landing mechanics and instability.

Question 31

Q: What subgroup includes patients with recent trauma and high tissue irritability?

Answer 31

A: Acute phase subgroup—characterized by pain, swelling, and limited ROM requiring protection and gradual loading.

Question 32

Q: What clinical signs define the movement coordination impairment subgroup?

Answer 32

A: Reports of instability, poor neuromuscular control, and positive special tests like pivot shift or Lachman.

Question 33

Q: Which subgroup benefits most from neuromuscular re-education and proprioceptive training?

Answer 33

A: Movement coordination impairments subgroup.

Question 34

Q: What impairment profile is typical in patients post-ACL reconstruction?

Answer 34

A: Quadriceps weakness, altered gait, and impaired dynamic stability.

Question 35

Q: How are patients with knee hypermobility classified?

Answer 35

A: As having generalized ligamentous laxity with potential for recurrent sprains and instability.

Question 36

Q: What subgroup includes individuals with chronic instability but minimal pain or swelling?

Answer 36

A: Chronic phase subgroup—focused on restoring function and preventing reinjury.

Question 37

Q: What impairments are prioritized in the acute protection phase?

Answer 37

A: Pain control, inflammation reduction, and gentle ROM restoration.

Question 38

Q: What subgroup is appropriate for patients with isolated MCL sprains and localized tenderness?

Answer 38

A: Local tissue injury subgroup—managed with bracing and progressive loading.

Question 39

Q: What is the focus of treatment in the return-to-sport subgroup?

Answer 39

A: High-level neuromuscular control, sport-specific drills, and psychological readiness.

Question 40

Q: How does effusion grading help guide subgroup classification?

Answer 40

A: Higher effusion grades suggest acute irritability, guiding clinicians toward protection and unloading strategies.

Question 41

Q: What is the primary special test used to assess ACL integrity?

Answer 41

A: The Lachman test—highly sensitive for detecting ACL tears, especially in acute settings.

Question 42

Q: Which test is most specific for diagnosing ACL rupture?

Answer 42

A: The pivot shift test, though it may be difficult to perform in acute or guarded patients.

Question 43

Q: What test is used to assess PCL integrity?

Answer 43

A: The posterior drawer test, often accompanied by the posterior sag sign.

Question 44

Q: How is MCL integrity evaluated during examination?

Answer 44

A: Valgus stress test at 30° knee flexion to isolate the MCL.

Question 45

Q: What examination technique helps assess joint effusion?

Answer 45

A: The stroke test or bulge sign to detect intra-articular swelling.

Question 46

Q: What functional test is recommended to assess dynamic stability post-ACL injury?

Answer 46

A: Single-leg hop tests (e.g., hop for distance, triple hop, crossover hop).

Question 47

Q: How is quadriceps strength commonly assessed in ligament injury rehab?

Answer 47

A: Isometric or isokinetic testing, or functional measures like single-leg squat.

Question 48

Q: What tool is recommended to assess psychological readiness for return to sport?

Answer 48

A: The ACL-Return to Sport after Injury (ACL-RSI) scale.

Question 49

Q: Why is range of motion assessment important in early rehab?

Answer 49

A: To monitor for extension lag or flexion deficits that may impair recovery.

Question 50

Q: What movement pattern should clinicians observe during gait analysis?

Answer 50

A: Antalgic gait, quadriceps avoidance, or knee hyperextension during stance phase.

Question 51

Q: What is the recommended approach during the acute phase of a knee ligament sprain?

Answer 51

A: Use of cryotherapy, protected weight bearing, and gentle ROM to reduce pain and swelling.

Question 52

Q: How soon should clinicians initiate early weight bearing after ACL reconstruction?

Answer 52

A: As tolerated, typically within 1 week, to promote joint health and function.

Question 53

Q: What is the role of neuromuscular electrical stimulation (NMES) post-ACL surgery?

Answer 53

A: NMES is recommended to improve quadriceps strength, especially in the early rehab phase.

Question 54

Q: What type of exercise is emphasized during the subacute and return-to-activity phases?

Answer 54

A: Progressive strengthening and neuromuscular control exercises targeting the hip and knee.

Question 55

Q: When is immediate postoperative mobilization recommended?

Answer 55

A: To increase ROM, reduce pain, and minimize adverse responses like arthrofibrosis.

Question 56

Q: What is the guideline stance on supervised rehabilitation vs. home-based programs?

Answer 56

A: Supervised rehab is preferred for better outcomes, especially in the early stages.

Question 57

Q: How should clinicians address movement coordination deficits in chronic ACL-deficient knees?

Answer 57

A: Through perturbation training and dynamic stability exercises.

Question 58

Q: What is the evidence for bracing after ACL reconstruction?

Answer 58

A: Routine use of functional bracing is not strongly supported for improving long-term outcomes.

Question 59

Q: What psychological factor should be addressed during rehab?

Answer 59

A: Fear of reinjury—clinicians should incorporate education and graded exposure to activity.

Question 60

Q: What criteria should guide return-to-sport decisions?

Answer 60

A: Objective strength and hop test symmetry, psychological readiness, and sport-specific performance.