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Knee CPGs > Knee Stability and Movement- Ligament Sprain 2010 and 2017 > Flashcards

Knee Stability and Movement- Ligament Sprain 2010 and 2017 Flashcards

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1
Q

What outcome measures should you use to assess knee symptoms and function associated with Knee ligament Sprains?

A

IKDC 2000- International Knee Documentation Committee 2000
KOOS- Knee Injury and OA Outcome Score
Lysholm

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2
Q

What combination of outcome measures should you use to assess activity level with knee ligament sprains?

A

Tegner or Marx Activity Scales

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3
Q

What outcome measure would you use to assess psychological factors for knee ligament sprains?

A

ACL- RSI- Anterior Cruciate Ligament Return to Sport After Injury

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4
Q

What physical performance measures can you use for examining baseline and assess readiness for return to activities?

A

Single leg hop tests:

  1. Single hop for distance
  2. Crossover hop for distance
  3. Triple Hop For distance
  4. 6 meter timed hop
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5
Q

What physical impairment measures should you assess for knee ligament sprains?

A 
Knee laxity/ stability 
Lower limb movement Coordination 
Thigh Muscle Strength 
Knee Effusion 
Knee joint ROM
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6
Q

What can be said about CPM after ACL reconstruction?

A

C (weak) evidence- can use to decrease post op pain

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7
Q

What can be said about early WB after ACL reconstruction?

A

C (weak) evidence- WBAT within 1 week after surgery
B (moderate) evidence- WBAT within 1 week to help increase joint ROM, decrease joint pain, reduce adverse response to surrounding soft tissue

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8
Q

What can be said about knee bracing for ACL deficiency? After ACL surgery? For other ligament injuries?

A

C (weak) evidence- May use for ACL deficiency
D (conflicting) evidence- elicit and document patient preferences- there is evidence for and against
F (expert opinion)- can use for PCL, MCL, or PLC injuries

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9
Q

What can you advise about cryotherapy after ACL

A

B- moderate evidence promotes use to decrease pain

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10
Q

What type of exercises can you recommend post ACL reconstruction?

A

A- strong evidence for WB and NWB concentric/ eccentric exercises implemented within 4-6 weeks, 2-3X/ week for 6-10 months

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11
Q

What recommendations can be made for neuro e-stim after ACL reconstruction?

A

A- strong evidence- in favor of use for 6-8 weeks to augment muscle strengthening in quads and increase short term functional outcomes

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12
Q

What recommendations can be made for neuro re-ed in those with knee stability and movement impairments?

A

A- strong evidence- should be incorporated with strengthening exercises

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13
Q

What is the % breakdown for ACL injuries for contact versus non- contact?

A

70% are non- contact

30% are contact

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14
Q

Female versus male- who is at higher risk for ACL injury?

A

Female, and are 4.5X more likely to sustain second injury in ipsilateral and contralateral side

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15
Q

Is it more likely that you will tear same side or contralateral side after returning to high risk sport?

A

Contralateral- risk is 4.9 fold versus 3.9 fold of ipsilateral

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16
Q

What age range is highest for incidence of ACL injuries?

A

III- case study level for 21-30; but peak incidence for women was age 14-18

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17
Q

Which two groups are most likely to sustain ACL injury?

A

Military and Professional athletes, then amateur athletes

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18
Q

What are the two most common multi- ligament knee injuries?

A

MCL and ACL

PLC (posterolateral corner) and ACL/ PCL

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19
Q

Describe most likely scenario/ mechanism for sustaining an ACL injury

A

Usually during acceleration/ deceleration with excessive quad contraction with reduced hamstring co-contraction at or near full knee extension

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20
Q

When is ACL load the highest

A

quad forces combined with knee IR
valgus load combined with knee IR
valgus load with deceleration

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21
Q

What is the most common mechanism (s) for PCL (posterior collateral ligament) injury

A
  1. “dashboard” or anterior tibial blow
  2. fall on flexed knee with foot in plantar flexion
  3. sudden, violent hyperextension off knee
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22
Q

What is the mechanism of injury for MCL injury

A

Valgus torque to the knee- direct hit to lateral aspect of knee

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23
Q

What is the role of the LCL

A

resists varus forces, especially in initial 0-30 deg of knee flexion.
Also with role in limiting ER of flexed knee

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24
Q

What is the mechanism for isolated injury to the PLC (posterolateral corner)

A

Posterolateral force to tibia at or near full knee extension, forcing knee into hyperextension and varus

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25
What is the mechanism for combined PLC (posterolateral corner) injuries?
Knee hyperextension, ER and varus rotation, complete dislocation, flexed and ER knee + posterior force to tibia
26
What sport accounts for 1/3 of ACL reconstructions
Soccor
27
What other activity/ sport has a high likelihood of isolated ACL injuries?
Skiing- 1.13X likelihood of isolated ACL injuries 2X likelihood of PCL 2X likelihood of MCL and multiligament injuries
28
Is there a difference between early ACL reconstruction versus structured rehab with option for later rreconstruction?
Similar mean change on KOOS and in 5 year f/up there was no difference between groups in PROs or radiographs
29
What are the findings comparing autografts for ACL?
ligament stability and PROs (patient- related outcomes) were similar among quad tendon, hamstring tendon, and bone- patella bone tendon
30
Describe incidence for copers and non- copers for return to activity c/o ACL reconstruction
58% of non- copers- failed the screening and are not rehab candidates for return to activity thru non-operative management 42% of copers- returned to pre- injury levels without ACL reconstruction 72% of copers + neuro re-ed returned to high- level activities
31
What type of autograft had more laxity in women after ACL reconstruction
hamstring compared to bone patella bone, and also compared to men with either autograft
32
How long can strength deficits persist after ACL reconstruction?
Quad and hamstring for up to 6 months after surgery and quad deficits up to 5 years after
33
What are the effects on balance and proprioception after ACL reconstruction?
Static postural control (SL balance with EO/EC) moderately impaired Dynamic postural control is moderately magnified (EO on unstable surfaces with perturbations)
34
What are some psychological factors that can impact return to sport after ACL reconstruction?
``` fear of movement/ reinjury Athletic confidence Self- efficacy and emotions Motivation Internal Locus of control Positive coping strategies- modeling, imagery, relaxation ```
35
What are some environmental risk factors for non- contact ACL injuries?
Dry weather and Artificial turf
36
What are some intrinsic risk factors for non- contact ACL injuries?
``` Female Narrow intercondylar notch lesser concavity depth of medial tibial plateau Greater ATFL (or PTFL) joint laxity prior ACL reconstruction familial predisposition ```
37
What are the diagnostic criteria for ACL sprain and associated clinical findings?
-Mechanism of deceleration and acceleration motions with non-contact valgus load at or near full extension - hearing/ feeling a "pop" at time of injury - hemarthrosis 0-12 hours after injury - h/o giving way + lachman with "soft" end feel/ increased anterior tibial translation + pivot shift test
38
What are the diagnostics for knee stability and movement coordination impairments for ACL sprains?
6 meter SL timed hop test < 80% of uninvolved limb Max voluntary quad strength index < 80% Giving way with 2 or more of daily activities
39
What clinical findings are seen with PCL regarding knee stability and movement coordination impairments?
- Dashboard/ anterior tibial blow injury, fall on flexed knee, sudden hyperextension of knee joint - localized posterior knee pain with kneeling or decelerating - Positive posterior drawer test at 90 deg with non- discrete end feel/ increased posterior tibial translation - Posterior sag (subluxation) of proximal tibia relative to anterior aspect of femoral condyles
40
What clinical findings are seen with MCL regarding knee stability and movement coordination impairments?
- trauma by force applied to lateral aspect of lower extremity - rotational trauma - medial knee pain with valgus stress test performed at 30 deg knee flexion - increased separation between femur and tibia with valgus stress test performed at 30 deg knee flexion - TTP over MCL
41
What clinical findings are seen with LCL regarding knee stability and movement coordination impairments?
- Varus trauma - localized swelling over LCL - TTP over LCL - lateral knee pain with varus stress test performed at 0 deg and 30 deg knee flexion - Increased separation between tibia and femur with varus test at 0 and 30 flexion
42
What are the Ottowa Knee Rules- to determine when to order radiographs with acute knee injury?
1. 55 or older 2. Isolated tenderness of patella 3. TTP to head of fibula 4. Inability to flex to 90 5. Inability to bear weight immediately and in emergency department for 4 steps regardless of limping
43
What findings have been made regarding clinical exam versus MRI
Clinical exam by WELL TRAINED clinicians are as accurate as MRI, and they may be reserved for complicated cases or to assist Orthopedic Surgeon aiding in pre-op planning
44
When performing hop testing- what can you recommend for bracing?
Recommended for all patients post- injury or < 1 year post- surgery
45
With hop testing- do you measure where toe or heel lands?
Heel
46
How many trials/recordings are done with hop testing
2 trials, then 2 recorded
47
Describe the method for the modified stroke test
Performed supine and in full extension. Starting at medial joint line- stroke upward 2-3X toward suprapatellar pouch . Then stroke downward on the distal lateral thigh superior to the suprapatellar pouch toward the lateral joint line
48
Describe the grading for the modified stroke test
0- no production Trace- small wave 1+ larger bulge of fluid medial to knee 2+ effusion fills medial knee sulcus with downward stroke or returns to medial knee without downward stroke 3+ inability to move effusion out of knee
49
What is the bulge sign
amount of fluid measured by visual inspection
50
What is the measurement method
hand superior to patella, pushes tissues and possibly fluid towards patella. keep hand in position, push medial aspect posterior to patella and then quickly along lateral opposite aspect observing for wave of fluid medially
51
Describe the measurement method of Lachman test
Patient supine, knee in 20-30 deg flexion, stabilize femur and hand posterior on tibia applies an anterior force. Increased anterior translation/ soft end point is + for ACL
52
Describe the units of measurement of Lachman test
Normal- 1 to 2 mm Nearly normal- 3-5 mm Abnormal- 6-10 mm Severely abnormal- > 10mm
53
What is the sensitivity and Specificity of the Lachman test- can it be used to rule in/ out ACL tear?
Sensitivity- 85% Specificity- 94% can be used to rule in
54
Describe the measurement method of the pivot shift test
Patient supine, knee extended. Pick up limp from ankle, IR and flex the knee while applying valgus stress with CL hand on lateral aspect of tibia. + test is as its moved into flexion, a sudden reduction (at about 20 deg flexion) of the anteriorly subluxed lateral tibial plateau and indicates a ACL disruption
55
What is the sensitivity/ specificity for pivot shift?
Sensitivity- 24% Specificity- 98% + can rule it in
56
Describe the measurement method for the posterior drawer test
Supine with knee flexed to 90. Examiner at the foot. Both hands to anterior proximal tibia and posterior force applied. Positive is increased posterior translation with soft end point + for PCL
57
What is the sensitivity and specificity of the posterior drawer test?
Sensitivity-90% Specificity- 99% Can rule out of negative and rule in if positive
58
Describe the measurement method for the posterior sag test
Supine, examiner holds heels of both limbs. Flexes knees and hips to 90. Examine the position of the tibia compared to uninvolved side + for PCL
59
What is the sensitivity and specificity of the posterior sag test
Sensitivity-79% Specificity- 100% Can rule in if positive
60
What is the description of the valgus stress test at 30 deg?
Separation of tibia and femur at MCL during the test
61
What is the sensitivity and specificity for valgus stress test at 30? is it the same for the test done to evaluate pain?
Sensitivity- 91% Specificity- 49% Negative test can rule out Not same for pain- poor sensitivity and specificity ( < 78%)
62
What is the test for the LCL
Varus test at 0 and 30 deg knee flexion

Knee CPGs (4 decks)

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