Ligament Injuries

Question 1

This ligament prevents anterior translation of the tibia

Answer 1

ACL

Question 2

This ligament is typically injured during acceleration or deceleration with an uncontrolled Valgus moment at the knee with slight flexion with tibial IR or ER

Answer 2

ACL

Question 3

This bundle of the ACL is most taught in flexion and is tested with the anterior drawer test

Answer 3

Anterior medial bundle

Question 4

This bundle of the ACL is most taught near extension and is tested with the Lachman’s test. This is the biggest part of the ACL

Answer 4

Posterior lateral bundle

Question 5

What two tests should be used to test the ACL?

Answer 5

Lachmans (sen: 85% and specificity: 94%) and pivot shift (sen: 24%, specificity 95% which increases to very high sen and sp if the patient is under anesthesia)

Question 6

Risk factors for this ligament include: dry weather conditions, artificial turf, female sex, narrow intercondylar femoral notch size, lesser contacts depth of the medial tibial plateau, greater ant/post joint laxity

Answer 6

ACL

Question 7

To signify an ACL injury when would you expect hemarthrosis?

Answer 7

0-12 hours

Question 8

This ligament is the primary restraint to tibial posterior translation between 30-90* of flexion

Answer 8

PCL

Question 9

This ligament is torn with a hyperflexion injury, hyperextension injury, or an external posterior directed force

Answer 9

PCL

Question 10

What are the three PCL tests and what is the best?

Answer 10

Posterior drawer sn 90, sp 99
Posterior sag sign
Quad activation test

Question 11

This is comprised of the lateral head of the gastroc, arcuate ligament, popliteus tendon, LCL, biceps tendon

Answer 11

Posterior lateral corner

Question 12

Is often injured along with the PCL but can be injured in isolation with a direct blow to the proximal tibia or hyperextension injury

Answer 12

Posterior lateral corner

Question 13

What are the two tests for posterior lateral corner?

Answer 13

Posterior drawer test: if positive at 30*

Dial test: pt in prone with knee bent to 30, tibia is taken to full ER and compared to other side. Looking for 10 difference

Question 14

What does the MCL deep fibers attach to? What do the superficial fibers do?

Answer 14

Deep fibers attach to the medial meniscus superficial fibers restrict Valgus forces at the knee

Question 15

This ligament has excellent blood supply and does not require surgery

Answer 15

MCL

Question 16

Valgus stress test at 0* tests what? Valgus stress test at 30* tests what?

Answer 16

0* tests ACL and PCL
30* isolates MCL (pain or 5* of laxity is positive) pain: sn is 78% sp: 67%, laxity: sn 91%, sp 49%

Question 17

This ligament is a cordlike structure the starts at the lateral epicondyle of the femur and attaches with the biceps femoris tendon at the fibular head

Answer 17

LCL

Question 18

This ligament is the primary restraint to varus forces and secondary restraint to ER of the tibia

Answer 18

LCL

Question 19

Varus stress test in full extension tests what? In 30* of flexion tests?

Answer 19

Full extension: ACL, PCL, LCL
30* tests LCL specifically

Question 20

What other two ligaments reinforce the posterior medial joint capsule?

Answer 20

Oblique popliteal ligament and posterior oblique ligament

Question 21

What does the medial arcuate ligament attach to?

Answer 21

Oblique popliteal ligament

Question 22

What does the lateral branch of the arcuate ligament attach to?

Answer 22

Posterior aspect of the fibular head giving support to the posterior lateral knee joint capsule.

Question 23

What are the Ottawa knee rules?

Answer 23

1. Age >55
2. Isolated tenderness of the patella with no other bony tenderness
3. Tenderness to fibular head
4. Unable to flex the knee to 90*
5. Inability to bear weight immediately or in the ER

Question 24

IKDC (international knee documentation committee) 2000 scale measures what?

Answer 24

Measures function, higher score means better function

Question 25

KOOS (knee injury osteoarthritis outcome score) measures what?

Answer 25

0-100 and measures function, higher score the better function

Question 26

Tegner scale is measured how?

Answer 26

0-10 point with higher number means better function

Question 27

Marks scale is scored to what? Measures?

Answer 27

Scored 0-16 with higher score meaning higher function

Question 28

What percent of the bad leg to good leg for quad strength, hop testing, and outcome measures mean return to sport?

Answer 28

90% of uninvolved leg

Question 29

What is the tx following ACL reconstruction?

Answer 29

WB and NWB exercises within 4-6 weeks, 2-3 x per week, NMES for 6-8 weeks, post op brace, immediate mobilization and ice

Question 30

Knee sprain tx

Answer 30

Supervised exercise that includes WB and NWB and use of NMR training

Question 31

How do non contact ACL injuries occur?

Answer 31

Usually in acceleration or deceleration, at or near full extension. Quad contraction with reduced hamstring contraction.

Question 32

ACLs fail at a rate of ___% and athletes that return to sport fail at a rate of __%.

Answer 32

15% and 23% Of the 23% half are the other side

Question 33

What is the one factor that predicts a second injury risk?

Answer 33

Time : return to sport in <9 mo increase injury 7x

Question 34

What components are necessary for ACL prevention?

Answer 34

More than one exercise, need to include proximal exercises (core and trunk exercises), both plyo and strength components

Question 35

What component is not necessary for ACL prevention?

Answer 35

Balance exercises

Question 36

When should ACL prevention exercises be done?

Answer 36

Always throughout season, preseason can be used in addition, but just preseason was not enough

Question 37

To screen for ACL copers these things have to be present:

Answer 37

Injury isolated to ACL Knee has to have full pain-free ROM No joint effusion MVIC of quads is 70% of uninvolved side

Question 38

After pre screening for copers is met then what are the criteria?

Answer 38

1. Have to report no more than one instance of giving way 2. Have to have 80% symmetry on 6 m hop test 3. Score at least 80% on KOS ADL 4. Score at least 60% for global rating of knee function

Question 39

What is a cyclops lesion and what are signs?

Answer 39

It is a hypertrophied graft tissue at tibia or at the root of the torn ACL of highly vascularized tissue following ACL repair. It’s why extension is so important at first. Lacks terminal knee extension with gait, passive extension is limited with sharp anterior knee pain without changes in ROM