MIDTERMS: ACL Reconstruction

Question 1

Q1: What are the general principles of ACL reconstruction rehabilitation?

Answer 1

A1: Exercise is the mainstay (strength, neuromuscular control, functional exercises), adjunct therapies can help early rehab but should not replace exercise, and RTR & RTS should be milestone-based.

Question 2

Q3: What are the recommended interventions in the Intermediate Phase (2-4 months)?

Answer 2

A3: Progressive resistance training (quads & hamstrings), eccentric strengthening, and low-impact plyometrics (e.g., hopping drills).

Question 2

Q5: What are two advantages and disadvantages of hamstring autografts for ACL reconstruction?

Answer 2

A5: Advantages: Less anterior knee pain, good stability. Disadvantages: Possible hamstring weakness, tibial tunnel widening risk.

Question 2

Q2: What is the primary goal of the Very Early Phase (<1 month) of ACL rehabilitation?

Answer 2

A2: Reduce pain/swelling, restore ROM, and regain quadriceps activation.

Question 2

Q4: Name three criteria for Return to Sport (RTS) after ACL reconstruction.

Answer 2

A4: Strength symmetry (LSI ≥90%), psychological readiness, and sport-specific training completion without symptoms.

Question 2

Q1: What are the three key components of ACL rehabilitation?

Answer 2

A1: Strength training, neuromuscular control, and functional exercises.

Question 2

Which ACL graft type is associated with higher risk of anterior knee pain?
A) Hamstring tendon
B) Patellar tendon
C) Quadriceps tendon
D) Allograft

Answer 2

B) Patellar tendon

Question 2

MCQ1: What is a key milestone for return to sport after ACL reconstruction?
A) Pain-free knee
B) Limb Symmetry Index (LSI) ≥90%
C) Successful completion of sport-specific training
D) All of the above

Answer 2

Answer: D) All of the above

Question 3

Which phase includes sport-specific drills, agility, and cutting exercises?
A) Very Early Phase (<1 month)
B) Early Phase (1-2 months)
C) Intermediate Phase (2-4 months)
D) Advanced Phase (>4 months)

Answer 3

D) Advanced Phase (>4 months)

Question 3

T/F4: Open kinetic chain (OKC) exercises should never be included in ACL rehab.

Answer 3

A: False – OKC exercises can be used safely in controlled ranges (90°-45° flexion).

Question 3

T/F1: Neuromuscular electrical stimulation (NMES) is not recommended in ACL rehab.

Answer 3

A: False – NMES helps improve quadriceps activation, especially early post-op.

Question 3

T/F2: Cryotherapy is only beneficial beyond 3 days post-op.

Answer 3

A: False – Cryotherapy is most effective in the first 3 days post-op.

Question 3

Q2: What is the main goal of preoperative rehabilitation before ACL reconstruction?

Answer 3

A2: Improve early post-op knee flexion/extension, enhance quadriceps strength, and educate the patient.

Question 3

Q4: At what phase can low-impact plyometrics (e.g., hopping drills) be introduced?

Answer 3

A4: Intermediate Phase (2-4 months).

Question 3

T/F3: Psychological readiness plays a role in safe return to sport after ACL reconstruction.

Answer 3

A: True – Psychological factors like fear of reinjury must be addressed.

Question 3

What is the purpose of Blood Flow Restriction (BFR) training in ACL rehab?
A) Prevent joint laxity
B) Improve proprioception
C) Reduce swelling and increase muscle strength with low loads
D) Increase cardiovascular endurance

Answer 3

C) Reduce swelling and increase muscle strength with low loads

Question 3

Q5: Name four key Return to Sport (RTS) criteria.

Answer 3

A5: Limb Symmetry Index (≥90%), psychological readiness, full ROM, and completion of sport-specific drills.

Question 3

Q7: What are two major risks of early return to sport after ACL reconstruction?

Answer 3

A7: High re-injury risk and graft failure.

Question 3

Q3: What is the role of adjunct therapies in ACL rehab?

Answer 3

A3: They help in early rehab (pain/swelling control, ROM) but should not replace exercise.

Question 4

Q8: What is the main advantage of using a patellar tendon autograft over a hamstring autograft?

Answer 4

A8: It provides superior graft stability but may increase anterior knee pain.

Question 4

T/F1: The optimal volume and intensity of exercise for ACL rehab is well-established.

Answer 4

A: False – Limited evidence exists on the exact volume/intensity.

Question 4

Q6: Why is early quadriceps activation important in ACL rehab?

Answer 4

A6: It prevents muscle atrophy and improves knee stability.

Question 4

T/F8: Neuromuscular Electrical Stimulation (NMES) can enhance quadriceps activation in early rehab.

Answer 4

A: True.

Question 4

Q9: When should Blood Flow Restriction (BFR) training be used in ACL rehab?

Answer 4

A9: In early rehab for patients who cannot tolerate heavy loads.

Question 4

Q10: What functional tests help assess readiness for return to sport?

Answer 4

A10: Single-leg hop test, drop vertical jump test, Y-balance test.

Question 4

T/F5: Psychological readiness is an important factor in return to sport after ACL reconstruction.

Answer 4

A: True.

Question 5

T/F2: ACL rehabilitation should follow a strict time-based protocol.

Answer 5

A: False – Progression should be criteria-based, not time-based.

Question 5

T/F3: Cryotherapy is most beneficial in the first three days post-op.

Answer 5

A: True.

Question 6

T/F7: Isometric quadriceps exercises should be avoided in the early phase of ACL rehab.

Answer 6

A: False – They help prevent muscle atrophy.

Question 6

T/F4: Strength training alone is enough for successful ACL rehabilitation.

Answer 6

A: False – Neuromuscular control and functional training are also essential.

Question 6

T/F6: Continuous Passive Motion (CPM) provides long-term benefits over active ROM exercises.

Answer 6

A: False – No significant long-term benefits.

Question 7

T/F9: Open kinetic chain (OKC) exercises should never be used in ACL rehab.

Answer 7

A: False – They can be used safely in controlled ranges (90°-45° flexion).

Question 8

T/F10: Allografts have a higher failure rate compared to autografts in young, active individuals.

Answer 8

True

Question 9

What is the main goal of the Early Phase (1-2 months) of ACL rehab? A) Reduce pain and swelling B) Improve strength, neuromuscular control, and movement patterns C) Initiate sport-specific drills D) Return to full competition

Answer 9

B) Improve strength, neuromuscular control, and movement patterns

Question 9

Which of the following is NOT a key component of ACL rehab? A) Strength training B) Neuromuscular control C) Immobilization for 6 weeks D) Functional training

Answer 9

C) Immobilization for 6 weeks

Question 9

: What is a primary concern when using hamstring autografts? A) Increased anterior knee pain B) Donor site morbidity C) High failure rate D) Poor graft integration

Answer 9

B) Donor site morbidity

Question 10

What is the primary role of NMES in ACL rehab? A) Increase hamstring strength B) Reduce pain and swelling C) Improve quadriceps activation and prevent atrophy D) Restore knee ROM

Answer 10

Answer: C) Improve quadriceps activation and prevent atrophy

Question 10

Which intervention is NOT recommended as a primary ACL rehab strategy? A) Neuromuscular training B) Cryotherapy C) Kinesio-taping D) Progressive resistance training

Answer 10

C) Kinesio-taping

Question 11

At what stage should high-intensity plyometrics (bounding, lateral hops) be introduced? A) Very Early Phase (<1 month) B) Early Phase (1-2 months) C) Intermediate Phase (2-4 months) D) Advanced Phase (>4 months)

Answer 11

D) Advanced Phase (>4 months)

Question 12

What is a key consideration for Return to Sport (RTS) after ACL reconstruction? A) Returning as soon as possible to prevent deconditioning B) Using a fixed time frame for return C) Meeting objective criteria like strength symmetry and functional testing D) Avoiding high-impact activities permanently

Answer 12

C) Meeting objective criteria like strength symmetry and functional testing

Question 12

What is the role of plyometric training in ACL rehabilitation?

Answer 12

Answer: Improves explosive power, neuromuscular control, and prepares for RTS.

Question 12

Which of the following is a contraindication for Blood Flow Restriction (BFR) training? A) Post-op quadriceps weakness B) Patients with cardiovascular risk factors C) Early-stage ACL rehab D) Muscle atrophy prevention

Answer 12

B) Patients with cardiovascular risk factors

Question 13

What is an appropriate Return to Running (RTR) criterion? A) 50% quadriceps strength compared to the uninjured limb B) Full knee extension but pain on weight-bearing C) Strength symmetry (LSI ≥90%) and proper biomechanics D) Completing rehab within 4 months

Answer 13

C) Strength symmetry (LSI ≥90%) and proper biomechanics

Question 13

3️⃣ What test assesses dynamic knee stability before RTS?

Answer 13

Answer: Single-leg hop test.