MSK clinical application- Grade III anterior cruciate ligament sprain

Question 1

what translation does the ACL prevent?

Answer 1

anterior translation of the tibia on a fixed femur
posterior translation of the femur on a fixed tibia

Question 2

the ACL prevents anterior translation of the __ on a fixed __ and posterior translation of the __ on a fixed __

Answer 2

tibia; femur
femur; tibia

Question 3

describe the structure of the ACL

Answer 3

broad cord with long collagen strands
poor blood supply

Question 4

the long collagen fibers of the ACL permit up to __ lbs of force prior to rupture

Answer 4

500

Question 5

because the ACL has poor blood supply, it does not have the ability to heal what grade ACL sprain?

Answer 5

grade III-complete tear

Question 6

injuries to the ACL most commonly occur with what movements/activities?

Answer 6

hyperflexion of the knee
rapid decceleration
hyperextension
landing in an unbalanced position

Question 7

where do grade III complete tears of the ACL typically occur?

Answer 7

within the midsubstance as opposed to its attachment on the femur or tibia

Question 8

grade III ACL sprains present with excessive laxity, not typically in a __ plane but instead is often classified as __ or __ laxity

Answer 8

straight; anterolateral or anteromedial

Question 9

what type of athletic activities increase incidence of ACL injury?

Answer 9

athletic activities involving high levels of agility (basketball, soccer, volleyball)
contact sports

Question 10

studies indicate that males/females involved in selected athletic activities experience significantly higher ACL injury rates than their male/female counterparts

Answer 10

female; male

Question 11

what are the causative factors (5) for ACL injury?

Answer 11

body movement and positioning
muscle strength
joint laxity
Q angle
narrow intercondylar notch

Question 12

the peak incidence of ACL injury occurs between __-__ years of age- why?

Answer 12

14-29- this age group corresponds an overall higher activity level which increases risk for injury

Question 13

what is a grade III ACL sprain characterized by (5)?

Answer 13

significant pain
effusion
edema that limits ROM
may be unable to WB on involved limb resulting in AD dependence

ligamentous testing reveals visible ligamentous laxity and may exacerbate pain

Question 14

ligamentous testing reveals __ __ __ and may __ __ in someone with a grade III ACL sprain

Answer 14

visible ligamentous laxity
exacerbate pain

Question 15

what imaging technique is the preferred imaging tool to identify the presence of an ACL tear and possible disruption to other soft tissue structures like ligaments and menisci?

Answer 15

MRI

Question 16

when is an xray indicated for a patient with grade III ACL sprain?

Answer 16

to rule out fracture
not gold standard for ACL tear identification

Question 17

what additional information should be obtained to confirm ACL grade III sprain?

Answer 17

subjective report of:
popping
feeling of knee giving way/buckling

special tests:
Lachman’s test
anterior drawer
pivot shift test

Question 18

feeling of what sensation at the knee is typically associated with ACL tear?

Answer 18

knee buckling

Question 19

it is important to perform test __ when performing special tests for ACL tear

Answer 19

bilaterally

Question 20

what subjective history info (7) should be documented during evaluation/treatment of someone with a grade III ACL sprain?

Answer 20

MOI
current symptoms
PMH
medications
living environment
social habits/history
social support system

Question 21

what objective tests and measures should be performed when evaluating someone with a grade III ACL sprain?

Answer 21

anthropometrics: effusion and edema circumferential measurements
A&O
pain perception assessment scale
A/PROM
sensation and skin assessment
muscle strength/endurance

joint integrity/mobility: Lachman/reverse lachman, anterior drawer, ligament and menisci testing, palpation of structures, joint play, soft tissue restrictions, joint pain
gait (safety with AD), locomotion, balance
orthotic, proprioceptive and supporting devices: bracing, taping, wrapping, foot orthotic assessment

assessment of functional capacity (self-care and home management)

Question 22

approximately 2/3 of the time an ACL is torn, there is an accompanying __ tear?

Answer 22

meniscal

Question 23

what other structures can be involved in an ACL tear injury, but not as commonly as the menisci?

Answer 23

the collateral ligaments

Question 24

unhappy triad

Answer 24

when all three structures (ACL, MCL and medial meniscus) are damaged

Question 25

when the ACL, MCL and medial meniscus are all impacted by injury, what is this referred to as?

Answer 25

unhappy triad

Question 26

immediate management of a patient following ACL tear includes (4)?

Answer 26

controlling edema increasing ROM strengthening improving fluidity of gait

Question 27

for patients electing to have ACL surgery, what tendon is the most commonly used as a graft?

Answer 27

patellar tendon

Question 28

initially following ACL surgery, what ADs/orthoses are typically prescribed? why?

Answer 28

a knee immobilizer and crutches to protect the reconstructed ligament

Question 29

what does physical therapy in the initial post-operative phase following ACL reconstruction focus on?

Answer 29

protecting the integrity of the graft controlling edema improving ROM

Question 30

what specific interventions does physical therapy in the initial post-operative phase following ACL reconstruction include (5)?

Answer 30

pain modulation patellar mobility AROM quadriceps exercises gait activities

Question 31

as the patient s/p ACL reconstruction progresses in their rehab program, what does treatment begin focusing on?

Answer 31

strengthening activities emphasizing closed chain exercises and select functional activities

Question 32

why are closed chain exercises more desirable than open chain exercises for a patient s/p ACL reconstruction beginning to progress in their rehab program, out of the initial post-operative phase?

Answer 32

closed-chain exercises minimize anterior translation of the tibia

Question 33

prior to returning to unrestricted athletics, a patient s/p ACL recontruction should be required to complete what?

Answer 33

a functional progression

Question 34

for patients with ACL grade III sprain opting for a conservative approach, it is necessary to begin an __ __ program once the acute phase of the injury has subsided

Answer 34

aggressive strengthening

Question 35

what should the home exercise program for a patient with grade III ACL sprain include (4) as warranted based on the results of patient examination and course (conservative versus operative) of treatment?

Answer 35

ROM strengthening palliative care functional activities

Question 36

what is the expected outcome in terms of return to athletic activity for a patient with grade III ACL sprain choosing a conservative course of treatment?

Answer 36

it is possible with an aggressive strengthening program and/or activity modification that patients may be able to participate in light-mod athletic activities

Question 37

it is possible with an aggressive strengthening program and/or activity modification that patients conservatively managing a grade III ACL sprain may be able to participate in __-__ athletic activities

Answer 37

light-mod

Question 38

what is the expected outcome in terms of return to prior level of function for patients electing to have ACL recontruction?

Answer 38

return to prior level of function within 4-6 months

Question 39

patients who elect to conservatively manage a grade III ACL sprain will likely be at increased risk for __ and subsequent __ __ __

Answer 39

instability and subsequent joint surface deterioration

Question 40

what is a common differential diagnosis for ACL sprain?

Answer 40

PCL sprain

Question 41

is ACL or PCL sprain more common?

Answer 41

ACL

Question 42

how does a PCL injury most often occur?

Answer 42

dashboard injury- forced knee hyperflexion combined with PF

Question 43

grade III PCL injury signs and symptoms

Answer 43

effusion posterior tenderness positive posterior drawer test limited knee extension (due to effusion, and stretching of the posterior capsule/gastroc)

Question 44

what does PCL sprain rehabilitation emphasize?

Answer 44

quad strengthening

Question 45

why is surgical intervention far less common for isolated PCL sprain compared to ACL sprain?

Answer 45

individuals with isolated PCL sprain may not exhibit functional performance limitations

Question 46

longterm, patients with prior PCL sprain are susceptible to what?

Answer 46

degenerative changes such as arthritis