WEEK 5 - MID TO LATE-STAGE REHAB OF LL INJURIES

Question 1

Common PRO’s for knee dirsorders

Answer 1

• The International Knee Documentation Committee Questionaire
  
  • Questionnaire looks at three (3) categories:
    
    • Symptoms,
    • Sports activity and…
    • Knee function
  • The symptoms subscale helps to evaluate pain, stiffness, swelling and giving-way of the knee
  • The sports activity subscale focuses on higher level functions such as;
    
    • going up and down the stairs, rising from a chair, squatting and jumping
  • The knee function subscale asks patients one simple question – “how is their knee at present versus how was their knee prior to injury”
• ACL-QoL test

Question 2

What are PRO’s

Answer 2

• Patient-reported outcome measures (PROMs) capture a person’s perception of their own health through the use of questionnaires
• They enable patients themselves to report on their quality of life, daily functioning, symptoms, and other aspects of their health and well-being

Question 3

Ankle PRO’s

Answer 3

PRO’s for the ankle

• Foot and Ankle Disability Index (FADI)
  
  • Considered most appropriate to quantify functional disabilities in patients with ankle injuries such as CAI
  • Also shows changes in activity limitations, participation restrictions and disability over time
  • FADI and FADI Sport shown to be sensitive to deficits associated with CAI Hale & Hertel (2005)
  • FADI SPORT – more sensitive at detecting Fx deficits and, as noted, better for higher functioning patient

Question 4

What are FOM’s

Answer 4

• functional outcome measures quantify a patients current level of function and then improvement across an episode of care
• validated and reliable outcome measures allow clinicians to establish a definitive baseline of patient function and compare advancements/changes in function in real-time

Question 5

Knee and ankle FOM’s

Answer 5

M-Less

• Single leg drop jump with 90º rotation
• 2 opportunities to assess landing and deceleration
  
  • Plus…
  • One take off – giving info about vertical
    propulsion and acceleration
• Qualitative (strategy used, presence of ”errors”) AND a…
• Quantitative score (height)

Star excursion balance test

• The SEBT requires a floor to be marked with a star pattern with between 3-8 directions, the marked directions being 45-135° apart from each other:
  
  • Anterior, posterior, medial, lateral
  • Posterolateral, posteromedial, anterolateral, and anteromedial.
• Foot placement: a “toe-heel” changing position should be used to minimize foot length differences
  
  • Anterior reach directions (anterior, anteromedial, anterolateral) the distal end of the longest toe placed at the center of the grid
  • The heel is at the center of the grid for posterior reaches (posterior, posteromedial, and posterolateral)
• Hand/arm placement = hands on hips

crossover / side hop test

• test set up two lines of tape 30cm apart
• the subject is instructed to hop laterally, without error, over the two lines 10times
  
  • each return to start position is 1rep
• a greater time to complete is associated with a less functionally stable ankle
• standardised hand position behind back

LSI

• single hop for distance
• triple hop for distance
• 6 meter hop for time
• 3x crossover hop test
• single leg drop jump
• muscle strength

LSI: Limb symmetry index

• LSI for single, triple, crossover hop =
  
  • mean distance for the involved limb divided by mean distance for the uninvolved limb x100

Question 6

List modifiable biomechanical risk factors for acute, high-energy knee and ankle injuries

Answer 6

Biomechanical
- GRF
- anterior tibial shear
COM - high or displacement
- knee valgus moment
- tibial IR or ER (foot position)
- lateral trunk motion)
- trunk rotation
- foot-strike pattern (heel vs mid)
- dynamic foot pronation

Non-contact ACLI typically arises from an accumulation of these factors required during rapid deceleration

Question 7

KNEE - Stage 1 return to sport framework inclusions

Answer 7

Generalised capacity building (S&C + aerobic conditioning)

Aerobic base maintenance (bike, swimming)

RTS: Deceleration and landing training:

Progression (in more detail):

Stage 1: Force absorption and preparation

PRO’s:
IKDC score >70%
FADI > 70%

Quiet knee/ankle/hip
- no knee effusion
- full, pain-free ROM

Aim: ability to decelerate and accept body weight, stepping, no airborne component

Examples: SL step to and hold -> DL horizontal/vertical jump and hold

Criteria to progress:

Achieved repeated SL squat and hold symmetry to >60% knee F

SL balance scores approaching R=L

Audibly rhythmic gait

Question 8

KNEE - Stage 2 return to sport framework inclusions

Answer 8

Generalised capacity building (S&C + aerobic conditioning)

Aerobic base maintenance (bike, swimming)

Aim: Decelerate and accept body weight on a single limb ant. and lat. From an airborne position with optimum control

Examples: DL jump to SL hold -> lunge jumps -> DL lateral jump to DL hold

Criteria to progress:

Muscle performance

> 90% LSI in knee E and F

Functional measures

> 80% SL hop for height with good landing

Achieved DL and SL squat symmetry to >90% knee F

Question 9

KNEE - Stage 2 return to sport framework inclusions

Answer 9

Generalised capacity building (S&C + aerobic conditioning)

Linear running mechanics + running load capacity building

Aim: Decelerate and accept body weight on a single limb anteriorly and laterally using repeated hopping with optimum control

Example: SL hop, hop to SL hold -> SL lateral hop and return to SL hold

Criteria to progress:

SL hop for distance

SL cross over triple hop for distance

SL vertical power hop

Tuck jump Ax

All within 15% of unaffected side

Drop vertical jump landing force BL symmetry within 15%

Modified T mobility

Question 10

KNEE - Stage 4 return to sport framework inclusions

Answer 10

Integration of multi-planar sports specific skills

Very specific and intense

Professionals in field