LE - knee (ligaments)

ACL, MCL, PCL, LCL

Which of the following is not a key mechanism of an ACL injury?

Acceleration

The dynamic knee valgus mech of ACL injuries involves all of the following except:

if UNI → IPSA trunk EXT and CL pelvic hike

The poor landing mech of ACL injuries involves:

asymetric land placing greater stresses on one extremity

The deceleration mech of ACL injuries involves sudden stop or direction change causing

INC ANT shear

(QUAD force > HS force)

The hyperEXT mech of ACL injuries involves

directly increases ACL strain

Which of the following is not a movement prevented by the ACL?

ANT femoral translation

ACL injuries rarely occur in isolation (25%). What percentage occurs in combination with other injuries?

MED meniscus (30%), MCL (25%), LAT meniscus (20%)

Which of the following is not a risk factor for ACL injuries?

Long distance running

What is the typical onset of P! for ACL injuries?

acute,

usually after cutting or landing a jump (accompanied by a pop or snap)

Patients with an ACL injury are typically unable to

walk w/o support or limp

or finish their activity

What happens within hours of an ACL injury?

swelling and hemiarthrosis

What is contraindicated for the first few months after ACL surgery?

RES knee EXT b/t 45-0º due to ANT tibial shear

What alternative exercise is suggested post-ACL surgery?

OKC knee EXT b/t 90-45º

Which special test is used to rule in an ACL injury?

The Lachman test.

Which of the following is NOT a consequence of conservative management for ACL injuries?

INC pain and swelling

What is the risk associated with delaying ACL reconstruction beyond 6 months?

INC risk of new / worsening meniscal tears

What is the most common treatment path for active or young individuals with ACL ruptures?

ACL reconstruction

Which of the following pairs is not part of the 6 main goals of ACL reconstruction rehab?

Activate HS / Improve Balance

What methods can be used to resolve knee effusion?

Ice, ELV, and ROM

All of the following exercises can help regain knee ROM after ACL injury except:

supine hang

All of the following are exercises recommended to activate the quadriceps after ACL injury except:

LAQ

What is involved in normalizing gait after ACL injury?

Gait w/ AD and balance exercises

Which of the following is not an advantage associated with 3-4 weeks of prehab?

pt can ambulate w/ AD and SLR w/ slight lag

What types of grafts are used in ACL reconstruction?

Autograft (own ipsilateral quadriceps or hamstring) or allograft.

What is the focus of rehabilitation in the first two weeks post-ACL surgery?

same as prehabilitation

How long does it typically take for effusion to resolve after ACL surgery?

w/in 1-3 months,

longer with allografts.

What role do SUP/INF patellar mobilizations play in ACL rehabilitation?

assist w/ P! and knee EXT

prevent patellar baja in patellar grafts

What does knee extension failure by three weeks post-op indicate?

scar tissue in joint (cyclops lesion)

What is the role of neuromuscular electrical stimulation (NMES) in ACL rehab?

muscle activation in the first two m of rehab

Intermediate phase of rehab can shift toward

maintaining knee EXT

gaining the final degrees of knee FLX

Which of the following is not a strength priority in the intermediate phase of ACL rehabilitation?

hip IR

What of the following is not an approach to plyometric training in ACL rehabilitation?

exercises 3-5 times/wk

Pro athletes will RTS at ______ performance level prior to injury and lower levels athlete will RTS at ______ performance level prior to injury.

decreased; same-ish

Which of the following is not a part of the 4 key points of RTS?

development of acute training load

Return to competition before 10-12 mnths

increase risk of ACL injury to IPSA and CL limb

Most MCL injuries are caused by

direct contact into VALGUS

MCL injuries are less frequently the result of

noncontact VALGUS (combined w/ excessive PRO)

In an MCL injury, what is generally tender to palpate?

MCL

What should be avoided early in MCL injury rehabilitation?

early hip ADD + valgus stressors

What does the Valgus stress test assess?

integrity of MCL

What are the characteristics of valgus stress test for Grade 1 MCL injury?

P! at 20-30 w/o laxity

rarely seen in PT

What are the characteristics of valgus stress test for Grade 2 MCL injury?

P! & laxity at 20

= partial tear, tender to palp, activity specific complaints

What are the characteristics of valgus stress test for Grade 3 MCL injury?

P!, laxity, soft end feel at 20

= palpable gap & lax tibial ER

What is the prognosis for non-operative treatment of Grade 1 and 2 MCL injuries?

excellent

For Grade 3 MCL injuries, how does the results with non-surgical compare to surgical intervention?

results are similar

Which of the following is not a key interventions for Grade 1 and 2 MCL injuries?

Grad knee ROM

Intervention for Grade 3 MCL injuries should use

hinged brace

to prevent valgus stress while allowing ROM from 0-90

What is the typical recovery time for Grade 3 MCL injuries with conservative treatment?

5-7 weeks to 6-9 months.

If reconstruction of MCL performed, generally

NWB for 4-6 wks

Which of the following is not a key rehabilitation focuses for MCL injuries?

gait to run progression

Many with MCL injuries have no residual deficits & are able to return to sport in

1-4 wk (up to 6)

What is the long-term risk of OA after MCL injuries?

no increased risk

PCL is a _____ sized ligament but is ____ commonly injured compared to ACL or MCL.

larger; less

Nearly all PCL injuries result from

trauma

(MVA or falls)

What is the mechanism of a PCL injury to due a fall?

landing on FLX knee / PF ankle driving tibia POST

PCL injuries do not normally have

effusion

Isolated PCL injuries rarely lead to

functional instability

(pt seek treatment/under diagnosed)

What is a potential long-term consequence of chronic PCL deficiency?

INC risk of MED knee OA

due to persistent knee joint laxity

Which of the following is not a special tests used to assess PCL injuries?

Varus stress test

What is the standard of care for PCL injuries?

Conservative management

Rehabilitation for PCL injuries should aim to limit

POST shear forces

w/ OKC HS exercises

How might a knee brace be used in the context of PCL injuries?

beneficial in managing PCL injuries.

The PCL can also be injured in combination w/ ACL from

hyperextension injuries

If ACL / PCL injury may result in reconstruction of

both or just ACL

The PCL and multiple other structures are typically injuried w/

knee dislocation

What results from sudden varus stress?

LCL injuries

LCL injuries are rare in isolation → more commonly in

catastrophic knee injuries involving multiple structures

What structures are commonly involved in catastrophic knee injuries with LCL injuries?

POSTLAT capsule, biceps femoris, and gastroc (LAT head)

What should a clinician do if pain and laxity are noted during a varus stress test?

Request an MRI or consult with an orthopaedist.

What is the significance of local tenderness along the LCL?

It indicates a potential LCL injury.

What are the characteristics of a varus stress test for Grade 1 LCL injury?

P! at 20-30 w/o laxity

What are the characteristics of a varus stress test for Grade 2 LCL injury?

P! and laxity at 20

What are the characteristics of a varus stress test for Grade 3 LCL injury?

P!, laxity, and soft endfeel at 20

All of the following are interventions that may benefit Grade 1 LCL injuries except

long-term use of AD

How are catastrophic knee injuries involving the LCL treated?

surgically w/ a staged approach

What does a staged surgical approach for a PCL injury involve?

portion of repair performed early,

addressing remaining at second surgery.

What is the nature of rehabilitation for LCL injuries?

complex and individualized