ACL

Question 1

The ACL passes from the anterior medial side of the tibial plateau and passes _______, ______ and _______ to the posterior notch of the femur

Answer 1

upward, backward, laterally

Question 2

ACL resists ______ translation of the tibia on the femur

Answer 2

anterior

Question 3

The ACL resists ______ of the femur on the tibia

Answer 3

rotation

Question 4

ACL acts in conjunction with ______ ligaments to resist valgus forces

Answer 4

collateral

Question 5

ACL assists with _____ -_____ mechanism

Answer 5

screw-home

Question 6

Do ACL injuries occur more in contact or non contact situations ?

Answer 6

non-contact (70%)

Question 7

What ROM do most ACL injuries take place in ?

Answer 7

0-30 degrees

Question 8

4 MOI’s for ACL?

Answer 8

1. planted food + rapid direction change (PIVOT)
2. excessive anterior tibial translation
3. hyper flexion or hyperextension
4. direct trauma to the knee

Question 9

What are 2 intrinsic factors that lead to higher incidence of ACL injuries in females?

Answer 9

1. anatomic

2. hormonal

Question 10

What are 3 anatomic factors that may lead to a higher incidence of ACL injuries in females?

Answer 10

1. limb posture
2. joint laxity
3. size of intracondylar notch

Question 11

What are 4 extrinsic factors that lead to higher incidence of ACL injuries in females?

Answer 11

1. leg dominance
2. ligament dominance
3. quads dominance
4. trunk dominance

Question 12

When there is a _____ collapse, supporting muscles do not adequately absorb GRF and more forces are imparted through _______ restraints

Answer 12

valgus; static

Question 13

____-____ landing posture, rather than flexed, = more risk for ACL tear

Answer 13

stiff-legged

Question 14

Impaired core proprioception predicted knee injury in female, but not male athletes (T/F).

Answer 14

TRUE

Question 15

4 factors in pt’s history that indicate an ACL injury?

Answer 15

1. pain that is poorly localized 2. unable to continue to play on
2. swelling (if it comes on within a few hours, most likely torn blood vessels in ACL)
3. complaints of instability

Question 16

4 special tests in examination for ACL tear?

Answer 16

1. anterior drawer
2. lachman
3. lever sing or lelli’s test
4. pivot shift

Question 17

6 conditions that can accompany an ACL rupture?

Answer 17

1. subchondral bone bruise
2. chondral injuries
3. meniscal damage
4. capsular damage
5. secondary ligament (often MCL!*)
6. fracture

Question 18

What is the name of the # commonly associated with ACL tear?

Answer 18

Segond’s; small avulsion # of tibia

Question 19

What is the single most important predictor for knee function 2 years following ACLR?

Answer 19

pre-op quads strength!

Question 20

Recent ACL treatment has evolved to include more ____ with less ____, and ____ chain exercises

Answer 20

load; reps; open

Question 21

2 surgical reconstruction options of the ACL?

Answer 21

1. bone-patellar tendon-bone

2. semitendinosus gracilis

Question 22

4 sequences of events in graft healing ?

Answer 22

1. avascular necrosis
2. cellular infiltration
3. vascular invasion
4. remodelling

Question 23

ACL contains _______ that provide the CNS with afferent info about joint position through the _____ nerve

Answer 23

mechanoreceptors; tibial

Question 24

Poor control of _____ movements is considered to be a major factor in ACL injury and re-injury risk

Answer 24

dynamic

Question 25

The goal with post op ACL pt's is to improve the NS ability to generate optimal muscle firing pattern to do what 3 things?

Answer 25

1. increase joint stability 2. decrease joint forces 3. relearn or unlearn movement patterns and skills

Question 26

6 stages in post op ACL rehab?

Answer 26

1. pre-op 2. immediate post - op 3. early rehab 4. intermediate rehab 5. advanced activity 6. return to activity

Question 27

Immediate post op?

Answer 27

1st week

Question 28

Early rehab?

Answer 28

weeks 2-4

Question 29

Intermediate rehab?

Answer 29

weeks 4-10

Question 30

Advanced activity?

Answer 30

weeks 10-16

Question 31

Return to activity?

Answer 31

weeks 16-22

Question 32

6 Rehab STAGES?

Answer 32

1. pre op 2. post op 3. progressive limb loading 4. unilateral load acceptance 5. sport specific training 6. unrestricted sport specific training

Question 33

__-__ weeks post op is when graft is fairly week

Answer 33

6-12

Question 34

4 pre op goals of Rx?

Answer 34

1. reduce inflammation, swelling and pain 2. restore normal ROM (ESP EXT!) 3. restore muscle activation 4. provide education re surgery

Question 35

6 goals of Rx immediately post op?

Answer 35

1. restore full passive extension 2. diminish swelling and pain 3. gradually restore flexion 4. re-establish quad control 5. control independent ambulation 6. restore hamstring length 80%

Question 36

Should have __ deg flexion by day 5, ___ deg by day 7

Answer 36

90; 100

Question 37

Goals or Rx early post op phase?

Answer 37

1. maintain full knee extension 2. diminish swelling and pain 3. gradually increase knee flexion, progress to 115 deg by week 3 4. muscle training and begin to restore proprioception 5. patellar mobility 6. restore hamstring length by 100% and progress as able

Question 38

5 goals of Rx intermediate post-op?

Answer 38

1. restore full knee ROM 2. improve lower extremity strength (quads 80%) 3. enhance proprioception, balance and neuromuscular control 4. improve muscular endurance 5. restore limb confidence and Fx

Question 39

5 goals of Rx advanced activity phase?

Answer 39

1. normalize lower extremity strength 2. progress proprioception, balance and neuromuscular control 3. enhance muscular power and endurance 4. perform selected sports specific drills 5. hop tests > 85% by week 12

Question 40

4 goals of Rx return to activity phase?

Answer 40

1. gradual return to full unrestricted sports 2. achieve maximal strength and endurance 3. normalize neuromuscular control 4. progress skill training