Lecture 6

Question 1

What is the structure of ligaments?

Answer 1

Dense bands of collagen tissue (collagen, elastin, proteoglycan, and other proteins), vary in size, shape, orientation and location

Question 2

What are the functions of ligaments?

Answer 2

Connect one bone to another (passive stabilization of the joint)
Ligaments can creep
Serve proprioceptive function

Question 3

How do ligaments respond to injury?

Answer 3

Healing follows the constant pattern, decreased porprioception

Question 4

Why do ligaments have high risk of re-injury?

Answer 4

Ligament scars have poor viscoelastic properties

Question 5

What % of force cause change of length and starts permanent elongation in ligaments?

Answer 5

Around 4%

Question 6

What are intra-articular ligamnets?

Answer 6

Inside the joint capsule (ex: cruciate ligaments of knee)

Question 7

What are extra-articular ligaments?

Answer 7

Outside joint capsule (ex: calcaneofibular ligamet)

Question 8

What are capsular ligaments?

Answer 8

Part of the joint capsule (ex: ant. talofibular ligament)

Question 9

Which types of ligaments can heal by themselves?

Answer 9

Extra-articular and capsular

Question 10

What is the first step of adapting to training post ligament injury?

Answer 10

Adapt slowly to increased loading, but weaken very rapidly as a result of immobilisation

Question 11

What is the second step of adapting to training post ligament injury?

Answer 11

Adapt to loading by increasing the cross sectional area

Question 12

What is the third step of adapting to training post ligament injury?

Answer 12

Normal everyday activity is sufficient to maintain mechanical properties

Question 13

What is the fourth step of adapting to training post ligament injury?

Answer 13

Systematic training can increase ligament strength by 10-20%

Question 14

What is important to do as soon as possible after a ligament injury?

Answer 14

Load the ligament as soon as possible

Question 15

What does joint stability depend on?

Answer 15

Interaction between the passive, active, and neural subsystems

Question 16

What do passive subsystems consist of?

Answer 16

Non-contractile connective tissues

Question 17

What is active subsystem controlled by? And to do what?

Answer 17

The neural subsystem to provide dynamic joint stability

Question 18

How are ligaments typically injured?

Answer 18

Because of acute trauma

Question 19

What do acute injuries and sudden overload injuries cause?

Answer 19

The ligament is rapidly stretched out

Question 20

What happens to the ligament during overuse injuries and repetitive loading?

Answer 20

Ligament is gradually stretched out

Question 21

What is the most common type of ligament injury, and why?

Answer 21

Knee, has less support, more wight, and joint is designed stupid

Question 22

What is the first question to ask when assessing a ligament injury?

Answer 22

Did you feel or hear a rip, pop, or tear?

Question 23

What is the second question to ask when assessing a ligament injury?

Answer 23

Did something come out of place?

Question 24

What are we looking for when we ask if something came out of place?

Answer 24

Knee CAP or knee

Question 25

What are some valgus mechanisms of injury?

Answer 25

ACL/MCL rupture, lateral dislocation of patella, lateral meniscus injury, lateral tibial plateau fracture

Question 26

What is the third question to ask when assessing a ligament injury?

Answer 26

Where is the pain?

Question 27

What is the fourth question to ask when assessing a ligament injury?

Answer 27

When did the swelling occur?

Question 28

What does it mean if swelling occurs within minutes?

Answer 28

Bleeding is inside the knee

Question 29

What is hemarthrosis?

Answer 29

Bleeding into the joint

Question 30

What injuries cause hemarthrosis?

Answer 30

ACL tear, peripheral meniscus tear, osteochondral injuries, fractures

Question 31

What injuries do not cause hemarthrosis?

Answer 31

MCL tear, central meniscus tear, pcl tear, cartilage injury

Question 32

How many bundles does the ACL have?

Answer 32

2

Question 33

What kind of fibers does the ACL have?

Answer 33

Proprioceptive

Question 34

What are we looking for in a primary physical examination of an ACL tear?

Answer 34

Stability of the joint

Question 35

When are MRIs needed for knee injuries?

Answer 35

For complex injuries, all DISLOCATED knees, for surgical planning purposes

Question 36

What are the 4 most common ACL complications

Answer 36

Osteochondral injury, ACL injury and meniscus tear, unhappy triad, osteoarthritis in 15-20 years

Question 37

What is the goal for ACL treatment?

Answer 37

To prevent recurrent giving way (to prevent subsequent injuries)

Question 38

What are the options of ACL treatment?

Answer 38

Modification of activity, bracing for light twisting, ACL reconstruction (never normal function)

Question 39

When is the graft of an ACL reconstruction the weakest?

Answer 39

At 3 to 6 months

Question 40

When is the highest re-injury rate for ACL reconstruction?

Answer 40

Over 2 years after reconstruction

Question 41

What is the ACL injury rate for girls/women?

Answer 41

6 times more likely

Question 42

What are some modifiable risk factors for prevention of ACL injuries?

Answer 42

Weak hip abductors and external rotators

Question 43

How much did the knee control program reduce ACL injruies?

Answer 43

64%

Question 44

What is shoulder subluxation?

Answer 44

Partial dislocation of articulating bone (some contact in joint)

Question 45

What is shoulder dislocation?

Answer 45

Complete separation of articulating bones (no contact in joint)

Question 46

What are the two main mechanisms of shoulder dislocations?

Answer 46

Direct blow to the shoulder, landing on outstretched arm

Question 47

What is a labrum injruy?

Answer 47

Injury of the cartilage ring around the shoulder joing

Question 48

What is the % of injury for shoulder injuries?

Answer 48

50-90% (depending on the type of sport)

Question 49

What is critical for long-term function of the shoulder post injury?

Answer 49

Rehabilitation

Question 50

4 preventions of shoulder dislocations and subluxations?

Answer 50

Protective equipment, muscle strength, tackle strategies, how to fall training