ACL Injury
how many patients had > 5 deg. differences in passive knee extension 4 wks after ACL reconstruction.
1/4 of patients. - They need to get full ext. ASAP for gait. -flexion will happen on its own.
Treatment for ACL
Adams (2012) Wright (2014) MOON guidelines (most current).
Patient Interview for ACL injuries
Decelerating or accelerating w/ non-contact dynamic valgus load near full extension. Feeling or hearing a "pop" Swelling within 2 hours after injury. Hx of the knee giving way or buckling.
What sport is # 1 related to ACL injuries?
High school girls soccer.
Outcome measures for ACL injuries
KOS- Knee Outcomes Survey LEFS Knee injury & Osteoarthritis Outcome Score (KOOS) Shortened version of the Tampa Scale of Kinesiophobia (TSK-11) (small % have sensitization issue).
Loss of full knee ROM after ACL injury influences what after surgery?
Knee ROM loss after surgery. - we want pts to get full ROM prior to surgery...it indicates how much they will have post op.
Special Tests for ACL injury
Lachman's Anterior drawer Pivot shift
ACL Injury nature of injury?
Likely traumatic in nature, related to sports injury.
Imaging for ACL: What can the MRI do?
MR: ruling out: SN 87-94 MR: Ruling In: SP 94-95
Triage & Screening for the Knee
Ottawa Knee Rules: - Ruling Out Fx = SN 100
MOI of ACL injury
Plant &/or Cut or twisting motion.
Pre-operative quad strength predicts what after ACL reconstruction?
Predicts knee function after ACL recon.
Why would the knee give way or buckle w/ an ACL injury?
Proprioception & muscle performance around the joint is inhibited.
Muscle performance tests for the knee
Quad & HS deficits after injury.
At 1 year post injury what muscles are asymmetric and which ones are restored?
Quad asymmetry, but HS are restored. - need to work multiplanar fashion to mimic what they will be doing outside the clinic.
Observation of ACL injury
Quad atrophy ambulation with stiff knee gait with flexed knee. - lack of knee extension b/c of lack of muscle activation.
Pivot Shift
SP 87; +LR 6.3, SN 88; -LR 0.13
Anterior drawer test (for chronic injury)
SP 91; + LR 8.9 SN 92; -LR 0.1
Lachman (for acute injury)
SP 94; +LR: 10.2, SN 85; -LR 0.2.
Immediate signs of ACL injury
Significant swelling & pain limited ROM.
Why should Clinicians should assess patella mobility with ACL reconstruction/ injury?
Superior translation has to occur in order to have full knee extension.
What physiologic response sets ACL apart from MCL?
Swelling within 2 hours after injury...meniscus swelling takes longer to appear.
Palpation for ACL injury
Tibial plateau (Fx) Joint line MCL & LCL