411 - knee

non-modifiable risk factors for ACL injury

-age (less than 20) -gender (female) -hormone stress (without contraception) -sports (soccer, skiing, handball, basketball common sports to get injured) -narrow intercondylar notch -generalized ligamentous laxity -synthetic floor or turf -poor weather (for outdoor sports) -infectious disease -history of muscle, tendon, knee or ankle injury

modifiable risk factors for ACL injury

-dynamic valgus -low flexion of hip and knee during landing -poor hip and trunk control -weakness of knee flexors -weakness of hip abductors -delayed activation of flexors -muscle fatigue -proprioceptive deficits -poor general fitness

extrinsic factors for female athletes ACL tear

-lower body strength and training -poor neuromuscular control -footwear and surface interaction -biomechanics of jumping and landing

D/Dx for knee injury

-patella fracture -patellar tendinopathy/tendinitis -lateral/medial meniscal tear -bursitis -osteoarthritis -rheumatoid arthritis -lymes disease -neuropathy (nerve damage) -ligament tear (ACL, MCL, LCL, PCL) -IT band injury -joint injury -muscle strain -popliteus tendinitis

intrinsic/anatomical factors in female ACL injuries

-smaller intercondylar notch -smaller ACL size -wider hips -larger Q angle -hormones (w/o contraception; estrogen and relaxin are highest during mid cycle --- most likely to ear) -biomechanics (females lands worse than males when jumping) -muscular imbalances (quad to hamstring rotation is 80:20 vs 60:40)

extension

0

3 screening tests (in article)

1. drop jump screening test 2. single leg squat test 3. functional movement screen test

3 most dangerous non-contact situations for ball sports and ACL sprains

1. landing after a jump 2. abrupt stopping 3. sudden direction change (including rotary knee motion)

4 limitations of Mortvedt article study (4)

1. only assessed players movements from frontal plane view only 2. picture quality and zoom factor differed slightly between tests 3. visual inspection of joint kinematics in complex tasks has been proven to be less accurate 4. some players in the non-injury group would sustain an ACL injury after the observation period (misclassifies them)

incidence for ACL tear

1/3500 (over 200,000 injuries)

flexion

135

% re-injury rate for ACL

15

internal rotation

30

lachmans test - patient in supine position with leg bent to __ degrees

30

most ACL tears are what degree

3rd

external rotation

40

prevalence for ACL injury - account for what % of all knee injuries

50 (2nd injury to ankle sprains)

cost for ACL injury in evaluation, treatment and rehab

500 billion

competition level return rate (%)

55

on the side the ACL was torn, patients were ___% more likely to have a previous unilateral ankle sprain (on that same side)

60

preinjury level return rate (%)

65

incidence is _ times higher in games vs practice

7

__% ACL sprains require surgery

80

same activity return rate (%)

81

sensitivity and specificity of MRI respectively (%)

86, 95

anterior drawer test - patient is in supine position with leg bent to__ degrees

90

O'Donoghue's Triad (unhappy triad)

ACL sprain, MCL sprain, medial meniscal tear (order in which usually torn; feel a pop in knee)

henning program

ACL tear prevention program for basketball players

vermont ACL prevention program

ACL tear prevention program for skiers

4 ligaments that hold the patella in place

ACL, PCL, LCL, MCL (anterior and posterior cruciate & lateral and medial collateral)

Q angle: angle between 2 lines -- these two lines are between:

ASIS - midpoint of patella and tibial tuberosity - midpoint of patella (Q angle changes the force that your quads are pulling the patella)

what is the gold standard for diagnosing ACL injury

MRI (most commonly used and really good at the knee)

SNOUT

Sensitive test with a Negative result rules OUT disease

SPIN

Specific test with Positive result rules IN disease

T/F. patients must be relaxed in order to perform exams

T

goal for both anterior drawer and lachmans test

anterior displacement of tibia

if you have a large athlete and small examiner, which test should the examiner do

anterior drawer

objective exams (3)

anterior drawer, lachmans, pivot shift

for a pivot shift test, the examiner..

applied valgus force on outside of knee and internally rotates tibia

joint moving

arthrokinematics

4 times more ACL tears in womens..

basketball players

knee joints are ____ diarthroidal

biaxial

intrinsic factors for ACL injury

biochemical, own ligament and muscle strength, hormone levels, sex, age

define 3rd degree ACL tear

complete rupture all the way through the middle of the ligament

screw home mechanism

describes how the knee flexes and extends with internal and external rotation

extrinsic factors for ACL injury

environment, shoe type, playing surface, sport, equipment

aim of the Mortvedt study

examine if sports medicine pros and coaches are able to identify players at risk for ACL injury by visually assessing player performance during a VDJ test

when the knee is fully extended (0), the tibia is at max..

external rotation (quads are contracting)

autograft

graft from a person's own body (BPB - bone patella bone graft or hamstring graft)

allograft

graft from another person or a cadaver (cadaver graft)

non-contact MOI for ACL

hyperextension and straight rotation with deceleration

if the pivot shift test is positive,

immediate joint line pain, tibia will sublux posteriorly (use this test if there are other parts other than ACL involved)

when the knee is flexed (135), the tibia is at mas

internal rotation (popliteus is contracting and causes the tibia to internally rotate)

avulsion tears are common in

kids (people who have open growth plates)

which test is most accurate

lachmans

which objective exam is the "gold standard" for detecting an ACL injury

lachmans test

most ACl tears happen in the ____ of the ligament

midsubstance

where the results of the area under curve for assessing risk rating ability high? how did it compare to a coin toss

no. ranged from 0.3-0.6 with a mean score of 0.47; results were NO better than tossing a coin

bones moving

osteokinematics

which test is most painful for the patient

pivot shift test

PEP program

prevent injury and enhance performance program; prevents ACL injuries in football

anterior compartment thigh muscles

rectus femoris, vastus lateralis, vastus medialis, vastus intermedius, tensor vastus intermedius, sartorius, TFL

3 pes anserine muscles (conjoined tendons of these 3 muscles)

sartorius, gracilis, semitendinosus

3-2 times more common to tear ACL in womens...

soccer players and gymnasts

cincinnati sportsmetric training program

tested on football, volleyball, and basketball athletes; consists of different jumping exercises with increasing complexity

knee joints (3)

tibiofemoral, patellofemoral, proximal tibiofibular

internal and external rotation occur in which plane

transverse

contact MOI for ACL

valgus force with rotation (force coming from outside source)

VDJ test

vertical drop jump test (visual observation; inexpensive and fast)

higher ACL tear rates are found among ___ in which 3 sports

women, team handball, volleyball, alpine skiing

is there a relationship between ACL tears and LAS

yes (on the sign that ACL was injured, patients were 60% more likely to have a previous unilateral ankle sprain)