Flashcards in Lecture 4 Deck (114)
Clinical presentation for ACL rupture?
1/3 hear a pop
Unable to continue training
What causes joint effusion with acl rupture?
Edges of the torn ligament bleeds into the joint (hemarthrois)
ACL rupture PE?
+/- MCL and meniscus test
What instability tests are positive with ACL rupture?
Lachman (most accurate)
Do they need an MRI? (ACL)
Clinical exam is as good as MRI
What is good about and MRI? (ACL)
It is sensitive and specific
Shows concomitant injuries
What are kissing lesions?
ACL tear MRI finding:
-Anterior lat femoral condyle
- Posterior lat tibial plateau
Touch on MRI
Initial tx for ACL rupture?
Early ROM and PT
ROM brace is used
What is the key for ACL rupture management?
Early ROM exercises
Full ext/flexion as soon as swelling permits
What will surgery not fix for ACL ruptures?
The risk of OA
CI for surgical repair of ACL rupture?
Response to non-operative therapy
What can you hope for with ACL nonoperative tx?
ROM of at least 0-120
Strength: quadriceps and hamstring w/in 90%
Surgical options for ACL rupture?
Patella tendon autograft
Patella tendon autograft info?
Most popular (NLF uses it)
Stable: late rupture is rare
Anterior knee pain is common
Hamstring autograft info?
MC in low intensity athletes
No anterior knee pain
Strength/stiffness is based on fixation method
50% strength of autograft
Used to augment or when donor tissue sucks
What is the risk of nonsurgical tx for ACL rupture?
Degnerative joint disease
ACL surgery adverse outcomes?
Numbness lateral to incision
Why do pts get numbness following ACL repair?
Infrapatellar branch of saphenous nerve is compressed
Often spontaneously resolves
What is the PCL?
Posterior cruciate ligament
Critical ligament in the knee and serves as the primary restraint to posterior translation of the tibia relative to the femur
Anatomically where is the PCL found?
Originates on the medial intercondylar wall of the femur, runs obliquely behind the anterior cruciate ligament and inserts on the posterior aspect of the tibia below the joint line
What is the MC cause of PCL injury?
Direct blow to the tibia such as dashboard injury in MVA
Why are PCL injuries often missed?
If you have an isolated PCL injury you can usually function at a near-normal level
Injury patterns that suggest PCL rupture?
Fall onto flexed knee w foot in plantar flexion
Hyperextension of knee
Hyperextension strong enough to rupture ACL and PCL
PE for PCL rupture?
Posterior drawer test
Posterior sag sinn
False positive lachman test
ACL and PCL injury
Radiographic studies for PCL?
MRI = useful for PCL and concomitant injuries to surrounding tissue
Adverse outcomes of PCL rupture?
Limb threatening vascular injury (dislocated knee)
Permanent perineal or tibial injury and sever knee instability can occur
Recurrent instability, subsequent tears and OA
What is the basis of PCL injury tx?
Initial: resolve swelling and restore ROM
After: strengthening exercises
Braces: for contact sports after return to sports
What is the purpose of the medial and lateral collateral ligaments?
They are outside the joint and stabilize the knee against valgus and vargus stress