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61

Clinical presentation for ACL rupture?

Instability immediately
1/3 hear a pop
Unable to continue training
Immediate effusion

62

What causes joint effusion with acl rupture?

Edges of the torn ligament bleeds into the joint (hemarthrois)

63

ACL rupture PE?

Decreased ROM
Effusion-hemarthrosis (immediate)
Instability tests
+/- MCL and meniscus test

64

What instability tests are positive with ACL rupture?

Lachman (most accurate)
Pivot shift
Anterior drawer

65

Do they need an MRI? (ACL)

No

Clinical exam is as good as MRI

66

What is good about and MRI? (ACL)

It is sensitive and specific
Shows concomitant injuries

67

What are kissing lesions?

ACL tear MRI finding:

-Anterior lat femoral condyle
- Posterior lat tibial plateau
Touch on MRI

68

Initial tx for ACL rupture?

RICE

Early ROM and PT

ROM brace is used

69

What is the key for ACL rupture management?

Early ROM exercises

Full ext/flexion as soon as swelling permits

70

What will surgery not fix for ACL ruptures?

The risk of OA

71

CI for surgical repair of ACL rupture?

Age >40
Stiffness
Response to non-operative therapy
Advanced arthritis
Compliance issues

72

What can you hope for with ACL nonoperative tx?

ROM of at least 0-120
Strength: quadriceps and hamstring w/in 90%

73

Surgical options for ACL rupture?

Patella tendon autograft
Hamstring autograft
Allograft

74

Patella tendon autograft info?

Most popular (NLF uses it)
Stable: late rupture is rare
Anterior knee pain is common

75

Hamstring autograft info?

MC in low intensity athletes
No anterior knee pain
Strength/stiffness is based on fixation method

76

Allograft information?

50% strength of autograft
Used to augment or when donor tissue sucks
Expensive

77

What is the risk of nonsurgical tx for ACL rupture?

Recurrent instability
Meniscal tears
Degnerative joint disease

78

ACL surgery adverse outcomes?

Arthrofibrosis (scarring)
Numbness lateral to incision

79

Why do pts get numbness following ACL repair?

Infrapatellar branch of saphenous nerve is compressed

Often spontaneously resolves

80

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

81

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

82

What is the MC cause of PCL injury?

Direct blow to the tibia such as dashboard injury in MVA

83

Why are PCL injuries often missed?

If you have an isolated PCL injury you can usually function at a near-normal level

84

Injury patterns that suggest PCL rupture?

Dashboard inj

Fall onto flexed knee w foot in plantar flexion

Hyperextension of knee

Hyperextension strong enough to rupture ACL and PCL

85

PE for PCL rupture?

Effusion
Posterior drawer test
Posterior sag sinn
False positive lachman test
ACL and PCL injury

86

Radiographic studies for PCL?

MRI = useful for PCL and concomitant injuries to surrounding tissue

87

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

88

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

89

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

90

What is the MOI for collateral ligament injury?

MC: Valgus force w/out rotation

“Clipping” injury

Less Common: pure vargus force to the knee