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PTA 2009
Orthopedic Management of knee
| Question | Answer |
|---|---|
| non surgical rehab, focus on what mm's? | hamstring strengthening. dynamic stabilizer, resister of anterior translation |
| ACL rehab....what exercise is a NO? | no open chain knee extension, running, jumping |
| concentrate on what mm group for ACL reconstruction? | Quads |
| exercise for max phase ACL reconstruct | isom co-contration of quads & hamstrings, NO OKC KNEE EXTENSION w/ or w/o wts |
| where is the least stress on ACL? | knee flexed to 60 deg |
| what is an important part of early ACL rehab? | OKC hamstring stengthening, hamstrings work as a dynamic stabilizer and limit anterior tibial shearing forces |
| exercise during MAX ACL reconstuct? | hip & tricep surae strengthening. (soleus, gastroc, plantaris) |
| Dynamic stabilizer of the ACL/Knee? | quads (atrophy begins < 48 hrs) |
| tissue from body for auto graph ACL? | bone-patella-bone, gracilis tendon, semitendinosous |
| When can you start OKC knee ext for ACL reconstruction? | 1-2 months |
| important to get _____firing early. | quads |
| Max phase ACL | early ROM!!,PROPRIOCEPTION EARLY ON! knee flex, PROM into flexion & ext, AROM 35 deg > end range flexion, early WB as tolerated, inflam/edema control |
| what can you do for ROM max phase ACL? | low load, long duration |
| Mod phase ACL | CKC, proprioceptive, cardio (not running), hamstring stg |
| what mm's important to stg for ACL in surgical repair? | Quads - act to control (hamstrings stabilize) |
| criteria to advance to Mod prot ACL reconstruction? | ROM 0-120, normal gait, quad & hamstring control, controlled pain & swelling, at least 6 weeks (no sooner) |
| Mod phase ACL reconstr | all Max phase, polycentric, may use brace, CKC emphasizing QUADS |
| criteria to move to MIN phase ACL reconst | full ROM, normal gait, good quad and hamstring stg, at least 12 wks, |
| MIN prot phase, ACL reconst | Pt ed on why to hold back on advancing....graft still 50%. more adv proprioceptive, mini-trampoline, balance board, slide board, staight line jogging if they have > 80% quad & ham stg, leg press, advanced CKC, functional |
| ACL reconstruct return to contact sports? | 9-12 mo |
| dynamic stabilizer of PCL non-op rehab | QUADS |
| No ____________ exercise first few weeks for PCL non-op | OKC hamstrings |
| MAX phase PCL reconstruct (0-12 wks) | WB'ing/NWB according to dr's orders, ROM may be limited to 50-60 deg flexion several wks (20-70 commonly), pain & swelling control, patellar mobs, quad isom |
| when do you want full ROM PCL reconstruct? | 2-3 months |
| MOD phase PCL reconstruct (13-24 wks) | CKC exercises, control forces, protect graph, stimulate collagen fiber, promote revascularization, obtain normal ROM & stg |
| MIN phase PCL reconstruct (25-36 wks) | same as ACL (isok, proprioceptvie), return to premorbid functional level, may need to continue wearing de-rotation brace if pt is athlete |
| what is the most common injury in the knee? | MCL |
| MCL injured by? | valgus force |
| unhappy triad | MCL, ACL, medial meniscus |
| usually repaired surgically or non? | non for all grades |
| most important for rehab | RO |
| what is the stabilizer for MCL? | gracilis |
| Max prot MCL non-surgical (3 days aft injury) | early ROM, early WBing as tolerated w/knee immobilizer or hinged brace locked at 0 degrees, isom, quad sets, SLR, ankle pumps, seated assisted knee flex, supine wall slides |
| avoid.........during MCL non-surg max phase | avoid rotational stresses, valgus forces |
| MOD phase MCL non-surgical rehab (10 days aft injury) | wall slides, wall squats, SLR w/wts |
| MIN phase MCL non-surg rehab (3 wks aft injury) | leg press, step ups w/wts, adductor w/theraband (gracilis) |
| stabilizer for LCL | IT band |
| Tx for LCL similar or different from MCL? | similar, protect against varus force |
| function of menisci | stability, shock absorption, load transmission, nutition, lubrication, control of motion |
| medial meniscus is what shape? | half circle, larger than lateral |
| lateral meniscus is what shape? | 80% of a circle |
| sx of meniscus lesion | giving way feeling, may lack extension (-20 degrees), joint line pain |
| contraindication for meniscus rehab | do not force into extension, do not do low load, long duration |
| how long NWB for meniscus repair? | NWB 4-6 wks, needs to heel |
| limit ROM to ________ for how many wks for meniscus repair rehab? | 0-100, 4-6 wks |
| exercises for the first 3-4 wks meniscus repair rehab | isom |
| what exercises 4-8 wks for meniscus repair rehab | OKC |
| when can you start CKC for meniscus repair rehab | after 8 wks |
| what ex is contraindicated 3-6 months for meniscus repair rehab? | NO FULL SQUATS |
| meniscectomy rehab is similar to? | simple knee rehab progression |
| meniscectomy rehab pt ed | limit stairs, squatting, repetitive vertical compression loads |
| patellar compression forces raise sharply after ______ knee flextion | 30 |
| ______ x's body weight w/stair climing | 3 |
| ____ x's body weight w/squats & deep knee bending | 8 |
| MOST PATTELLAR COMPRESSION FORCES OCCUR _____________ | 60-90 deg |
| what exercises to avoid to avoid patellar compression forces? | full squats |
| why are SAQ a good choice for patella rehab | 0-30 deg don't have a lot of compression forces |
| stability structures of the patella | quadriceps tendon, patella tendon, medial & lateral retinaculum, IT band |
| CAUSES OF PATELLOFEMORAL SYNDROME | tight lateral retinaculum, weak VMO, Hypoextensible quads &/or hamstrings & IT band, pes planus, poor mechanics (groove too shallow), significant Q-angle |
| PATELLA TRACKING LATERALLY, pt c/o of medial pain DUE TO.....? | the pull on the medial retinaculum (usually due to hypoextensible surfaces) |
| signs & sx of PF syndrome | painful descending steps, post sitting w/knees bent, sitting w/10-30 deg of flexion |
| quad activating test for PF syndrome | block superior movement w/quad contraction, knee at 30 deg, poor sensitivity (false positive) |
| tx for PF syndrome - exercise | VMO stg (e-stim) SAG 0-30, SLR, quad sets, mini squats w/ball, step ups, prevent exercise over 30 deg of knee flex |
| what is the function of the VMO? | to realign the patellar during extension |
| higher angle of flexion causes highter______ | compression forces |
| tx for PF syndrome | QUAD STRETCH! brace or McConnell taping, patellar mobs (teach pt) - medial |
| PF syndrome - what ex to avoid? | deep squats, prevent patella loading, no ex past 30 deg of flex |
| PFS surgical interventions | (1) proximal realignment - lateral release & VMO advancement, (2) distal re-alignment - elev &/or shift tibial tubercle to improve mechanical advantage of quads (3) articular cartilage shaving (4) abrasion chondroplasty |
| rehab aft PFS surgery | usually WBing & knee flexion precautions - not more than 45 deg, aft first few wks, rehab very similar to non-op tx |
| cause of patellar tendonitis | overuse |
| tx for patellar tendonitis | quad stretch, need to wk on eccentric function |
| patellar tendonitis in young adults is? | Osgood slatter |
| cause of patellar bursitis | kneeling |
| Patellar bursitis rehab | similar to PFS, must control inflam 1st, good brace for tx /sports |
| avoid patellar bursitis | NO kneeling |
| movement at the talocrural jt? | DF & PF, mortis, artic betwe tibia, fibula & talus |
| supination is | adduction, plantarflexion, inversion |
| medial arch supported by | 1st MT to calcaneous, spring ligament |
| transverse arch | 1st to 5th mt heads |
| lateral longitudinal arch | 5th mt to calcaneous on lateral side of foot |
| shin splints caused by? | overactive ant tib or post tib, (anterior) heel contact on hard surfaces, wearing a shoe w/hard heel, forefoot varus, tight gastroc, mm imbalance (posteromedial) excessive pronation, problems at toe--off, |
| cause of pronation | anteversion, tibial internal rotation |
| what structure does the spring ligament support? | talar head and medial longitudinal arch (resists pes planus) |
| what is O & I of spring ligament? | O - Calcaneus, I - navicular tubercle |
| what does the plantar aponeurosis support? | longitudinal arch |
Created by:
djbari
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