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PTA 2009

Orthopedic Management of knee

QuestionAnswer
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