Question | Answer |
What type of grafts are there? | Autograft, Allograft and Artifical ligaments |
What is the difference between an Auto and Allograft? | Autograft uses tissue from the body of the pt and the Allograft uses biologic tissue taken from another human body or cadaver |
In an Autograft what are the common sites used for grafts? | Gracilis tendon, TFL, semitendinosus tendon, and central 1/3 of patellar tendon |
Of the sites used for the Autograft what site is the best to use? | Patellar tendon because it is the strongest, bone tendon-bone graft(does have longer rehab) |
When Allograft is done what site is most commonly used? | Gracilis tendon, TFL, semitendinosus tendon, and central 1/3 of patellar tendon and ALSO GASTROC (achilles) tendon |
When doing a patella tendon autograft where is the tendons attach to? | It is harvested from the involved knee and is surgically routed through tunnels placed in the femur and tibia, then securing the graft to the bone to allow for stable healing |
What helps with bleeding after an autograft? | A drainage tube is inserted to help evacuate the joint of resdual bleeding. Leg is put in a brace or immobilizer |
What is the process of healing following a graft? | It begins radual process of Avascular necrosis over the first 6-8 wks. |
What happens to the graft after it is put in? | Graft loses strength and is fragile during 2 months so avoid excessive forces? |
How long does it take a graft to revascularize? | 3 months strength is less than 50%, may take as long as a year to mature but may never reach pre-op strength |
What are the rehab goals after a ACL/PCL repair? | 1.Protect graft
2.>pain and swelling
3. |
What are the phases of rehab? | Max, post-op to 6 wk, Mod 7-12 post-op, Min,13 week to prior level of activity |
Max phase of ACL what do you want to avoid? | Hyperextension and rotary motions. |
What is the WB status in Max phase of ACL repair? | Ambulation WBAT with brace and crutches |
What therapy is done in Max phase? | PROM, AROM and isometrics at various joint angles. |
What are the 6 things done in the max phase of ACL repair? | 1.Protect joint with hinge brace to avoid hyperextension and rotary motions
2.Control swelling w/modalities and rest
3.Patellar mobs
4.WBAT
5.PROM,AROM
6.Isometrics at variors joint angles
4.WBAT |
When a pt is is the mod phase of ACL repair they should be? | FWB/with no brace |
During mod phase what is to be avoided in strengthening ex? | Any position to avoid hyperextension |
What retraining is done in the mod phase? | Proprioceptive and CKC ex, start w/brace for CKC & progress to ex without |
What are the 5 things done in MOD Phase? | 1.FWB no longer needs brace
2.CKC ex and Proprioceptive retraining
3.Stationary bike or elliptical
4.Cont. AROM and stretching
5.Progressive resistance w/strengthening ex |
MIN phase of ACL protocal? | 1.13 wk have pt return to prior level of activity
2.Progressive propriception ex using dynamic surfaces
3.Progressive strengthening-OKC & CKC using < resistance, weight machines
4.Jogging, running, simulate sport or work activities |
Non-op PCL rehab is controversal why? | How to best manage a PCL injury either surgery or non but both groups have a high incidence of articular cartilage degeneration as resuld of instability |
What is the most important goal in NON-op PCL repair? | Strengthening the quad/quad strength exceed that of the unaffected leg |
NON-op acute phase what is the first thing to do? | A knee immobilizer or hinged brace is used for pt comfort. Rice & NASAIDS are used to min swell & > pain |
What are other things done in the acute stage of NON-op rebab PCL? | 1.Immobilizer is removed for PROM/AROM 2.FWB is allowed Pt doed quad sets and SLR ASAP |
SUB-acute NON-op what are the 3 parts of rebab? | 1.Starts when pain,swelling, & quad control impove. Brace removed for ex 2.CKC quad ex are done. Leg press, step ups, wall squats, reverse stair stepper SAQ 3.AVOID open chain resistive hamstring curls |
How long to return after PCL NON-op recovery? | Return to full activity after 8 weeks |
What happens in Post-op surgical PCL ? | Same grafts choices as ACL and is either arthroscopic or open tech |
PCL max protection Phase are? | 1.Hinge brace until FWB & full quad control 2.Limit FWB for 4-6wks 3.AROM limited 50-60 degrees of knee flexion 4.Full ROM 2 months post-op 1-13 wk 5.Protect healing of graft |
What rebab is done in MAX phase-PCL surgical repair? | -Isometrics and PRE strengthening of quads -Patellar Mods -CKC when FWB and quad control |
Why is the mod phase of PCL surgical repair diffenent than ACL? | CLC ex emphasize strengthening of quads -partial quats -stairstepper -step ups -lunges -elliptical -bike set set higher |
During the mod phase of PCL sur. what is done with proprioceptive and balance retraining? | Progress to dynamic surfaces -double leg stance -SL stance -EO OR EC 13-24wk |
What is the Min protection phase of PCL post-op phase? | 24 wk return to prior functional activities with running jumping and cutting etc |
Where is the graft recontructed at? | ACL the petalla tendon,along with pedicles of bone from the patella and tibial tubercle is harvested and then surgicaly routed through tunnels drilled through the femur and tibia |