Orthopedic Management of knee
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| non surgical rehab, focus on what mm's? | hamstring strengthening. dynamic stabilizer, resister of anterior translation
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| ACL rehab....what exercise is a NO? | no open chain knee extension, running, jumping
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| concentrate on what mm group for ACL reconstruction? | Quads
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| exercise for max phase ACL reconstruct | isom co-contration of quads & hamstrings, NO OKC KNEE EXTENSION w/ or w/o wts
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| where is the least stress on ACL? | knee flexed to 60 deg
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| what is an important part of early ACL rehab? | OKC hamstring stengthening, hamstrings work as a dynamic stabilizer and limit anterior tibial shearing forces
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| exercise during MAX ACL reconstuct? | hip & tricep surae strengthening. (soleus, gastroc, plantaris)
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| Dynamic stabilizer of the ACL/Knee? | quads (atrophy begins < 48 hrs)
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| tissue from body for auto graph ACL? | bone-patella-bone, gracilis tendon, semitendinosous
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| When can you start OKC knee ext for ACL reconstruction? | 1-2 months
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| important to get _____firing early. | quads
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| 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
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| what can you do for ROM max phase ACL? | low load, long duration
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| Mod phase ACL | CKC, proprioceptive, cardio (not running), hamstring stg
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| what mm's important to stg for ACL in surgical repair? | Quads - act to control (hamstrings stabilize)
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| 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)
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| Mod phase ACL reconstr | all Max phase, polycentric, may use brace, CKC emphasizing QUADS
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| criteria to move to MIN phase ACL reconst | full ROM, normal gait, good quad and hamstring stg, at least 12 wks,
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| 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
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| ACL reconstruct return to contact sports? | 9-12 mo
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| dynamic stabilizer of PCL non-op rehab | QUADS
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| No ____________ exercise first few weeks for PCL non-op | OKC hamstrings
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| 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
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| when do you want full ROM PCL reconstruct? | 2-3 months
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| MOD phase PCL reconstruct (13-24 wks) | CKC exercises, control forces, protect graph, stimulate collagen fiber, promote revascularization, obtain normal ROM & stg
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| 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
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| what is the most common injury in the knee? | MCL
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| MCL injured by? | valgus force
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| unhappy triad | MCL, ACL, medial meniscus
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| usually repaired surgically or non? | non for all grades
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| most important for rehab | RO
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| what is the stabilizer for MCL? | gracilis
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| 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
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| avoid.........during MCL non-surg max phase | avoid rotational stresses, valgus forces
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| MOD phase MCL non-surgical rehab (10 days aft injury) | wall slides, wall squats, SLR w/wts
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| MIN phase MCL non-surg rehab (3 wks aft injury) | leg press, step ups w/wts, adductor w/theraband (gracilis)
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| stabilizer for LCL | IT band
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| Tx for LCL similar or different from MCL? | similar, protect against varus force
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| function of menisci | stability, shock absorption, load transmission, nutition, lubrication, control of motion
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| medial meniscus is what shape? | half circle, larger than lateral
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| lateral meniscus is what shape? | 80% of a circle
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| sx of meniscus lesion | giving way feeling, may lack extension (-20 degrees), joint line pain
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| contraindication for meniscus rehab | do not force into extension, do not do low load, long duration
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| how long NWB for meniscus repair? | NWB 4-6 wks, needs to heel
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| limit ROM to ________ for how many wks for meniscus repair rehab? | 0-100, 4-6 wks
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| exercises for the first 3-4 wks meniscus repair rehab | isom
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| what exercises 4-8 wks for meniscus repair rehab | OKC
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| when can you start CKC for meniscus repair rehab | after 8 wks
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| what ex is contraindicated 3-6 months for meniscus repair rehab? | NO FULL SQUATS
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| meniscectomy rehab is similar to? | simple knee rehab progression
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| meniscectomy rehab pt ed | limit stairs, squatting, repetitive vertical compression loads
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| patellar compression forces raise sharply after ______ knee flextion | 30
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| ______ x's body weight w/stair climing | 3
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| ____ x's body weight w/squats & deep knee bending | 8
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| MOST PATTELLAR COMPRESSION FORCES OCCUR _____________ | 60-90 deg
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| what exercises to avoid to avoid patellar compression forces? | full squats
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| why are SAQ a good choice for patella rehab | 0-30 deg don't have a lot of compression forces
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| stability structures of the patella | quadriceps tendon, patella tendon, medial & lateral retinaculum, IT band
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| 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
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| PATELLA TRACKING LATERALLY, pt c/o of medial pain DUE TO.....? | the pull on the medial retinaculum (usually due to hypoextensible surfaces)
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| signs & sx of PF syndrome | painful descending steps, post sitting w/knees bent, sitting w/10-30 deg of flexion
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| quad activating test for PF syndrome | block superior movement w/quad contraction, knee at 30 deg, poor sensitivity (false positive)
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| 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
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| what is the function of the VMO? | to realign the patellar during extension
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| higher angle of flexion causes highter______ | compression forces
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| tx for PF syndrome | QUAD STRETCH! brace or McConnell taping, patellar mobs (teach pt) - medial
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| PF syndrome - what ex to avoid? | deep squats, prevent patella loading, no ex past 30 deg of flex
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| 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
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| 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
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| cause of patellar tendonitis | overuse
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| tx for patellar tendonitis | quad stretch, need to wk on eccentric function
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| patellar tendonitis in young adults is? | Osgood slatter
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| cause of patellar bursitis | kneeling
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| Patellar bursitis rehab | similar to PFS, must control inflam 1st, good brace for tx /sports
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| avoid patellar bursitis | NO kneeling
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| movement at the talocrural jt? | DF & PF, mortis, artic betwe tibia, fibula & talus
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| supination is | adduction, plantarflexion, inversion
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| medial arch supported by | 1st MT to calcaneous, spring ligament
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| transverse arch | 1st to 5th mt heads
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| lateral longitudinal arch | 5th mt to calcaneous on lateral side of foot
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| 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,
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| cause of pronation | anteversion, tibial internal rotation
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| what structure does the spring ligament support? | talar head and medial longitudinal arch (resists pes planus)
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| what is O & I of spring ligament? | O - Calcaneus, I - navicular tubercle
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| what does the plantar aponeurosis support? | longitudinal arch
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