The ACL (Anterior Cruciate Ligament)
Internal ligament of the knee
Stabilizes lateral and extension knee
unhappy triad
Tears to the ACL, MCL and Medial meniscus
valgus force
Large Q angle can increase the ___ moment on the knee excessive stress on the ACL and MCL.
Intracondylar notch
Women have a narrower __ than men, therefore, the space for the ACL's movement is more limited
Autograft
From the patient
Patellar tendon or Bone-patellar-bone graft
Harvest graft from the patellar tendon of involved knee
weight bearing 75% wbat;
brace used 1-2 wks post op
rom = 0-75 deg;
straight leg raise,
post op acl week 1-2, wb percentage/status/rom
0-110 deg.
gait training, full weight bearing;
closed chain 0-60 deg.
mini squats, heel raises
avoid knees anterior to toes
post op acl weeks 2-4, rom/wb status/type of exercise-what degree/what exercises
0-60 deg
acl stress weight bearing what how many degrees?
greatest at 30-60;
least at 60-90;
what is the greatest degree range of acl stress non weight bearing ?
90-40 deg
low load pre of hamstrings;
Aerobic conditioning
Stationary cycle
Emphasize
Quadriceps control
Core stability
Avoidance of varus / valgus moment with exercises
Balance activities
Proprioception exercises
acl post op 2-5 wk
o.c knee ext. :
No active hamstring exercises until 2 weeks
No open-chain resisted hamstring curls until 4 weeks post-op
acl post op wk 2-4;
if hamstring graft
No resisted leg extension machine at any point.
Stationary bike
Aquatic exercise
Upper body conditioning
acl post op wk 2-4;
if patella tendon graft
Closed chain strengthening and PRE
Continue with AROM- open chain
Patient should be able to actively move knee from 0-115
ACL - Anterior Cruciate
Post-Operatively
Weeks 4-6
Single-leg/unilateral workouts
i.e. on weight machines, squats, side & forward step-downs
Increase challenge of proprioceptive balance exercises
LE stretching
Aggressive core stabilization program
Physioball, foam roller exercises, etc.
ACL - Anterior Cruciate
Post-Operatively
Weeks 4-6;
what kind of workouts?
increase what balance?
Initiate a walk/jog program.
Advance closed chain exercises
Initiate plyometrics
Progress agility drills
Simulated work or sport-specific straining
Transition to full speed running, sprints and cutting
ACL - Anterior Cruciate
Weeks 7-10;
Weeks 11-24
joint capsule;
acle
pcl is inside the ___ and stronger than the ___
post sag sign;
Tibia sagging back on the femur
Patient placed in supine with knee flexed to 90 degrees.
positive sign :
Patients are touch-down weight bearing with crutches for 4 weeks post-operatively
in 4 wks post op pcl, wb status? how many weeks?
8 wks
pcl
pt's use hinged neoprene brace for __ weeks post op.
4;
0-30;
pcl
locked in full ext. for __ wks.;
progress to ___(deg) @ 4 wks and 15 deg until week 8
full passive terminal extension equal to the opposite side
No resisted knee flexion exercises for 8 weeks post-op. [Passive flexion is OK]
pcl recon rehab gen considerations: early emphasis on what? / no resisted knee ___ exercises for _ wks
Prone hip extension exercises performed in full knee extension [only after 2 weeks]
Aquatic exercise as soon as incisions are well-healed.
pcl recon rehab wks 2-4, what hip extension exercises performed in full knee extension?
Introduce mild isometric resisted knee extension within range of motion restrictions
Short range squats/knee bends within range of motion restrictions.
PCL Posterior Cruciate
RECONSTRUCTION REHABILITATION
Weeks 4-6 , mild ___ resisted knee extension w/in rom restrictions, what kinda of exercises?
Gradually increase the depth of knee bends, step exercises and proprioception exercises;
After 7 weeks - hamstring curls/ag/without resistance;
Continue to increase the intensity & resistance of other exercises.
PCL Posterior Cruciate
PCL RECONSTRUCTION REHABILITATION
Weeks 6-8:
Wean off the use of the brace for ADLs
Begin hamstring flexion exercises against light resistance & increase as tolerated
Cautiously add lateral training exercises (i.e. lateral stepping, lateral step ups).
PCL Posterior Cruciate
PCL RECONSTRUCTION REHABILITATION ;
8-12;
Goals are to increase strength, power and cardiovascular conditioning.
PCL Posterior Cruciate
PCL RECONSTRUCTION REHABILITATION : 12-16 wks
mcl
extra articular = outside joint capsule;
restricts abduction of tibia on femur
2 weeks following injury, except in PT ;
valgus stress
No adductor
When working adductors stress point should be superior to knee or work
Medial Collateral Ligament
MCL REPAIR REHABILITATION PROTOCOL
General Considerations. how long on immoblizer? no __ stress in open chain for 6 wks. no ___ leg raise.
lcl
restricts adduction of tibia on femur
6wks post op;
6-7 wksEarly emphasis on achieving full passive terminal extension equal to the opposite side.
LCL RECONSTRUCTION/REPAIR REHABILITATION (WITH OR WITHOUT ACL/PCL)
Patients are touchdown weight-bearing with crutches for ___.
wear mobilizer for ___.
8 wks;
Regular manual care of the patella, patellar tendon, and portals;
No VARUS STRESS throughout rehab.
LCL RECONSTRUCTION/REPAIR REHABILITATION (WITH OR WITHOUT ACL/PCL)
general considerations :
no resisted knee flx exercises for __ wks postop.
what should be performed ot prevent fibrosis?
2 weeks;
aquatic
LCL REHABILITATION (WITH OR WITHOUT ACL/PCL)
Weeks 2-4.
Prone hip extension exercises performed in full knee extension only after ___ wks.
___ exercise as soon as incisions are well-healed.
isometric;
6-7 wks
LCL REHABILITATION (WITH OR WITHOUT ACL/PCL)
Weeks 4 - 6.
introduce mild ___ reisted knee ext w/in rom restrictions.
short range squats/knee bends w/in rom restrictions.
fit with bledo medial aligner brace at __ wks to start @ 8 weeks postop.
introduce hamstring curls AG w/out resistance/focus on eccentrics
LCL REHABILITATION (WITH OR WITHOUT ACL/PCL)
Weeks 6 - 8.
passive rom should be near normal;
gradually increase depth of knee bends, step exercises, and proprioceptive exercises;
after 7 wks , introduce what kind of exercises?
Wean off the use of the brace for activities of daily living (12 weeks)
Begin hamstring flexion exercises against light resistance - increase as tolerated.
LCL REHABILITATION (WITH OR WITHOUT ACL/PCL)
Weeks 8 - 12
lateral;
medial.
__ meniscal repairs better than ___ repairs.
do conservative
partial intitially
after meniscal surgery weight bearing is ?
with menisectomy , rehab more figourous, early wb and rehab
3;
4;
4;
leg extension machines;
SIMPLE MENISCUS REPAIR
General Considerations;
knee immobilizer , wb, __ wks;
fwb ext __ wks;
no pivoting for __ months post op;
no resisted ___.
3-4 wks;
20-90 deg.
submaximal ckc;
4; 6.
6-8 wks
SIMPLE MENISCUS REPAIR
General Considerations.
closed chain at __ wks post op, beginning b/t __ - __ deg.
avoid ____ exercises for 6 wks;
active hamstring exercises done at __ wks and resistive at __ wks;
no lateral exercises for ___ - __ wks
closed;
15-20
SIMPLE MENISCUS REPAIR
Weeks 2-4
start doing ___ chain exercises;
avoid the last __ - ___ of extension.
no more knee imobilzer,
use leg weight machines;
add hamstring curls w/out resistance;
full ext, 110 deg of flexion
SIMPLE MENISCUS REPAIR
Weeks 4-6
Introduce resistive hamstring curls
Add lateral training exercises (i.e. lateral stepping, lateral step-ups, step- overs);
SIMPLE MENISCUS REPAIR
Weeks 6-12
Progress to running as able to demonstrate good mechanics and appropriate strength
SIMPLE MENISCUS REPAIR
Weeks 12- 16
Patellar Tendinitis
Sometimes called "jumper's knee.
Limited quadriceps flexibility
Plica Syndrome
Chronic irritation of the synovial tissue around the patella resulting in a tender fibrotic band usually medial to the patella.
Fat Pad Syndrome
Irritation of the inrfapatellar fat pad from trauma or overuse
IT frictions Syndrome
Irritation of the IT band at the lateral femoral condyle usually secondary to tightness of the TFL/Glutes
Prepatellar bursitis
Housemaid's Knee" secondary to prolonged kneeling
Chondromalacia
Softening of the articular cartilage of the patella
Osgood Schlatters
Repetitive stress or tension on part of the growth area of the upper tibia (the apophysis;
Inflammation of the patellar tendon and surrounding soft tissues at the point where the tendon attaches to the tibia.
Usually secondary to overuse during rapid grow
Patellofemoral Pain Syndrome
Mal-alignment of the patella in the intratrochlear groove
Can be accompanied by subluxation or dislocation