Knee

• The ACL faces backwards and forwards movement, lateral and medial rotation, and valgus and varus force
• LCL sprain is caused by varus stress at the knee
• signs of LCL sprain:

  • pain and tenderness over it
  • swelling and effusion (fluid buildup)
  • joint laxity (looseness)
• care for LCL sprain:

  • following management of MCL injuries depending on severity
• MCL sprain caused by valgus stress at the knee
• care for MCL sprain:

  • RICE for at least 24 hours
  • crutches if necessary
  • follow with 2-3 week period of protection with functional hinge brace
  • Is surgery required?
• meniscal injuries caused by weight bearing or rotation
• medial meniscus more often injured than lateral due to MCL attachment and it is less mobile
• S/S of meniscal injury:

  • gradual effusion
  • instability
  • locking/catching
• you should either repair or remove damaged meniscus
• zones of healing for meniscus: red, red-white, and white
• surgical repair for meniscus is usually arthroscopic partial meniscectomy
• unhappy triad includes the MCL, medial meniscus, ACL
• ACL injury recovery is no repair is needed?

  rehabilitation
• ACL injury repair: allograft (cadaveric)

  • patellar tendon
  • achilles tendon
• ACL injury recovery: autograft (self)

  • patellar tendon (BTB)
  • hamstring tendon
  • quadriceps tendon
• for a hamstring tendon graft, the semitendinosis and gracilis tendons are partially removed
• 23% chance of suffering a second ACL rupture
• only 65% chance of returning to previous level of sport, 55% return to full competitive sport after ACL injury
• after ACL injury, 4-fold increase in likelihood of developing osteoarthritis no matter if surgically repaired or not
• "pre-hab" = rehabilitation prior to surgery

  • regain ROM, decrease swelling, increase strength
• post-surgical rehab:

  • restore ROM (particularly knee extension), restore strength, preserve stability
• rehab phase 1:

  • ROM - flexion and extension
  • eliminate swelling
  • lift leg
  • normal walking pattern
• rehab phase 2:

  • increase lower extremity and core strength
  • improve proprioception
  • full active ROM (equal to unaffected side)
  • normal basic movements (squats, stationary lunge, single leg balance, walking)
• rehab phase 3:

  • move from single plane to multi-plane strengthening and functional exercises
  • eccentric neuromuscular control (in prep for plyo (explosive exercises, exert max force in short time))
  • dynamic flexibility
  • full AROM and PROM
• rehab phase 4:

  • double-leg to single-leg exercises
  • jogging, cutting, pivoting
  • eliminate apprehension with complex sport-related movements
• psychological aspects of rehab:

  • loss of athletic identity
  • pain-related fear of movement and re-injury
  • delayed or lack of return
  • quad weakness
  • lower self-reported levels of function
  • self-efficacy, mood, PROs, readiness to return
  • social aspects (pressure to return and social support)
• non-modifiable risk factors for injury:

  • sex: females in "high risk" sports 4-6x greater risk
• non-modifiable risk factors for injury: anatomy

  • notch width, ACL size and laxity
  • lower extremity bony alignment
  • Q-angle larger in women (angle formed between quad muscles and patella tendon)
• non-modifiable risk factors for injury: hormones

  • changes throughout menstrual cycle
• non-modifiable risk factors for injury: environmental

  • shoe/surface interface
• modifiable risk factors for injury: muscular strength

  • ham/quad ratio
• modifiable risk factors for injury: neuromuscular control/biomechanics

  • increase flexion during landing
  • lower extremity alignment during sport activities
  • gluteus medius activation
• modifiable risk factors for injury: environment

  • gendered environment
  • pre-sport environment
  • training environment
  • competition environment
  • treatment environment
• ACL injury:

  • 57.5% for women
  • 39.7 for men
• injury prevention programs impact:

  • reduction of ground reaction forces
  • increased hip and knee flexion
  • improved single-leg balance
  • performance
  • vertical jump height, hop distance, hop speed, sprint speed
  • increased muscle strength (quad : ham ratio)
• injury prevention programs:

  • choose exercises from at least 3 of these categories
  • balance, agility, strength, plyometric, flexibility
• injury prevention programs: feedback

  • verbal, visual, self-assessment, expert
  • external focus of control most effective
• injury prevention programs: time

  • at least 15 minutes, 2-3 times per week
• majority of ACL injuries are non-contact