Procedures 2

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Author:
kellymillerSPTA
ID:
177710
Filename:
Procedures 2
Updated:
2012-10-16 08:08:33
Tags:
Knee
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Description:
Wonderful world of knees
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  1. Knee Complex
    • suprapatellar and infrapatellar tendon
    • 5 posterior facets w/ hyaline cartilage
    • facets articulate w/ femoral condyles
    • Q angle= 15 degrees
    • influenced by quads strength and balance, IT band tightness adn Q angle
  2. Knee complex structure & support
    • medial and lateral ligametous & mm support
    • ant/post ligamentous & mm support
    • ligamentous support- quadrilateral
    • muscular support- triangular & causes glide
    • medial capsule prevents valgus forces
    • lateral capsul prevents varus
  3. Forces knee exposed to
    • compressive
    • WB
    • shear
    • rotary
  4. Injuries knee is susceptible to
    • sprains
    • strains
    • degenerative process
  5. What is different about the knee from the hip and ankle
    it is not triplanar
  6. Mild Ligament Injury
    (grade 1)
    • incomplete-stretching of fibers
    • minimal pain
    • minimal or no swelling
    • no decrease in jt function
    • no instablility
  7. Moderate Ligament Injury
    (grade/degree 2)
    • incomplete tear
    • moderate pain
    • moderate swelling
    • some loss of joint function
    • some decrease in stablilty
  8. Severe
    (grade/degree 3)
    • rupture completely torn ligament
    • profound pain the area but stress to the ligament itself not painful
    • marked swelling
    • decreased jt funct
    • instability
  9. Stress radiograph instability
    • mild- 5mm<
    • moderate-4-10mm
    • severe- >10 mm
  10. ACL injury common cause
    • noncontact mechanism, from quads, involving deceleration (sudden stopping), twisting of tibia/femur on planted foot
    • valgus stress and adds medial meniscus tearing and MCL
    • whic becomes the "unholy triad" "terrible triad"
  11. ACL Injury physiological response
    • hemoarthorsis indicated by rapid swelling, tense, & extreme pain.
    • requires arthrocentesis (aspiration)- means vascular supply was damaged
    • increasing # of tears in female athletes
  12. Lachmans test
    • knee flexed 25 degrees proximal tibia glided anteriorly on fixed femur
    • asses pain
    • how far does it move?
    • Most reliable especially for acute injuries
    • Open Packet Position
  13. Anterior drawer test
    knee flexed 90 degrees proximal tibia glided anterior on fixed femur
  14. Treatment of ACL tears
    • nonsurgically
    • arthroscopic grafting (not good results with suturing ends of torn ligaments)
    • usually dont with autotgraft (patients own tissue)
  15. Most Common Procedure Name
    Central 1/3 bone-patellar-tendon-bone autograph
  16. Post allograph
    • avascular necrosis of graft for first 6-8 wks
    • revascularizes slowly
    • at 3 months < 50% original strength
    • *Graft os very fragile at this time
    • - Pt is feeling better =bad combo
  17. Post Allograph Contraindications of Movement
    • takes up to one year to mature
    • control loads and forces
    • -anterior tibial shear
    • posterior femoral shear
    • rotary forces
  18. Post Surgery
    • NWB to PWb to WBAT 1st wk
    • adjustable rang immobilizer double hinge brace
    • -IROM is locked into extension for 1st 1-2 wks
    • unlocked to 0-90 after 1-2 wks during WB
  19. What stresses the ACL
    • forward translation of the tibia on the femur
    • greatest stresses occur between 0-20 degree of flexion
    • OKC extension 60-0 with resistance on tibia
    • -increased ant tibia translation
    • CKC squats between 60-90 degress
    • -increases tibial translation
  20. Rehab Phases
    • Max 1-4 wks
    • Mod 5-10 wks
    • Min 11-24 wks
    • Return to activity 6+ months
  21. Difference Between Max and Acute
    • Max is do's & don'ts
    • tx is different to pathology
    • Acute tx all the same
  22. PCL Injuries
    • less common than ACL
    • caused by flexion injuries or post shear forces
  23. Godfrey posterior tibial sag test
    • pt supine with hip and knee flexed 90 degrees
    • pt holds heel-tibia sags down

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