Knee

Knee

1. ACL

   • prevents anterior translation
   • "pop"
   • trauma
     • posterior to anterior blow OR lateral to medial blow
   • non-contact trauma
     • valgus near full extension ("LE pronation" - hip IR and eversion @ ankle)
   • edema
     • w/in 2 hrs
   • "giving way"
   • loss of extension
   • risk factors
     • shoe traction, narrow female femoral notch, joint laxity, hormones (maybe), combined loading/multidirectional stress (ext. w/valgus), muscular strength/firing (strong eccentric quad contraction, like when jump landing)
   • avoid OKC ext. -45 to 0
   • Post-Reconstruction
     • in general: cryotherapy is good early on but not late in rehab, CKC & OKC exercises are necessary, eccentric strengthening is good, NMES as well
     • 0-6 weeks
       • -brace -ROM (regain full ext. ASAP b/c necessary for walking; also regain full flexion by 6 weeks) -quad control (SLR, quad set) -gait training
     • 6-12 weeks
       • -balance -strengthening - CKC -aerobics -quad control
     • 3-6 months
       • -cutting (4-5 months) -CKC strengthening -plyometrics/jumping -running (~12 wks) -balance -weight-lifting
     • 4-9 months
       • -activity-specific training -cutting (4-5 months)
     • poor outcomes?
       • poor postural control, difficulty controlling IR moment, early onset of OA

2. PCL

   • "pop"
   • loss of extension
     • during gait and/or exam
   • posterior pain
     • localized
   • trauma
     • -sudden hyperextension -anterior to posterior blow -tibia is pushed posteriorly (as in car wreck, when tibia smashes dashboard)

3. PCL Sprain Treatment

   • 0-6 weeks
     • -ROM (gain full extension ASAP, and full flexion within 6 weeks!) -quad control -NO ACTIVE HAMSTRING/avoid flexion -brace -gait training
   • 6-12 weeks
     • -CKC exercises -strengthening -balance -quad control -aerobics -cutting (2-3 months)
   • 3-6 months
     • -jumping/plyometrics -running -CKC exercises -weight lifting -activity specific training

4. MCL/LCL

   • -usually occur w/fixed leg  (MCL - lateral to medial LCL - medial to lateral)  -sudden rotation
   • point tenderness
   • local effusion
     • usually contained to medial or lateral side
   • MOI: fixed leg
     • medial to lateral (LCL) lateral to medial (MCL)
     • sudden rotation
   • Sprain Treatment
     • 0-6 weeks
       • -brace (prevents valgus/varus stress) -->much more effective in MCL/LCL than with ACL/PCL -CFM (possibly promotes stronger healing) -quad control -gait -ROM 
     • 6-12 weeks
       • -balance -running -plyometrics/jumping -activity specific training -weight lifting  -aerobics -cutting (8-12 wks) -return to prior activity (could be as soon as 3-4 wks if grade 1-2 with no laxity)

5. Knee Meniscal Tear

   • -medial tears are more common, but also easier to manage than lateral -greatest blood flow to the peripheral 1/3 of the meniscus, so are repairable 
   • trauma
     • -rotational injuries -could be non-contact, for ex., as simple as the leg turning the wrong way 
   • loss of end ROM
   • joint line pain
   • springy end feel
     • with extension; meniscus tear makes knee "spring back" into flexion when extended
   • "giving way"
   • Post-Menisectomy
     • 0-3 weeks
       • -ROM -quad control -gait training -balance
     • 6-12 weeks
       • -CKC exercises -balance -weight-lifting -plyometrics/jumping -activity specific training
     • 3-6 weeks
       • -CKC -Balance -Aerobics
   • Post Meniscal Repair
     • 0-3 weeks
       • flexion restricted to ~90 degrees to allow healing
     • 4-6 weeks
       • -quad control -ROM -gait training (partial WBing) -pool
     • 6-12 weeks
       • -CKC -balance -quad control -aerobics
     • 3-4 monhs
       • balance, weight lifting, plyometrics, jumping, running, activity specific training

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