1. Injuries to the Knee ACL, PCL, MCL, & LCL

2. How These Injuries Occur?  ACL Commonly known as a “Deceleration” Injury Commonly known as a “Deceleration” Injury As the body slows down, an excessive force allows the tibia to shift anteriorally (forward) As the body slows down, an excessive force allows the tibia to shift anteriorally (forward) Due to a weakness in the hamstrings Due to a weakness in the hamstrings Other factors Other factors Q Angle (>18°)Q Angle (>18°) MenstruationMenstruation

3. ACL Tears in Action (videos)

4. How These Injuries Occur? (CONT.)  PCL Commonly occur from falling on a bent knee Commonly occur from falling on a bent knee Very little swelling Very little swelling Usually does not need surgical intervention (depends on the surgeon’s preference) Usually does not need surgical intervention (depends on the surgeon’s preference)  LCL Occurs from a Varus force placed on the knee (a blow or excessive force from the medial side of the knee) Occurs from a Varus force placed on the knee (a blow or excessive force from the medial side of the knee)

5. How These Injuries Occur? (CONT.)  MCL Occurs from a Valgus force (force or blow from the lateral (outside) of the knee) Occurs from a Valgus force (force or blow from the lateral (outside) of the knee) Occurs more frequently than an LCL injury Occurs more frequently than an LCL injury Due to lack of muscle/tendon protectionDue to lack of muscle/tendon protection Usual swelling, bruising (if grade 2 or 3), & loss of function will occur Usual swelling, bruising (if grade 2 or 3), & loss of function will occur Rarely will surgical intervention occur Rarely will surgical intervention occur Also look for an injury to the medial meniscus Also look for an injury to the medial meniscus

6. MCL Injury in Action (video)

7. Assessments/Diagnosis  Take an accurate history How did it happen? How did it happen? Did you feel a pop, snap, or crack? Did you feel a pop, snap, or crack? Pain level? 0 (no pain) to 10 (Ambulance time!) Pain level? 0 (no pain) to 10 (Ambulance time!) Numbness or tingling Numbness or tingling Pain with specific movements Pain with specific movements  Manual Evaluation Assess ROM & Strength Assess ROM & Strength Special Tests (Lachman’s, Anterior & Posterior Drawer, Valgus, & Varus, Posterior Sag) Special Tests (Lachman’s, Anterior & Posterior Drawer, Valgus, & Varus, Posterior Sag)

8. Assessments/Diagnosis (CONT).  Diagnositics X-rays X-rays Done to check for an injury to the boneDone to check for an injury to the bone MRI/CT scans MRI/CT scans Most accurate tests to determine injury to the ligaments & other soft tissuesMost accurate tests to determine injury to the ligaments & other soft tissues Ultrasound Ultrasound Rarely used, but still a means to diagnose the injuryRarely used, but still a means to diagnose the injury

9. ACL Tear (MRI)

10. LCL Tear ULTRASOUNDX-Ray

11. PCL Tear (MRI)

12. Treatments  Initial Treatments PRICE PRICE NSAIDs NSAIDs Use an immobilizer & crutches for a grade 2 or 3 injury Use an immobilizer & crutches for a grade 2 or 3 injury Seek MD evaluation for a grade 2 or 3 injury…seek an ATC for any grade Seek MD evaluation for a grade 2 or 3 injury…seek an ATC for any grade

13. Prehab  Pre-Surgical Rehabilitation Maintain or increase muscle strength Maintain or increase muscle strength Prevent muscular atrophy (decrease in muscle size due to lack of use) Prevent muscular atrophy (decrease in muscle size due to lack of use) Allow for a quicker return after surgery Allow for a quicker return after surgery  Usually done from the time of injury to one week or less leading to the surgery

14. Rehabiliation Goals  Restore normal ROM  Control pain & swelling  Restore & increase muscle strength  Restore & increase balance  Restore & increase proprioception  Post-Surgical (9-12 months) 0-14 days: Pain, swelling, & inflammation control 0-14 days: Pain, swelling, & inflammation control 2 weeks to 4 weeks: Restore normal ROM 2 weeks to 4 weeks: Restore normal ROM 4 weeks to 6 months: Restore & increase muscle strength 4 weeks to 6 months: Restore & increase muscle strength 6 months to 1 year: Restore proprioception…begin sport specific activity 6 months to 1 year: Restore proprioception…begin sport specific activity

15. Rehab Techniques  Isometrics (Quad Sets)  Progressive Resistance Exercises (PREs) Exercises that gradually increase in level of resistance) Exercises that gradually increase in level of resistance)  Manual Resistance Exercises (MREs) Exercises where the PT or ATC applies the resistance to the action performed Exercises where the PT or ATC applies the resistance to the action performed  ROM Active (AROM): The patient performs the exercise Active (AROM): The patient performs the exercise Passive (PROM): The ATC or PT performs the ex. Passive (PROM): The ATC or PT performs the ex. Active Assisted (AAROM): A Combination of AROM & PROM Active Assisted (AAROM): A Combination of AROM & PROM

16. Up Next…  Homework Read Chapter 14 & answer the questions for review Read Chapter 14 & answer the questions for review  Other Injuries/Conditions of the Knee  Lab  ACL reconstruction video (entire class period)