ACL Dysfunction (04:49)
ACL injuries are commonplace in sports. The total disruption of the ACL is more common than any other ligament injury in the knee. Not everybody who has ACL trouble needs to have it repaired.
ACL Patients (04:39)
Bone bruises may contribute to a delay of surgery. Combination injuries are detrimental to an athlete. Studies suggest that players who return to the NFL following an ACL injury have a short career.
ACL Diagnoses (05:05)
ACL disruption causes a sense of loss during knee extension. Pivot shift is challenging to complete non-sedated. Dashboard injuries occur during tackling situations on the football field.
G-code Outcome Tool (03:23)
The lower extremity function scale is based on zero to eighty points. Test scales help insurance providers like Medicare. Ryan August recommends using percentages to gain clients.
Types of Grafts (04:19)
Therapists should know what ligament had surgery. Allograft is synonymous with cadaver. Doctors take into consideration the patient’s age and activity level before performing surgery.
Allograft Advantages and Disadvantages (04:40)
This operation has a high failure rate and risk of disease. Surgeries performed from within have better outcomes, particularly in younger athletes.
ACL Reconstructions (06:23)
A group of individuals entering the military academy had allografts and autografts, followed by rehab. Bone patella tendon grafts and hamstring grafts have low failure rates.
Graft Stresses (04:17)
Some exercises are better than others for muscle firing and strengthening. Do not put undue stress on a healing graft. The open kinetic chain exercise puts less strain on the knee.
Post-Operative Exercises (04:26)
Some of the highest strain stresses on the ligament come from the wrong exercise. Walking is the best exercise after surgery. Total Gym is a good option for leg presses.
Knee Patients (04:51)
Knee exercises should start with a warm up that lasts ten minutes on each leg. Some elliptical exercise machines place shearing movements on the graft site and the ligaments.
Knee Extensions (04:07)
Walking works the long arc quads. Plyometrics involves balance and proprioceptive control. When exercising on a rocker board, it is important to develop difficulty throughout the entire time on the equipment.
Flexion Exercises (04:09)
Keep the hips aligned when stretching. This will prevent extra compression on the spine. Other problems could arise if too much stress is put on muscles.
Working the Great Hamstring (03:46)
If someone is gifted in athletic ability, he or she should be able to handle multi-dimensional balance equipment. More surface area for the quads tends to get more recruitment.
Hop Tests (06:30)
Using the modified NFL combine test identifies functional deficits in athletes following ACL reconstruction. A single limb test identifies a player's risk for re-injury.
Star Excursion Balance Test (05:38)
Integrator and integrated tests may identify athletes who are at elevated risk for injury. These tools help identify danger and locate where an athlete may be lacking.
Star Excursion Balance Test Predictor (05:34)
Test athletes for the anterior, posterior, medial, and lateral directions during preseason; normalize the score. The scale ranges from extreme difficulty to no problem.
Hop Test Demonstration and Scoring (07:53)
Do warm ups before testing. The first test is the single limb hop test; the triple hop test measures strength and distance. Compare the right side to the left side to get a normal range number. The Wilk and Good Stat Charts use percentages as guidelines for recovery.
Audience Practice Session (12:35)
Participants practice movements while the instructor answers questions. Testing can be applied to all persons, not just athletes. Some patients may have balance stability issues.
Motion Loss Following Ligament Injury (04:26)
It is common to see a loss of flexion and extension after surgery. The extension is more problematic. The loss of flexion is easier to treat.
Cadaveric Study (04:51)
Identify the loss of range of motion in the knee. Flexion contracture is more often related to soft tissue or the shortening of posterior structures.
ACL Nodule (05:57)
The Infrapatellar Contracture Syndrome is when the infrapatellar fat pad becomes bound. Hamstring tightness may not be a fiber issue. Post-operative infections are hard to treat.
Surgery Timing (04:05)
Surgery within seven days of injury results in stiffness. A delay in surgery causes no stiffness. Wasilesky noted a correlation of stiffness in knees that were operated on early.
Normal Graft Placement (06:20)
If there is a tunnel edge drilled too deep through the tibial component, the femur moves into extension. The bone pinches or snags, causing the loss of knee extension.
Total Knee Patient (05:29)
If the patient does not move after surgery, he or she will experience more scarring and stiffness. Patients who take it easy because of hot joints will have more loss of motion.
Knee Replacement (05:44)
After surgery, the therapist should focus on the range of motion and patella mobility. It is important to control edema. A hot knee may have an active inflammatory response.
Mobilization, Glides, and Tilting (03:25)
Glides are good for general mobility. The theory of rolls and glides in arthrokinematics is mechanical pushing; most bodies are similar.
Knee Demonstration (05:21)
Participants get involved in demonstrations with their knees. August starts with a relaxed leg and then locates the kneecap. Pushing inferior is going straight down the leg.
Flexion Demonstration (06:00)
Textbooks recommend squaring up the leg and then pushing straight down. This concept may not work on a patient who has a neutral resting position that is at an angle.
Gliding Demonstration (08:54)
Start by stabilizing the patient and do not let the leg rotate. Stay as close to the joint line as possible. When applying a medial glide, stabilize the upper leg to get a full extension before it torques.
Home Care Demonstration (03:05)
Find the nub and thrust forward, then hold for five seconds and continue repetitiously. Patients can do this exercise at home.
Lecture Review (04:07)
A 17-year-old female athlete with no previous history of knee problems suffers an ACL injury and undergoes ACL reconstruction. Women are more susceptible to ACL injuries.
Meniscal and Articular Cartilage Lesions (04:55)
Meniscal tears often occur with ACL injuries; most happen in conjunction with other issues. Cartilage is the structure that covers the ends of the bones. Cartilage rips are common with ACL damage.
Chondral Lesions (04:55)
A meniscectomy is the removal of the meniscus that has debridement. When this substance is removed, the force doubles and causes a breakdown in the area.
Meniscal vs Cartilage Presentation (05:23)
A twisting meniscal appearance delays diffusion. Cartilage presentation presents almost immediately and is considered an acute trauma. Pain with hyperextension is noticeable.
Catching and Locking (05:10)
A physical therapist should not rely on one test to make assessments. Many group tests are being researched and published in medical journals.
Outcome Measures and Surgical Options (04:21)
Hands should be on the hips when performing tests. A debridement surgery on the knee cuts and removes debris within the joint.
Post-Operative Protocol (05:25)
It is important to understand biomechanics of the joint. August recommends getting a copy of the surgeon’s operation notes. He suggests calling the physician for a consultation on the procedures.
Meniscal Repair Considerations (04:10)
Post-operative recovery for peripheral knee repairs is at least three weeks before putting any weight on the joint. Closed chain exercises are good for the first movements after surgery.
Meniscal Transplants (05:10)
A true cadaver meniscus transplant has a survivor rate of approximately ten years. Failure rates start to occur in fifteen years. This allows people many years before needing a total knee replacement.
Individualize the Patient (06:00)
The more mass placed on the knee, the more stress on the repair site. Be sure the patient understands the depth and significance of the surgery.
Autologous Chondrocyte Implantation (05:52)
The ACI procedure is done by drilling holes in non-weight bearing bones, and then scraping chondrocytes from within the body. These are sent to the lab where they are stored in test tubes for the second surgery.
High Impact Athletics (06:47)
Athletes report good results after surgery. After initial improvement, players saw their test scores decrease. Smaller individuals with less adhesions return to activities sooner.
Walking Shoes and Braces (05:05)
Stiffness of the lateral sole is greater than the medial. A shoe that is softer on the medial aspect will allow the foot to fall into the gap of the medial joint line.
Quad Weakness (04:47)
Quad shakiness is associated with higher than average rates of KAM. Fragility of hip abduction is linked to progression of medial knee osteoarthritis. Quad feebleness persists for years after surgery.
Arthroplasty Muscle Impairments (04:06)
Two years after surgery, total knee replacement patients still have substantial quad strength deficits. Surgery involving muscles improve balance and stair climbing ability.
Early High Intensity Rehab (04:47)
When putting someone on a rocker board, make sure to use safety precautions. The first step to surgery recovery is walking. Phase two incorporates multi-directional stepping.
Patellofemoral Pain Syndrome (05:02)
This joint is complicated; theories and treatment vary. The primary cause of patellofemoral pain is poorly understood and likely a multi-factorial injury.
Patellofemoral Research (05:30)
Members of the Fourth International Patellofemoral Pain Research Group discuss the most recent studies. They write position statements based on current evidence.
Patellofemoral Treatment and Knee Pain (05:51)
Therapeutic exercises include hip abductors, hip external rotators, and hip extensors. Some patients do not have insurance coverage for therapy. Hip exercises are better than quad exercises.
Post-Operative Hip Patients (05:01)
Patients with low back pain need to work their gluteus medial muscles. The clam exercise activates medial firing. Side stepping exercises fire the glutes.
Dorsiflexion Assessments (07:35)
Use an altimeter to measure angles. Everyone needs good ankle mobility to do the star excursion exercise. This is useful if the patient cannot squat correctly.
Kinesio Taping Demonstration (06:46)
August measures the amount of tape needed. Kinesio tape is used for low stretch or relaxation of the tissue being taped. Leave tape on for three days at the most.
Patella Taping (03:59)
Taping changes the tilt of the patella. There have been subjective improvements with taping techniques, but here is no evidence that taping does anything mechanical.
Tendon Histology (04:58)
Tendinosis is a histopathological finding of collagen disorganization and fiber separation. Tendinosis increases mucoid ground substance, hypersolularity, and nerve in-growth.
Concentric vs. Eccentric Loading (06:09)
Tissue changes can be seen in an ultrasound. The knee and patella tendon need squat exercises. Use a chair to help the patient rise from the squatting position.
Tendon Facts (03:11)
The tendon is a mechanically passive structure. It lengthens when the load increases. The tendon may lengthen more under a greater force.
Clamshell Exercise Demonstration (04:54)
The standard clam workout lifts the knee while the patient is lying on his or her side. Stabilize and control the forces on the knee. If the person can handle weight, move to hip abduction.
Hamstring Injury Tests and Stats (04:05)
Hamstring strains account for a small percentage of athletic problems. Prior history of hamstring damage increases the risk of harm up to six fold. Hamstring strains commonly occur at the terminal swing phase of running.
Hamstring Injury Signs and Symptoms (06:04)
Hamstring lock-ups are usually sudden. Pain from this muscle damage may range from minimal to severe and fluctuate.
Eccentric Hamstring Techniques (04:35)
To stretch the hamstring, place the individual on his or her back and use a pulley system attached to the leg for resistance. The "taking off the shoe test" gives immediate visual assessment of an individual.
General Distraction Demonstration (06:53)
A pure anterior glide forces the patient into extension. For a medial meniscal issue, find the joint line, lift the leg, and reinforce with the finger. This procedure can also be done in a sitting position.
Hamstring Taping Demonstration (03:04)
Before applying tape, round off the edges with scissors to help prevent snagging. Pre-rip the tails of the tape so it is easier to apply.
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