Recognition and Recognition and Management of Management of Specific InjuriesSpecific Injuries

Medial Collateral Medial Collateral Ligament SprainLigament Sprain

MOI = severe blow or outward twistMOI = severe blow or outward twist Grade I: Signs and Symptoms Grade I: Signs and Symptoms

Little fiber tearing or stretchingLittle fiber tearing or stretching Stable valgus testStable valgus test Little or no joint effusionLittle or no joint effusion Some joint stiffness and point tenderness on Some joint stiffness and point tenderness on laterallateral aspect of the knee aspect of the knee

Relatively normal ROMRelatively normal ROM

Grade I: ManagementGrade I: Management RICE for 24 hoursRICE for 24 hours Crutches if necessaryCrutches if necessary RehabRehab

CryokineticsCryokinetics Isometrics Isometrics Progress to SLRs, bicycle Progress to SLRs, bicycle

riding, and isokineticsriding, and isokinetics

Return to play when all Return to play when all areas have returned to areas have returned to normalnormal

May require 3 weeks to May require 3 weeks to recoverrecover

Grade II: Signs and SymptomsGrade II: Signs and Symptoms Complete tear of deep capsular ligament and Complete tear of deep capsular ligament and

partial tear of MCLpartial tear of MCL No gross instability; laxity at 5-15 degrees of No gross instability; laxity at 5-15 degrees of

flexionflexion Slight swellingSlight swelling Moderate to severe joint tightness Moderate to severe joint tightness Decreased ROMDecreased ROM Pain along medial aspect of kneePain along medial aspect of knee

Grade II: ManagementGrade II: Management RICE for 48-72 hoursRICE for 48-72 hours Crutch use until acute inflammation phase has Crutch use until acute inflammation phase has

resolvedresolved Possibly a brace or casting prior to the initiation of Possibly a brace or casting prior to the initiation of

ROM activitiesROM activities Modalities 2-3 times daily for painModalities 2-3 times daily for pain Gradual progression from isometrics (quad exercises) Gradual progression from isometrics (quad exercises)

to CKC exercises; functional progression activitiesto CKC exercises; functional progression activities

Grade III: Signs and Symptoms Grade III: Signs and Symptoms Complete tear of supporting ligamentsComplete tear of supporting ligaments Complete loss of medial stabilityComplete loss of medial stability Minimum to moderate swellingMinimum to moderate swelling Immediate pain followed by acheImmediate pain followed by ache Loss of motion due to effusion and Loss of motion due to effusion and

hamstring guardinghamstring guarding Positive valgus stress testPositive valgus stress test

Grade III: ManagementGrade III: Management RICERICE Conservative non-operative versus surgical Conservative non-operative versus surgical

approachapproach Limited immobilization (with a brace)Limited immobilization (with a brace) Progressive weight bearing and increased Progressive weight bearing and increased

ROM over 4-6 week periodROM over 4-6 week period Rehab would be similar to Grade I & II Rehab would be similar to Grade I & II

injuriesinjuries

MOI = Varus force usually with the tibia MOI = Varus force usually with the tibia internally rotatedinternally rotated

Direct blow is rare MOIDirect blow is rare MOI If severe enough damage may also If severe enough damage may also

occur to occur to Cruciate ligamentsCruciate ligaments ITBITB MeniscusMeniscus Bony fragments may result as wellBony fragments may result as well

Lateral Collateral Lateral Collateral Ligament SprainLigament Sprain

Signs and SymptomsSigns and Symptoms Pain and tenderness over LCLPain and tenderness over LCL Swelling and effusion around the LCLSwelling and effusion around the LCL Joint laxity with varus testingJoint laxity with varus testing May cause irritation of the peroneal nerveMay cause irritation of the peroneal nerve

ManagementManagement Same as MCL injury managementSame as MCL injury management

MOI = tibia externally rotated with a valgus force MOI = tibia externally rotated with a valgus force Occasionally the result of hyperextension resulting Occasionally the result of hyperextension resulting

from a direct blowfrom a direct blow Research is quite extensive in regards to impact of Research is quite extensive in regards to impact of

femoral notch, ACL size and laxity, mal-alignments femoral notch, ACL size and laxity, mal-alignments (Q-angle), and faulty biomechanics(Q-angle), and faulty biomechanics

Extrinsic factors may include, conditioning, skill Extrinsic factors may include, conditioning, skill acquisition, playing style, equipment, preparation timeacquisition, playing style, equipment, preparation time

May also involve damage to other structures including May also involve damage to other structures including meniscus, capsule, and MCLmeniscus, capsule, and MCL

Anterior Cruciate Anterior Cruciate Ligament SprainLigament Sprain

Signs and SymptomsSigns and Symptoms Experience pop with severe pain and disabilityExperience pop with severe pain and disability Positive anterior drawer and Lachman’s Positive anterior drawer and Lachman’s Rapid swelling at the joint lineRapid swelling at the joint line Other ACL tests may also be positiveOther ACL tests may also be positive

ManagementManagement RICE; use of crutchesRICE; use of crutches Arthroscopy may be necessary to determine extent of injuryArthroscopy may be necessary to determine extent of injury Surgical repairSurgical repair

Without surgery, joint degeneration may resultWithout surgery, joint degeneration may result Surgery may involve joint reconstruction with grafts (tendon), transplantation Surgery may involve joint reconstruction with grafts (tendon), transplantation

of external structuresof external structures Also requires 4-6 months of rehabAlso requires 4-6 months of rehab

MOI = fall on bent knee (most common)MOI = fall on bent knee (most common) Most at risk during 90 degrees of flexionMost at risk during 90 degrees of flexion Injury may result due to a rotational forceInjury may result due to a rotational force

Signs and SymptomsSigns and Symptoms Feel a pop in the back of the kneeFeel a pop in the back of the knee Tenderness and relatively little swelling in Tenderness and relatively little swelling in

the popliteal fossathe popliteal fossa Laxity with posterior sag testLaxity with posterior sag test

Posterior Cruciate Posterior Cruciate Ligament SprainLigament Sprain

ManagementManagement RICERICE Non-operative rehab Non-operative rehab

Appropriate for grade I and II injuries Appropriate for grade I and II injuries Focus on quad strengtheningFocus on quad strengthening

Post-operative rehabPost-operative rehab Surgery will require 6 weeks of Surgery will require 6 weeks of

immobilization in extension immobilization in extension Full weight bearing on crutchesFull weight bearing on crutches ROM after 6 weeks ROM after 6 weeks PRE at 4 monthsPRE at 4 months

Most common MOI is rotary force with Most common MOI is rotary force with knee flexed or extendedknee flexed or extended

Tears may be longitudinal, oblique, or Tears may be longitudinal, oblique, or transverse transverse

Medial meniscus is more commonly Medial meniscus is more commonly injured due to ligamentous attachments injured due to ligamentous attachments and decreased mobilityand decreased mobility Also more prone to disruption through Also more prone to disruption through

torsional and valgus forcestorsional and valgus forces

Meniscal LesionsMeniscal Lesions

Signs and SymptomsSigns and Symptoms Effusion developing over 48-72 hoursEffusion developing over 48-72 hours Pain in joint line Pain in joint line Loss of motionLoss of motion Intermittent locking and giving wayIntermittent locking and giving way Pain with squattingPain with squatting Portions of meniscus may become Portions of meniscus may become

detached causing locking, giving way, or detached causing locking, giving way, or catching within the jointcatching within the joint

If chronic injury, recurrent swelling or If chronic injury, recurrent swelling or muscle atrophy may occurmuscle atrophy may occur

ManagementManagement No locking but indications of a tear are presentNo locking but indications of a tear are present

Further diagnostic testing may be requiredFurther diagnostic testing may be required

If locking occurs, anesthesia may be necessary If locking occurs, anesthesia may be necessary to unlock the joint to unlock the joint Possible arthroscopic surgery Possible arthroscopic surgery

Healing dependent on location of tearHealing dependent on location of tear Menisectomy Menisectomy

Partial weight bearing, quick return to activityPartial weight bearing, quick return to activity

Repaired meniscusRepaired meniscus Requires immobilization, gradual return to activity Requires immobilization, gradual return to activity

over the course of 12 weeksover the course of 12 weeks

MOI = irritation of the plica MOI = irritation of the plica Often associated with chondromalaciaOften associated with chondromalacia

Signs and SymptomsSigns and Symptoms Possible history of knee pain/injuryPossible history of knee pain/injury Recurrent episodes of painful pseudo-lockingRecurrent episodes of painful pseudo-locking Possible snapping and poppingPossible snapping and popping Pain with stairs and squattingPain with stairs and squatting Little or no swellingLittle or no swelling No ligamentous laxityNo ligamentous laxity

ManagementManagement Treat conservatively w/ RICE and NSAID’s if the result of traumaTreat conservatively w/ RICE and NSAID’s if the result of trauma Recurrent conditions may require surgeryRecurrent conditions may require surgery

Knee PlicaKnee Plica

MOI = twisting, sudden cutting, or direct blowMOI = twisting, sudden cutting, or direct blow Signs and SymptomsSigns and Symptoms

Hear a snap Hear a snap Feeling of giving wayFeeling of giving way Immediate swelling Immediate swelling Considerable painConsiderable pain

ManagementManagement Diagnosis confirmed through arthroscopic examDiagnosis confirmed through arthroscopic exam Surgery used to replace fragments in order to avoid joint Surgery used to replace fragments in order to avoid joint

degeneration and arthritis degeneration and arthritis

Osteochondral Knee Osteochondral Knee FracturesFractures

Osteochondritis Osteochondritis DissecansDissecans

MOI = partial or complete separation of MOI = partial or complete separation of articular cartilage and subchondral bonearticular cartilage and subchondral bone

Exact cause is unknown but may include: Exact cause is unknown but may include: Blunt trauma, Blunt trauma, Possible skeletal or endocrine abnormalities, Possible skeletal or endocrine abnormalities, Prominent tibial spine impinging on medial Prominent tibial spine impinging on medial

femoral condyle, or femoral condyle, or Impingement due to patellar facetImpingement due to patellar facet

Signs and SymptomsSigns and Symptoms Aching pain and point tendernessAching pain and point tenderness Recurrent swelling Recurrent swelling Possible lockingPossible locking Possible quadriceps atrophy Possible quadriceps atrophy

ManagementManagement Rest and immobilization for childrenRest and immobilization for children Surgery may be necessary in teenagers and adults Surgery may be necessary in teenagers and adults

Drilling to stimulate healing, pinning, or bone graftsDrilling to stimulate healing, pinning, or bone grafts

MOI = repeated traumaMOI = repeated trauma May result due to osteochondritis dissecans, meniscal May result due to osteochondritis dissecans, meniscal

fragments, synovial tissue damage, or cruciate ligaments fragments, synovial tissue damage, or cruciate ligaments injuryinjury

Signs and SymptomsSigns and Symptoms May become lodged and cause locking or poppingMay become lodged and cause locking or popping Pain Pain Sensation of instabilitySensation of instability

ManagementManagement If not surgically removed it can lead to conditions causing If not surgically removed it can lead to conditions causing

joint degenerationjoint degeneration

Loose Bodies Loose Bodies

MOI = direct blow MOI = direct blow Signs and SymptomsSigns and Symptoms

Severe painSevere pain Acute inflammationAcute inflammation Loss of movement Loss of movement SwellingSwelling

If not resolved within a week then a chronic condition may exist (synovitis or If not resolved within a week then a chronic condition may exist (synovitis or bursitis) bursitis)

EcchymosisEcchymosis Possible capsular damagePossible capsular damage

ManagementManagement RICE RICE Progress to normal activity following return of ROM Progress to normal activity following return of ROM Padding for protectionPadding for protection

Joint ContusionsJoint Contusions

MOI = compression due to a direct blowMOI = compression due to a direct blow Signs and SymptomsSigns and Symptoms

Local pain and possible shooting nerve painLocal pain and possible shooting nerve pain Numbness and paresthesia Numbness and paresthesia Added pressure may exacerbate conditionAdded pressure may exacerbate condition Generally resolves quickly Generally resolves quickly

In the event it does not resolve, it could result in drop footIn the event it does not resolve, it could result in drop foot

ManagementManagement RICE RICE Return to play once symptoms resolve and no weakness is Return to play once symptoms resolve and no weakness is

presentpresent Padding for fibular headPadding for fibular head

Peroneal Nerve Peroneal Nerve ContusionContusion

MOI = acute, chronic, or recurrent swellingMOI = acute, chronic, or recurrent swelling Prepatellar = continued kneelingPrepatellar = continued kneeling Infrapatellar = overuse of patellar tendonInfrapatellar = overuse of patellar tendon

Signs and SymptomsSigns and Symptoms Localized swelling that results in ballotable patellaLocalized swelling that results in ballotable patella Swelling in popliteal fossa may indicate a Baker’s cystSwelling in popliteal fossa may indicate a Baker’s cyst

Associated with burse over the semimembranosus or medial head of Associated with burse over the semimembranosus or medial head of gastrocnemiusgastrocnemius

Commonly painless and causing little disabilityCommonly painless and causing little disability May progress and should be treated accordinglyMay progress and should be treated accordingly

ManagementManagement Eliminate causeEliminate cause RICE and NSAID’sRICE and NSAID’s Aspiration and steroid injection if chronicAspiration and steroid injection if chronic

BursitisBursitis

MOI = direct or indirect trauma MOI = direct or indirect trauma Semi-flexed position with forceful contraction, which may occur Semi-flexed position with forceful contraction, which may occur

while falling, jumping or runningwhile falling, jumping or running

Signs and SymptomsSigns and Symptoms Hemorrhaging and joint effusion Hemorrhaging and joint effusion Possible capsular tearing, separation of bone fragments, and Possible capsular tearing, separation of bone fragments, and

possible quadriceps tendon tearing due to bone fragmentspossible quadriceps tendon tearing due to bone fragments

ManagementManagement X-ray necessary for confirmation X-ray necessary for confirmation RICE and splinting if fracture suspectedRICE and splinting if fracture suspected ReferRefer Possible immobilize for 2-3 monthsPossible immobilize for 2-3 months

Patellar FracturePatellar Fracture

MOI = deceleration with simultaneous cutting in MOI = deceleration with simultaneous cutting in opposite direction (valgus force)opposite direction (valgus force) Quad pulls the patella out of alignmentQuad pulls the patella out of alignment Repetitive subluxation will impose stress to medial Repetitive subluxation will impose stress to medial

restraintsrestraints

Signs and SymptomsSigns and Symptoms SubluxationSubluxation

Pain, swelling, restricted ROM, and palpable tenderness over Pain, swelling, restricted ROM, and palpable tenderness over adductor tubercleadductor tubercle

Dislocations Dislocations Total loss of functionTotal loss of function

Patella Subluxation or Patella Subluxation or DislocationDislocation

ManagementManagement Reduction Reduction

Performed by flexing hip, moving patella medially, and slowly extending the Performed by flexing hip, moving patella medially, and slowly extending the kneeknee

Following reduction, immobilize for at least 4 weeks Following reduction, immobilize for at least 4 weeks Use crutches Use crutches Isometric exercises Isometric exercises

After immobilization period, horseshoe pad with elastic wrap should After immobilization period, horseshoe pad with elastic wrap should be used to support patellabe used to support patella

Rehab focuses on strengthening the muscles around the knee, thigh, Rehab focuses on strengthening the muscles around the knee, thigh, and hip and hip

Possible surgery to release tight structuresPossible surgery to release tight structures Improve postural and biomechanical factorsImprove postural and biomechanical factors

MOI = becomes wedged between the tibia and MOI = becomes wedged between the tibia and patellapatella Irritated by chronic kneeling, pressure, or traumaIrritated by chronic kneeling, pressure, or trauma

Signs and SymptomsSigns and Symptoms Capillary hemorrhaging and swellingCapillary hemorrhaging and swelling Chronic irritation may lead to scarring and Chronic irritation may lead to scarring and

calcificationcalcification Pain below the patellar ligament during knee Pain below the patellar ligament during knee

extensionextension May display weakness, mild swelling, and stiffness May display weakness, mild swelling, and stiffness

during movementduring movement

Infrapatellar Fat PadInfrapatellar Fat Pad

ManagementManagement Rest Rest

Avoid irritating activities until inflammation has subsidedAvoid irritating activities until inflammation has subsided

Utilize therapeutic modalities for inflammationUtilize therapeutic modalities for inflammation Heel lift to prevent irritation during extensionHeel lift to prevent irritation during extension Hyperextension taping to prevent full extensionHyperextension taping to prevent full extension

MOI = softening and deterioration of the MOI = softening and deterioration of the articular cartilagearticular cartilage

Three stages:Three stages: Swelling and softening of cartilageSwelling and softening of cartilage Fissure of softened cartilageFissure of softened cartilage Deformation of cartilage surfaceDeformation of cartilage surface

Often associated with abnormal trackingOften associated with abnormal tracking Abnormal patellar tracking may be due to genu Abnormal patellar tracking may be due to genu

valgum, external tibial torsion, foot pronation, valgum, external tibial torsion, foot pronation, femoral anteversion, patella alta, shallow femoral femoral anteversion, patella alta, shallow femoral groove, increased Q angle, laxity of quad tendongroove, increased Q angle, laxity of quad tendon

Chondromalacia patellaChondromalacia patella

Signs and SymptomsSigns and Symptoms Pain with walking, running, stairs, and squattingPain with walking, running, stairs, and squatting Possible recurrent swellingPossible recurrent swelling Grating sensation with flexion and extensionGrating sensation with flexion and extension Pain at inferior border during palpationPain at inferior border during palpation

ManagementManagement Conservative measuresConservative measures

RICE, NSAID’s, isometrics, orthotics to correct dysfunctionRICE, NSAID’s, isometrics, orthotics to correct dysfunction

Surgical possibilitiesSurgical possibilities Altering muscle attachmentsAltering muscle attachments Shaping and smoothing of surfacesShaping and smoothing of surfaces DrillingDrilling Elevating tibial tubercleElevating tibial tubercle

MOI = lateral deviation of patella while tracking in femoral MOI = lateral deviation of patella while tracking in femoral groovegroove May result due to tight structures, pronation, increased Q angle, May result due to tight structures, pronation, increased Q angle,

insufficient medial musculatureinsufficient medial musculature Signs and SymptomsSigns and Symptoms

Tenderness at lateral facet of patella Tenderness at lateral facet of patella Swelling associated with irritation of synoviumSwelling associated with irritation of synovium Dull ache in center of kneeDull ache in center of knee Patellar compression will elicit pain and crepitusPatellar compression will elicit pain and crepitus Apprehension when patella is forced laterallyApprehension when patella is forced laterally

ManagementManagement Correct imbalances (strength and flexibility)Correct imbalances (strength and flexibility) McConnell tapingMcConnell taping Lateral retinacular release if conservative measures failLateral retinacular release if conservative measures fail

Patellofemoral Stress Patellofemoral Stress SyndromeSyndrome

Osgood Schlatter’s is apophysitis at the tibial Osgood Schlatter’s is apophysitis at the tibial tubercle tubercle MOI = repeated avulsion of patellar tendonMOI = repeated avulsion of patellar tendon Bony callus develops enlarging the tibial tubercleBony callus develops enlarging the tibial tubercle Resolves with agingResolves with aging

Larsen Johansson is the result of excessive Larsen Johansson is the result of excessive pulling on the inferior pole of the patellapulling on the inferior pole of the patella

Osgood-Schlatter Osgood-Schlatter Disease, Larsen-Disease, Larsen-Johansson DiseaseJohansson Disease

Signs and SymptomsSigns and Symptoms SwellingSwelling Hemorrhaging Hemorrhaging Gradual degeneration of the apophysis due to Gradual degeneration of the apophysis due to

impaired circulationimpaired circulation Pain with kneeling, jumping, and runningPain with kneeling, jumping, and running Point tendernessPoint tenderness

ManagementManagement ConservativeConservative Reduce stressful activity Reduce stressful activity Possible castingPossible casting Ice before and after activityIce before and after activity IsometericsIsometerics

MOI = sudden or repetitive extensionMOI = sudden or repetitive extension Jumping or kicking places tremendous strain on patellar or Jumping or kicking places tremendous strain on patellar or

quadriceps tendonquadriceps tendon Signs and SymptomsSigns and Symptoms

Pain and tenderness at inferior pole of patellaPain and tenderness at inferior pole of patella 3 phases: 3 phases:

1) pain after activity, 1) pain after activity, 2) pain during and after activity,2) pain during and after activity, 3) pain during and after activity that may become constant3) pain during and after activity that may become constant

ManagementManagement Ice, phonophoresis, iontophoresis, ultrasound, heatIce, phonophoresis, iontophoresis, ultrasound, heat ExerciseExercise Patellar tendon bracingPatellar tendon bracing Transverse friction massageTransverse friction massage

Patellar TendinitisPatellar Tendinitis (Jumper’s or Kicker’s Knee)(Jumper’s or Kicker’s Knee)

MOI = sudden, powerful quad contractionMOI = sudden, powerful quad contraction Rare unless a chronic inflammatory condition exists Rare unless a chronic inflammatory condition exists

resulting in tissue degenerationresulting in tissue degeneration Occurs primarily at point of attachmentOccurs primarily at point of attachment

Signs and SymptomsSigns and Symptoms Palpable defectPalpable defect Lack of knee extensionLack of knee extension Considerable swelling and pain (initially)Considerable swelling and pain (initially)

ManagementManagement Surgical repair is neededSurgical repair is needed Proper conservative treatment of jumper’s knee can Proper conservative treatment of jumper’s knee can

minimize chances of occurringminimize chances of occurring

Patellar Tendon RupturePatellar Tendon Rupture

MOI = repetitive/overuse conditions attributed to MOI = repetitive/overuse conditions attributed to mal-alignment and structural asymmetriesmal-alignment and structural asymmetries

Signs and SymptomsSigns and Symptoms IT Band Friction SyndromeIT Band Friction Syndrome

Irritation at band’s insertion Irritation at band’s insertion Commonly seen in individual that have genu varum or Commonly seen in individual that have genu varum or

pronated feetpronated feet Pes Anserine Tendinitis or BursitisPes Anserine Tendinitis or Bursitis

Result of excessive genu valgum and weak vastus medialisResult of excessive genu valgum and weak vastus medialis Often occurs due to running with one leg higher than the Often occurs due to running with one leg higher than the

other other Running on a slope or crowned roadRunning on a slope or crowned road

Runner’s Knee & Runner’s Knee & Cyclist’s KneeCyclist’s Knee

ManagementManagement Correction of mal-alignmentsCorrection of mal-alignments Ice before and after activityIce before and after activity Utilize proper warm-up and stretching techniquesUtilize proper warm-up and stretching techniques Avoidance of aggravating activitiesAvoidance of aggravating activities NSAID’s NSAID’s OrthoticsOrthotics

Giving way of knee Giving way of knee Result of… Result of…

Weak quadricepsWeak quadriceps Chronic instability of ligamentous structuresChronic instability of ligamentous structures Torn meniscusTorn meniscus Loose bodies within the kneeLoose bodies within the knee Subluxating patellaSubluxating patella ChondromalaciaChondromalacia Due to painDue to pain

The Collapsing KneeThe Collapsing Knee

Prevention of Knee Prevention of Knee InjuriesInjuries

Total body conditioning is requiredTotal body conditioning is required Strength, flexibility, cardiovascular and Strength, flexibility, cardiovascular and

muscular endurance, agility, speed and muscular endurance, agility, speed and balancebalance

Muscles around joint must be conditioned Muscles around joint must be conditioned to maximize stabilityto maximize stability Flexibility and strengtheningFlexibility and strengthening

Must avoid abnormal muscle action Must avoid abnormal muscle action through flexibilitythrough flexibility

ACL Prevention ProgramsACL Prevention Programs Focus on strength, neuromuscular control, Focus on strength, neuromuscular control,

and balanceand balance Series of different programs which address Series of different programs which address

balance board training, landing strategies, balance board training, landing strategies, plyometric training, and single leg plyometric training, and single leg performanceperformance

Can be implemented in rehabilitation and Can be implemented in rehabilitation and preventative training programspreventative training programs

Shoe TypeShoe Type Change in football footwear has drastically Change in football footwear has drastically

reduced the incidence of knee injuriesreduced the incidence of knee injuries Shoes with more short cleats does not allow Shoes with more short cleats does not allow

foot to become fixed foot to become fixed Still allows for control during running and cuttingStill allows for control during running and cutting

Functional and Prophylactic Functional and Prophylactic Knee BracesKnee Braces Used to protect MCLUsed to protect MCL Used to prevent further Used to prevent further

damage to grade 1 and grade damage to grade 1 and grade 2 ACL sprains 2 ACL sprains

Used to protect the ACL Used to protect the ACL following surgeryfollowing surgery

Can be custom molded and Can be custom molded and designed to control rotational designed to control rotational forcesforces

Knee Joint Knee Joint RehabilitationRehabilitation General Body ConditioningGeneral Body Conditioning

Must be maintained with non-weight bearing Must be maintained with non-weight bearing activitiesactivities

Weight BearingWeight Bearing Initial crutch use, non-weight bearingInitial crutch use, non-weight bearing Gradual progression to weight bearing while wearing Gradual progression to weight bearing while wearing

rehabilitative bracerehabilitative brace Knee Joint MobilizationKnee Joint Mobilization

Used to reduce arthrofibrosisUsed to reduce arthrofibrosis Patellar mobilization is key following surgeryPatellar mobilization is key following surgery CPM unitsCPM units

FlexibilityFlexibility Must be regained, maintained, and improvedMust be regained, maintained, and improved

Muscular StrengthMuscular Strength Progression of isometrics, isotonics, Progression of isometrics, isotonics,

isokinetics, and plyometricsisokinetics, and plyometrics Incorporate eccentric muscle actionIncorporate eccentric muscle action Open vs. closed kinetic chain exercisesOpen vs. closed kinetic chain exercises

Neuromuscular ControlNeuromuscular Control Loss of control is generally due to pain and Loss of control is generally due to pain and

swellingswelling Through exercise and balance equipment Through exercise and balance equipment

proprioception can be enhanced and regainedproprioception can be enhanced and regained

BracingBracing Variety of braces Variety of braces

Some used to control for specific injuries while Some used to control for specific injuries while others are designed for specific forces, stability, others are designed for specific forces, stability, and providing resistanceand providing resistance

Typically worn for 3-6 weeks after surgeryTypically worn for 3-6 weeks after surgery Used to limit ROM for a period of time Used to limit ROM for a period of time

Functional ProgressionFunctional Progression Gradual return to sports specific skillsGradual return to sports specific skills Progress with weight bearing, move into Progress with weight bearing, move into

walking and running, and then onto sprinting walking and running, and then onto sprinting and change of directionand change of direction

Return to ActivityReturn to Activity Based on healing process Based on healing process

Sufficient time for healing must be allowedSufficient time for healing must be allowed

Objective criteria should include…Objective criteria should include… Strength assessmentStrength assessment ROM measuresROM measures Functional performance testsFunctional performance tests

SummarySummary

Review anatomyReview anatomy AssessmentAssessment

History, observation, palpationHistory, observation, palpation Special TestsSpecial Tests

Injury preventionInjury prevention Injury recognitionInjury recognition RehabilitationRehabilitation