40 Questions
What degree of flexion is required for the flexion-rotation drawer test?
15-20°
What is the primary aim of the acute phase of treatment?
Control pain and swelling
What is the primary reason for using crutches in the acute phase?
To minimize joint effusion and edema
What is the expected outcome for knee extension in the acute phase?
Equal to the contralateral limb
What is the purpose of patella mobilization in the acute phase?
To increase ROM
What is the indicator for progression to full weight-bearing?
Patient can demonstrate normal gait mechanics without crutches
What is a precaution that should be taken in the acute phase?
Monitor for episodes of knee buckling
What is the goal of quadriceps activation in the acute phase?
Establish good quadriceps activation
What is the primary focus of Phase 1 in the provided rehabilitation program?
Maintaining full ROM and flexibility
What is added to the exercise routine in Phase 2?
Leg press and leg curl
When should the physician be alerted?
If the patient reports knee buckling
What type of exercises are initiated in Phase 1?
Gait and weight-bearing exercises
What is the primary goal of Phase 1 (0-2 weeks) of the rehabilitation program?
Eliminate swelling and improve range of motion
What is the goal of strengthening exercises in Phase 2?
To strengthen the affected limb
What is the recommended treatment for the first week of Phase 1?
Cryotherapy and electrotherapy
What type of exercises are continued from Phase 1 in Phase 2?
Strengthening exercises
What is emphasized in Phase 2 to minimize joint stress?
Avoiding patella femoral joint stress
What is the target range of motion for knee flexion during Phase 1?
100°-110°
What is the purpose of static quadriceps contractions?
To relearn how to contract the quadriceps
What is added to the exercise routine to improve neuromuscular control?
Single-limb balance exercises
How often should the quadriceps strengthening exercises be performed during Phase 1?
4-5 times a day
What is the purpose of patellar mobilization?
To improve patellar tracking
What is the purpose of gait drills during Phase 1?
To re-educate gait
What is the purpose of ankle pump exercises during Phase 1?
To reduce swelling
What is the primary focus of Phase 3 in the rehabilitation program?
Maintaining full range of motion and flexibility
What type of exercises are initiated in Phase 3 to improve neuromuscular control?
Plyometric exercises
What is a caution or contraindication in Phase 3?
Pivoting or lateral movements
What is the criteria for progressing to Phase 3?
Physician approval
What is a sign to alert the physician in Phase 3?
Increased knee effusion
What type of exercises are progressed in Phase 3?
Step-ups and lunges
What is the goal of maximizing strength in Phase 3?
To optimize lower extremity function
What is the final goal of Phase 3?
Return to full activity and sport
What is the warning to the patient regarding the knee when sitting or laying down?
Keep the knee straight
What percentage of partial weight bearing with two crutches is allowed from the first postoperative day?
50%
How long must cryotherapy be performed after every exercise session?
20 min
What is added to the protocol if there is lack of extension?
Passive knee extension in prone position
How often should patellar mobilization be done?
Three times a day
What is the best way to check extension during the exercise?
Observe heel height
What is the primary goal of Phase 2 of the rehabilitation protocol?
Improve knee extension and strength
What is the weight used for passive knee extension in prone position?
0.5-1 kg
Study Notes
Flexion-Rotation Drawer Test
- The flexion-rotation drawer test is performed with the knee flexed 15-20° and the tibia in neutral rotation.
- The examiner grasps the leg at the ankle, and the weight of the thigh leads to posterior translation with lateral rotation of the femur and anterior translation of the tibia, resulting in anterolateral instability.
Rehabilitation Phases
Phase 1 (Acute Phase, 0-2 weeks)
- Aim: Control pain and swelling, restore pain-free ROM, and emphasize knee extension.
- Recommended treatment:
- Gait and weight-bearing exercises with crutches, progressing to full weight-bearing without crutches.
- ROM exercises, strengthening exercises, patella mobilization, and quadriceps/adductor sets.
- Partial range squats, standing terminal knee extension, standing or prone hamstring curls, and heel raises.
Phase 2 (Sub-Acute Phase, 2-12 weeks)
- Aim: Maintain full ROM and flexibility, progress strengthening exercises, and improve neuromuscular control.
- Recommended treatment:
- Continue Phase 1 exercises, adding bicycle/elliptical with increased resistance.
- Avoid patella femoral joint stress.
- Single leg balance exercises and proprioception exercises.
Phase 3 (Limited Return to Activity/Sport, 2-12 weeks)
- Aim: Maintain full ROM and flexibility, maximize strength, initiate single leg exercises, and maximize neuromuscular control.
- Recommended treatment:
- Straight ahead jogging, plyometrics, and treadmill with progressive resistance.
- Continue Phase 2 exercises, adding step-ups, single-limb balance, and static lunges.
- Avoid patella femoral joint stress, especially with plyometrics.
- Initiate return to sport/work activities with physician approval.
Exercise Program
Phase 1 (0-2 weeks)
- Gentle knee flexion exercises to achieve 100°-110° knee flexion.
- Extension ROM to 0°, quadriceps/VMO setting, supported calf raises, hip abduction and extension, and hamstring pulleys/rubbers.
- Static quadriceps contractions, ankle pump, and patellar mobilization.
Patient Education
- Keep the knee straight when sitting or laying down.
- Warning: Avoid placing supports under the knee to prevent loss of extension.
- Gait drills: partial weight bearing with two crutches, gradually increasing as tolerated.
This quiz assesses your understanding of the flexion-rotation drawer test, a procedure used to diagnose orthopedic injuries. The test involves flexing the knee and grasping the leg at the ankle to detect posterior translation and lateral rotation of the femur.
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