11. Knee Flashcards
What are the self-report measures for the knee?
AIMS
WOMAC
LEAP
LEFS
LEAS
Lysholm Knee Scale
Tegner Activity Scale
Knee OA Outcome Scale (KOOS)
Which 2 Self-Report Measures are for ACL?
Lysholm Knee Scale
Tegner Activity Scale
What are the performance measures for Knee patients?
Wall Sit Test
8” step down test
LE agility test
Hop Tests (4)
Vertical Jump
LQ Y-balance test
What type of joint is the knee? How many DoF in the knee?
Hinge Joint
2 DoF
- flexion/extension
- IR/ER
The knee is strongly affected by mechanics of ___ and ______
Hip
Foot/Ankle
4 important nerves at knee?
Femoral –> Saphenous
Fibular x 3
Sural Nerve
Tibial Nerve
T/F: Tibial Nerve runs posterolateral and Sural Nerve runs posteromedial.
False
Tibial N. runs along tibia which is posteromedial and Sural runs posterolateral
What plane is the Tibiofemoral angle measured in?
Frontal plane
How do you measure the Tibiofemoral Angle?
Angle between longitudinal axes of femoral shaft and tibial shaft
Normal Tibiofemoral Angle?
165-175 degrees
Genu Valgum Angle
<165 degrees
Genu Varum Angle
> 175 degrees
Do you measure Tibiofemoral angle medially or laterally?
Laterally
How do you measure Q-Angle?
Line from ASIS to midpatella, line from central patella to tibial tuberosity
Flexed knee: what is tight?
Hamstrings
Hip flexors
What is normal Q Angle?
10-15 degrees
(females > males)
What is the malignant Q angle?
> 20 degrees
Increased Q angle increases risk for _________
Lateral Patellar subluxation
Possible causes of > Q angle?
Genu valgum
Excessive femoral anteversion
Tibial ER
What does Genu Valgum lead to?
Overpronation of foot
Longer Leg
ER of tibia
OA of Lateral knee compartment
Who might you see Genu Valgum for a period of time?
Children
What does Genu Varum lead to?
Supination of foot
Shorter Leg
IR of tibia
OA of Medial Knee
Who is your classic TKA Patient?
Genu Varum
What defines Genu Recurvatum?
Knee Hyperextension past 5 degrees
What are possible causes of Genu Recurvatum?
- Anterior Pelvic Tilt
- Quad weakness
- Gastroc/soleus weakness
- Ankle PF contracture OR DF restriction
- Global ligamentous laxity
What does Genu Recurvatum result in?
- Anterior tibiofemoral compression
- Posterior knee laxity
What are knee flexion contracture causes?
- Immobilization
- Prolonged wheelchair use
- sleeping with pillows under knees
- Capsular adhesions
- Abnormal hamstring tone
What do knee flexion contracture result in?
- excessive patellofemoral compression
- over-worked quads and triceps surae
- Loss of hip extension
- Abnormal gait pattern
What are hip flexion contracture causes?
- Immobilization
- prolonged wheelchair use
- sleeping with LEs elevated
- Capsular adhesions
- Transtibial or transfemoral amputation
- Abnormal hip flexor tone
What do hip flexion contractures result in?
- Excessive lumbar compression
- Overactive erector spinae
- Loss of hip extension
- Abnormal gait pattern
You are evaluating a 63-year-old female patient and she only has 93 degrees of knee flexion. Which of the following activities will she be limited from doing?
A. Safely climb stairs
B. Safely descend stairs
C. Riding a bike
D. Walking
C. Riding a bike
Note: Requires 115 degrees knee flexion
Full knee flexion = ____ degrees (KF= knee flexion)
140 degrees
Ride a bike = ____ degrees KF
115
Get up from a chair = _____ degrees KF
105
Safely descend stairs = ____ degrees KF
90
Safely climb stairs = ____ degrees KF
83
Walking = ___ degrees KF
60-70
Normal documentation of knee flexion –> hypertextension
5-0-140
5 hyper extension
0 normal
140 flexion
knee end feels
flex=soft
extend=firm
capsular end feel of knee
ext > flex
causes of Patellofemoral Pain syndrome (PFPS/PFS)
- Trauma: excessive compression to anterior knee
- Microtrauma: patellar maltracking
Patellofemoral Pain syndrome pt presentation
- Anterior knee pain
- Grinding clicking
- Peripatellar swelling
- Pain with patellar compression & quad activation
- Anterior knee pain with squatting
- Pain with descending stairs!
PFPS Outcome measures
Kujala Anterior Knee pain scale (AKPS)
SLB
SLS
8” step down test
PFPS Tests and Measures
Posture - standing
Gait
ROM: knee flex/ext - pain!
MMT
Ober/Thomas
Foot - posture/arch
Patellar Tendonitis “Jumper’s Knee” Causes
- Overuse/overload of patellar tendon
- Repetitive landing on hard surfaces with poor mechanics
Patellar Tendonitis “Jumper’s Knee” pt presentation
- Anterior knee pain
- Infrapatellar pain
- Possible delayed swelling in knee
- Tenderness at patellar tendon, “gritty”
- Pain with ascending stairs!
IT Band Syndrome Causes
- Overuse/overtraining of lateral knee
- postural deviations
- biomechanical issues from prox/distal jts
IT Band Syndrome pt presentation
- Tight TFL, IT Band, piriformis
- Weak Glute max/med
- Positive Obers Test
IT Band Syndrome Outcome measures
LEFS
LEAS
LEAP
Meniscal Tears Causes
- Trauma: torsional, particularly in WB
- Microtrauma: anything –> degenerative changes
Meniscal Tears pt presentation
- Popping, clicking, locking * Delayed swelling in the knee
- Tenderness at the joint line
ACL Tear Causes
- Rapid direction change on planted foot or sudden stop
- Incorrect biomechanics with landing from jump
- Medially directed blow to knee
- Non-contact/contact
ACL Tear pt presentation
- rapid swelling in knee joint
- decreased quad activation
- feeling of knee “giving way”
ACL Outcome measures
- Tegner Activity scale
- Lysholm Scale
- 8” step down
- YBT
- Hop Test
PCL Tear Causes
- MVA/dashboard injuries
- athletic hyperextension injuries
PCL Tear pt presentation
- immediate knee swelling
- feeling of instability
- usually not injured in isolation cuz of forceful trauma
MCL tear causes
- VALGUS hit to knee
- forceful tibial ER
MCL tear pt presentation
- swelling
- pain
- knee giving way medially
MCL fun fact!
MCL can heal on its own in 6 weeks
LCL tear causes
rare injury in isolation
- forceful VARUS force to knee
- forceful tibial ER
LCL tear pt presentation
- swelling
- pain
- feeling unstable
- may have numbness/tingling due to stretch of fibular nerve
Knee OA causes
- genu varum/valgum
- obesity
- female >male
- repetitive microtrauma at work
- prior knee injuries
- age
- weak hip musculature
- hereditary
Knee OA findings
- loss of knee ROM
- knee flexion during stance
- loss of hip ROM/strength
TKA reasons
- advanced OA
- severe trauma
TKA post op considerations
- avoid knee twisting or crossing legs
- priority: FULL EXT
- WB restrictions
- don’t allow gait deviations
TKA Outcome measures
LEFS
KOOS
TUG w/ AD
10 MWT
Gait