Acute Knee Injuries Flashcards
List common injuries to the knee
- Medial meniscus tear.
- MCL sprain.
- ACL sprain.
- Lateral meniscal tear.
- Articular cartilage injury.
- PCL injury.
- Patellar dislocation.
Time relation to onset of injury (intermediate hemarthrosis)
- 0-2 hrs. Degree and time of onset can reflect either intra articular of extra articular injury.
- Patellar dislocation.
- Major chondral lesion.
- MCL sprain (deep)
Time relation to onset of injury (Delayed effusion)
- 6-24 hrs. Degree and time of onset can reflect either intra articular of extra articular injury.
- Meniscus.
- Smaller chondral lesion.
- May represent synovitis and is a feature of meniscal and chondral injury.
Time relation to onset of injury (no swelling)
- Degree and time of onset can reflect either intra articular of extra articular injury.
- MCL sprain (superficial).
- May represent synovitis and is a feature of meniscal and chondral injury.
Why is the time of injury vs. time of onset of swelling important
Degree and time of onset can reflect either intra articular of extra articular injury.
List special tests that indicate ACL injury
- Lachman’s test. (30 deg. knees flexion + tibia ext. rotation then ant. drawers test)
- Anterior drawer test.
- Pivot shift test.(int. rot. valgus stress and knee flexion)
List special tests that indicate PCL injury
- Posterior drawer test.
- Posterior sag sign.
- Reverse Lachman’s test.(30 deg. knees flexion + tibia int. rotation then post. drawers test)
List special tests that indicate Meniscal injury
- McMurrays’s test. (knee fully flexed, internal rotation(for lateral) or medial rotation(for medial) and move into extension)
- Joint line tenderness.
- Apley’s test.
List special tests that indicate MCL injury
- Valgus stress test.
List special tests that indicate LCL injury
- Varus stress test.
List some key outcome measures to assess functional activity level
- International knee documentation committee (IKDC) Subjective evaluation form.
- Knee injury and osteoarthritis score (KOOS).
- Lysholm knee scoring scale.
- Tehner activity scale.
- Activity rating scale.
List the 6 types of meniscal tear injuries
Longitudinal tear (progress to Bucket handle tear).
Horizontal tear (progress to Flap tear).
Radial tear (progress to Parrot Beak tear).
Meniscal rehab goals Phase 1
(Time and 5 points)
- 0-1 week.
- control swelling.
- maintain knee ext.
- knee flexion to 100 deg.
- 4/5 quad strength.
- 4/5 hamstring strength.
Meniscal rehab goals Phase 2
(Time and 5 points)
- 1-2 weeks.
- Full ROM.
- 4+/5 quadricep strength.
- 5/5 hamstring strength.
Meniscal rehab goals Phase 3
(Time and 5 points)
- 2-3 weeks.
- Full ROM.
- Full strength.
- Full squat.
- Dynamic proprioceptive training.
- Return to running and restricted sport specific drills.
Meniscal rehab goals Phase 4
(Time and 5 points)
- 3-5 weeks.
- Full ROM.
- Full Strength.
- Full endurance.
- Return to sport specific drills and restricted training and match play.
Mild MCL rehab goals Phase 1
(Time and 5 points)
- 0-1 week.
- Control swelling.
- Knee flexion to 100.
- Allow +20 extension.
- 4/5 quadriceps strength.
- 4/5 hamstring strength.
Mild MCL rehab goals Phase 2
(Time and 6 points)
- 1-2 weeks.
- Eliminate swelling.
- Full ROM.
- Allow +10 extension.
- 4+/5 quadriceps strength.
- 5/5 hamstring strength.
- Return to light jogging.
Mild MCL rehab goals Phase 3
(Time and 5 points)
- 2-4 weeks.
- Full ROM.
- Full strength.
- Full squat.
- Dynamic proprioceptive training.
- Return to running and restricted sports specific drills.
Mild MCL rehab goals Phase 4
(Time and 4 points)
- 3-6 weeks.
- Full ROM
- Full strength
- Full endurance
- Return to sports specific drills and restricted training and match play.
Moderate MCL rehab goals Phase 1
(Time and 5 points)
- 0-4 weeks.
- Control swelling.
- Knee flexion to 90.
- Allow +30 extension.
- 4/5 quadriceps strength.
- 4/5 hamstring strength.
Moderate MCL rehab goals Phase 2
(Time and 5 points)
- 4-6 weeks.
- Eliminate swelling.
- Full ROM.
- FWB.
- 4+/5 quadriceps strength.
- 5/5 hamstring strength.
Moderate MCL rehab goals Phase 3
(Time and 5 points)
- 6-10 weeks.
- Full ROM.
- Full strength.
- Full squat.
- Dynamic proprioceptive training.
- Return to light jogging.
- Return to running and restricted sports specific drills.
Moderate MCL rehab goals Phase 4
(Time and 5 points)
- 8-10/12 weeks.
- Full ROM.
- Full strength.
- Full endurance.
- Return to sports specific drills and restricted training and match play.
ACL prehab goals
(4 points)
- N/minimal swelling.
- Restore FROM particularly extension.
- General 4+/5 lower limb strength or better.
- Education.
ACL rehab goals Phase 1
(Time and 5 points)
- 0-2 weeks.
- PWB FWB.
- Eliminate swelling.
- 0 -100 ROM.
- 4+/5 quadriceps strength.
- 5/5 hamstring strength.
ACL rehab goals Phase 2
(Time and 6 points)
- 2-12 weeks.
- No swelling.
- Full knee extension.
- Knee flexion to 130 +.
- Full squat.
- Good balance and control.
- Unrestricted walking.
ACL rehab goals Phase 3
(Time and 4 points)
- 3-6 months.
- Full ROM.
- Full strength and power.
- Return to jogging, running, and agility.
- Return to restricted sport specific drills.
ACL rehab goals Phase 4
(Time and 1 point)
- 6 -12 months.
- Return to sports.
List problems that are unaccounted for during ACL rehab
(non treatment and non surgical)
- Lower back pain.
- Instability.
- Symptomatic meniscus tears.
List problems that are unaccounted for during ACL rehab
(surgical treated)
- Patellar region pain.
- Soft tissue stiffness.
- Soft tissue laxity.
- Muscle weakness.
- Poor proprioception.
- Psychosocial problems.
Outcomes after ACL Rx.
(4 points)
- Patient’s own perception of knee function.
- Return to pre injury sporting activity.
- Re injury rate.
- Prevalence of osteoarthritis.
PCL rehab goals Phase 1
(Time and 5 points)
- 0 - 2 weeks.
- PWB.
- Eliminate swelling.
- 0 - 100 ROM.
- 4+/5 quadriceps strength.
- 5/5 hamstring strength.
PCL rehab goals Phase 2
(Time and 4 points)
- 2 - 4 weeks.
- No swelling.
- Full ROM.
- 4+/5 quadriceps strength.
- 5/5 hamstring strength.
PCL rehab goals Phase 3
(Time and 4 points)
- 4 - 6 weeks.
- Full ROM.
- Full strength & power.
- Return to jogging, running, and agility.
- Return to restricted sports specific drills.
PCL rehab goals Phase 4
(Time and 1 point)
- 6 -10 weeks.
- Return to sports
Explain four functions of the meniscus
- Increase stability of the femorotibial joint.
- Distribute axial load.
- Absorb shock.
- Provides lubrication and nutrition to the knee joint.