acute soft tissue injury- knee Flashcards
second degree lig injury
joint opens on stress
definite palpable endpoint
first degree ligament classification
local tenderness
no instability on stress
third degree ligament injury
joint opens on stress
no endpoint
what is the most common lateral injury
MCL injury
how does MCL injury happy
direct blow to lateral aspect of knee
valgus stress
physical exam with MCL injury
plain on valgus
laxity of medial structures
Tx of 3 grades for LCL and MCL
1- symptoms- stay off 2 weeks
2- knee brace- 4 weeks off
3- nonoperative brace or surgery- 6 weeks off
pe of LCL injury
pain on vargus
lateral laxity
what do you have to check for with LCL injury
peroneal nerve dysfunction (runs under biceps femoris and wraps around head of fibula)
ACL mech of injury
rapid deceleration, hyperextension with rotation on a planted foot
gender in ACL tears
m>f in tear risk, but F>m x4 of rupture risk
hx of ACL injury
audible pop followed by immediate pain and swelling after injury
PE of ACL injury
hemarthrosis (bleeding into joint) and limited ROM
tests to exam ACL
Lachman (hard to do but most sensitive)
anterior drawer
pivot shift tests
tx of acl injury depends on the
pathogenesis
ACl tear–>instability–>stress on secondary restrainign structures–>meniscal tears–>arthritis
osteoarthritis risk with ACL tear
surgery does not decrease the risk; remains high after the tear
decision whether or not to operate on ACL depends on
age, athletciism, rehab, motivation, ass injuries, failed no op tx
what are PCL injuries usually from
vehicular injuries
dx PCL injury
difficult and often missed
-hyperextension, + drawer test, MRI
tx PCL injury
non-operative if isolated (need to avoid popiteal artery)
operative if complex
knee dislocation
grossly unstable knee that has disruption of both cruciate ligaments and at least one collateral ligaments
natural history of knee dislocation
usually decreases spontaneously by patient or caregiver
what is always recommended for a knee dislocation?
arteriogram –>popiteal artery or peroneal nerve injury–>if disrupted emergency surgery necessary
knee dislocation tx options
cast immobilization for 6-8 weeks
surgical ligament reconstruction and early motion
vasculization and menisci
peripheral 1/3 is vascularized
job of menisci
shock absorbers
increase stability by cupping femoral condyles
decrease chrondral stress
dx of menisci injury
joint line tenderness, effusion, incomplete extension, positive mcmurray sign
how do you really dx an menisci tear
mRI
tx of menisci
usually just observe (not everyone needs a surgery)p
you can also do arthroscopic partial excision/repair
paterallar femoral disorder vascular supply
geniculate arteries
what is fx of patella
increase force of extension
contact stresses of patella increase with
flexion
hx of patellar-gemoral disorder
knee "giving way" pain on inclines pain associated with prolonged flexion crepitation swelling
PE of patello femoral dx
peri-patellar tenderness, pain w/ compression (quadriceps atrophy, exam aprehension)
patello0femoral syndrome is commonly seen in
adolescent females
signs of patelllo-femoral syndrome
pain or crepitation in knee at PF joint
positive effusion
positive patellar compression test
tx of patello-femoral syndrome
non-operative quadriceps strengthing
patellar dislocation often presents as
ACL tear
patellar dislocation occurs from
direct or indirect trauma–>patella dislocated laterally
inital tx of patellar dislocation
decrease dislocation acutely if locked by applying gental medial pressure with knee extended
if dislocation reduced spontaenously, check for signs of medial tenderness, effusion and apprehension
later tx of patellar dislocation
if first time an dno fx, immobilze
if recurrent, operative repair
patellar tendininitis
jumper’s knee
stress at insertion site of patellar tendon
