Articular pathology of the Knee Flashcards
T or F: knee OA is common and arthritis is strongly associate with major depression
T
what is the most common cause of disability in the US?
arthritis
are males or females more at risk for articular knee injuries
female
does the medial or lateral compartment of the knee experience more wear and tear? why?
medial b/c we load in extension and create a varus moment
if your pt has a medial compartment knee injury what kind of exercises may you need to avoid for a time?
weight bearing exercises close to full extension
if your pt has an injury to their patella where should you have them do exercises at first?
close to full extension because the patella isn’t making contact
what part of the meniscus is innervated
outer 2/3
during flexion and extension the meniscus moves with the ______
tibia
(ant with ext, post with flexion)
during rotation the meniscus moves with the _____
femur
(during tibial IR, medial meniscus goes anterior and lateral meniscus goes posterior)
meniscus cluster testing
1 - catching/locking
2 - joint line tenderness
3 - pain with forced hyperextension
4 - pain with max passive knee flexion
5 - pain or clock with McMurray’s
4/5 = 96% specificity, 5/5 = 99%
what kind of MOI do pts typically have with a traumatic meniscus injury
twisting
T or F: degenerative and traumatic meniscal tears are examined and treated the same
F: examined the same but degenerative tend to be treated much more conservatively because their outcomes are the same as surgery long term
special tests for meniscus (3)
McMurray
Apley’s
Thessaly’s
T or F: no single test accurately identifies meniscal injuries
T
what is the gold standard imaging for meniscus injuries
MRI
with a meniscectomy you get flattening of the ______
condyles
4 surgical treatments for meniscus injury
1) in situ - flap the tear back over and leave it
2) debridement - cut out torn parts or entire thing
3) repair - fix tear
4) allograft - transplant meniscus from cadaver (not common)
are repairs usually completed on the lateral or medial meniscus? why?
lateral - b/c better blood flow
what is one of the most critical parts of rehabbing meniscal repairs?
getting full knee extension
the first 4 weeks after meniscal repair, keep knee flexion ROM below ___- degrees
90
therex progression post meniscal repair
0-4 wks = unloaded knee exercise
4-8 wks = closed kinetic chain
8-12 wks = strength training
functional progression post meniscal repair
0-2 weeks = weight bearing progression
2-4 weeks = walking progression
4-12 weeks = functional progression
what is the main difference rehab wise between an allograft and meniscal repair
allografts are normally NWB for a longer periods of time and need radiographic evidence of healing
articular cartilage loss s/s
- ROM loss
- joint line tenderness
- crepitus
how many grades of articular cartilage defects? is higher better or worse?
5 (0,1,2a, 2b,3)
the higher the grade the worse the damage
what are some traumatic MOIs for articular cartilage pathologies
1 - superficial lesions
2 - blunt trauma
3 - deep penetrating wound
as you get older, articular cartilage gets _________
softer
T or F: genetics can play a role in how quickly articular cartilage wears down
T
pigmented villonodular synovitis
- idiopathic synovial overgrowth
- hemarthrosis
most common joint for pigmented villonodular synovitis
knee
T or F: pigmented villonodular synovitis may spontaneously resolve or take years
T
medial unloader braces are designed to put a _____ stress on the knee while lateral braces put a ______ stress
valgus
varus
what are 3 things that have proven to have positive effects on knee OA
weight loss
exercise
PT
For knee OA what kind of exercises should you start with
non-weight bearing
what intervention could be useful for pain control in knee OA
joint mobilizations
did research show a difference in WOMAC scores between pts who had arthroscopic debridement and those who had PT and conservative medical management
no
debridement for knee OA usually leads to a …
joint replacement
are autografts (OATS) or allograft articular cartilage surgeries more common
autografts
two parts of autologous chondrocyte implantation (MACI)
1 - harvest cells
2 - debride and implant
do most athletes return to “high level” activity after MACI procedures
yes
MACI post-op rehab phases
0-6 wks = early protection (control effusion, ROM within limits)
6-12 wks = transition (full ROM, increase WB)
12-26 wks = remodeling (strength and function)
6 months-3 years = maturation
T or F: early WB is proven to be superior to later WB in MACI rehabilitation
F: WB restrictions are highly dependent on surgeon preference
do athletes tend to do better with an OATS or MACI procedure
OATS
salter-harris fracture
a fracture on the epiphyseal plate in children
salter-harris classification
type 1 & 2 = no surgery
type 3 = sometimes surgery
type 4&5 = need surgery
*type 2 most common
what are kids with type 4&5 salter harris fractures more likely to have
a leg length difference because you damaged the growth plate
T or F: you need full knee extension for daily activities
T: knee extension is important
