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In order Cuccurullo > Ch 4 - MSK: Knee Pathology > Flashcards

Ch 4 - MSK: Knee Pathology Flashcards

1
Q

What are meniscal injuries associated with?

A

Cutting maneuvers

Tibial rotation w/ knee partially flexed in WB

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2
Q

What sports are medial meniscal injuries associated with?

A

Football

Soccer

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3
Q

What sports are lateral meniscal injuries associated with?

A

Squatting

Wrestling

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4
Q

What is the clinical presentation of an acute meniscal tear?

A

– Pop after an incident
– May cause true locking
– Effusions ~24 hours
– Knee stiffness

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5
Q

What is the most common MOI for posterior horn meniscal tears?

A

Valgus and ER

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6
Q

What is the clinical presentation of a degenerative meniscal tear?

A

– Minimal trauma
– >40 yo
– Impingement episodes may be minimal

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7
Q

What is seen on physical exam in meniscal injury?

A

Dec ROM
Effusion limits flexion
Meniscal fragment limits extension
Medial/lateral joint line tenderness

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8
Q

What is the gold standard for diagnosing meniscal tears?

A

MRI
– Sagittal views will best show the anterior and posterior meniscal horns
– Coronal views are the best views for the meniscal body

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9
Q

How do meniscal tears appear on MRI?

A

Line of increased signal extending from articular surfaces

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10
Q

What is the treatment of an inner 2/3 meniscal injury?

A

Surgical resection because of avascularity and resultant poor tissue healing
WBAT 1-2 day post op

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11
Q

What is the treatment of an outer 1/3 meniscal injury?

A

Repaired due to better vascular supply
NWB 4-6 weeks
Strengthening at 6 weeks

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12
Q

What is the most common ligament injured in athletics?

A

ACL
Soccer
Football
Downhill skiing

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13
Q

What is the MOI for ACL injury?

A

Cutting, deceleration, and hyperextension of the knee
Valgus force to a flexed and rotated knee
Noncontact injuries MC

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14
Q

What is the terrible triad?

A

ACL, MCL and medial meniscus injury

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15
Q

What is the clinical presentation of an ACL injury?

A

– Sudden pop, anterior knee pain w/ posterior lateral joint line pain
– Instability of the knee
– Swelling ~24 hours, and significant effusion

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16
Q

What is seen on exam in an ACL injury?

A

– Effusion
– Tenderness is variable
– +/- anterior drawer test
– Lachman’s test may be positive or can yield a false negative in approximately 10% of cases. It is examiner dependent and also influenced by muscle guarding.

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17
Q

What can be seen on X-ray in ACL injury?

A

Avulsion fx of tibial insertion of the ACL or the lateral capsular margin of the tibia

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18
Q

What is the accuracy of MRI to detect ACL tear?

A

85-90%

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19
Q

What is the initial treatment for ACL injury?

A

Partial WB, ice, and compression are used while evaluation is ongoing

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20
Q

What is the treatment after ACL reconstruction surgery?

A

– Partial WB
– Flex ROM 1st 2 wks
– Progress to closed chain kinetics
– Avoid open chain exercises
– Resistive exercises b/w 0° and 45° flex avoided 3 to 6 mo
– Lenox Hill derotation orthosis controls knee axial rotation, AP and medial–lateral control
– Sports-specific exercises 6 to 12 wks
– Complete rehab in 6 mo-1 yr w/ max ROM, strength, and agility

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21
Q

What is the MOI of a PCL injury?

A
  • MCC is impact to the front of the tibia with the knee flexed
  • Athletics: hyperflexion
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22
Q

What is the clinical presentation of a PCL injury?

A

– (+/-) pop
– Swelling inc ~24 hr
– Impaired extension
– (+/-) pain w/ WB

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23
Q

What is seen on exam in PCL injury?

A

– Effusion
– Popliteal tenderness
– (+/-) Posterior drawer test and sag tests

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24
Q

What can be seen on x-ray with PCL injury?

A

Avulsion

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25
Q

What is the treatment of a PCL injury?

A
  • Surgical repair if ligament is avulsed w/ tibial fragment

* Quadriceps strengthening

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26
Q

What is the most common injured ligament of the knee?

A

MCL injury

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27
Q

What is the MOI of MCL injury?

A
  • Football and skiing
  • Impact force to the lateral knee
  • Sustained valgus force
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28
Q

What is the clinical presentation of a MCL injury?

A

– Pop
– Medial knee pain
– Complete tears may allow walking and running after initial pain
– Knee stiffness

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29
Q

What is seen on exam in MCL injury?

A

– Medial swelling/ tenderness
– Min effusion
– Medial instability on valgus stress testing
– Opening of 5 to 8 mm compared to the opposite side may indicate a complete tear
– Instability in slight flex 30° specific for MCL injury
– Instability in full extension: MCL and posterior capsule injury

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30
Q

What can be seen on x-ray in MCL injury?

A

Epiphyseal fx

31
Q

When would MRI be useful in MCL injury?

A

Delineate the MCL tear and investigate associated injuries

32
Q

What is the treatment for MCL injury?

A
  • Isolated tears treated conservatively
  • Knee brace
  • Strengthening and stability
  • Tear with concomitant injuries may require surgical intervention
33
Q

What is the MOI of LCL injury?

A

Knee dislocation

34
Q

What other injuries can be associated with LCL injury?

A

Vascular
Cruciate
Peroneal nerve
Posterior lateral corner instability

35
Q

When does the ITB slide over the lateral femoral condyle?

A

During flexion and extension

36
Q

Where does the ITB insert?

A

Gerdy’s tubercle on the lateral tibia

37
Q

What leads to ITB dysfunction?

A

Inflexibility of the ITB

Adductor/abductor muscle imbalances

38
Q

What is the clinical presentation of ITB syndrome?

A
  • Pain over the lateral femoral condyle and/or Gerdy’s tubercle
  • Worse by walking or jogging
  • Better with running
39
Q

How do patients adapt to ITB syndrome?

A

ER hip
IR lower leg
Pronating foot

40
Q

What is the treatment for ITB syndrome?

A
  • Stretching the ITB, hip flexors, and gluteus max
  • Strengthening the hip abductors, gluteus max, and TFL
  • Orthotics may be helpful and foot over-pronation must be corrected
  • Injection at the lateral femoral condyle in resistant cases
41
Q

What increases weight bearing to patellofemoral joint?

A

– Knee flexion
– Walking: 0.5x BW
– Stairs: 3.3x BW
– Squatting: 6.0x BW

42
Q

What helps to prevent patellar subluxation?

A

Lateral lip of patellar surface of femur

43
Q

What can increase risk for lateral patellar subluxation?

A 
Less prominent lateral lip
Inc genu valgum
Vastus medalis weakness
Tibial external torsion
Shallow lateral femoral condyle
Laterally attached infrapatellar tendon on tubercle
44
Q

What can increase risk for medial patellar subluxation?

A

Increased genu varum

45
Q

What is the clinical presentation of a patellar subluxation?

A
  • Displaced medially or laterally
  • Knee buckles
  • Pain at peripatellar region
  • (+/-) effusion
  • (+/-) vastus medialis wasting
  • Full extension
  • Reset at 25° to 30° flexion
46
Q

What imaging should be done for patellar subluxation?

A

– AP view: patellar position over the sulcus
– Lateral view: patellar height; done at 45° knee flexion and in full extension
– Sunrise (tunnel) view: patellofemoral articulation and femoral condyle height

47
Q

What is the most common cause of anterior knee pain?

A

Patellofemoral pain syndrome

48
Q

What is a patella alta?

A

High-riding, laterally shifted patella due to vastus lateralis tightness and relative medial weakness, causing tracking dysfunction

49
Q

What is a patella baja?

A

Low patella

Less common and may indicate quadriceps rupture

50
Q

What is a squinting patella?

A

Patellar IR

51
Q

What is a frog eye’s patella?

A

Patellar ER

52
Q

What can predispose to patellofemoral pain syndrome?

A
  • Tight hip flexors or abductors can alter gait and cause symptoms
  • Inc Q angle
  • Tight hamstrings can increase patellofemoral loading
53
Q

What factors can increase Q angle?

A

Internal torsion of
Femur
Lateral insertion of the infrapatellar tendon on the tibia
Genu valgum

54
Q

What are treatments for patellofemoral pain syndrome?

A

VMO/hip abductor strengthening
Patellar taping/bracing
Limit biking, jumping, squatting
Bike fitting

55
Q

What is chondromalacia patella?

A

Cartilage appears roughened or fibrillated on arthroscopy

56
Q

What is plica syndrome?

A

Redundant fold of the synovial lining of the knee, which is susceptible to tearing as it passes over the condyles

57
Q

Where does the synovial lining extend in the knee?

A

Infrapatellar fat pad medially around the femoral condyles

and under the quadriceps tendon above the patella and lateral to the lateral retinaculum

58
Q

What is the clinical presentation of plica syndrome?

A

Anterior knee pain of insidious onset that can gradually increase
with prolonged knee flexion or sitting, but is made worse by standing and extension

59
Q

When can plica syndrome give the sensation of knee buckling?

A

When plica is trapped between patella and medial condyle

60
Q

What activities are associated with patellar tendonitis (jumper’s knee)?

A

Repetitive, high quadriceps loading: Jumping, squatting, kneeling, and climbing stairs

61
Q

What is the most common location for patellar tendonitis (jumper’s knee)?

A

Inferior pole of patella

62
Q

What is the clinical presentation of patellar tendonitis (jumper’s knee)?

A
  • Pain on high impact activity
  • Pain may diminish during activity and become more apparent afterward
  • TTP over patellar tendon and inferior/superior patellar pole
63
Q

What is Osteochondritis dissecans?

A

Localized AVN at the end of a long bone l/t formation of dead subchondral bone covered with articular hyaline cartilage

64
Q

What is the cause of Osteochondritis dissecans?

A

Repetitive small stresses to subchondral bone that disrupt blood supply to that area of bone

65
Q

What are potential locations of Osteochondritis dissecans?

A 
Medial femoral condyle
Distal femur
Patella
Elbow
Talus
Distal humerus
66
Q

Who is affected by Osteochondritis dissecans?

A

Adolescents

67
Q

What is the clinical presentation of Osteochondritis dissecans?

A
  • Gradual onset of joint pain, effusion, buckling

* Loose body may cause locking

68
Q

What can help relieve pain of Osteochondritis dissecans (patella)?

A

Walking with the foot rotated outward may relieve pain

69
Q

How can the medial femoral condyle be palpated?

A

Knee flexed 90° with pressure directed medial

to the inferior pole of the patella

70
Q

What is the treatment of Osteochondritis dissecans?

A
  • Prior to fragmentation: rest and protected WB

* After fragmentation: surgical excision

71
Q

What is the origin and insertion of popliteus?

A

Origin: lateral face of the lateral femoral condyle
Insertion: triangular area in the posterior tibia

72
Q

What does the popliteus do?

A
  • IR of the tibia
  • Unlocks the knee by laterally rotating the femur
  • With the ACL, it limits anterior translation of the femur
73
Q

What is the clinical presentation of popliteus tendonitis?

A
  • Lateral knee pain during downhill activities and with excessive pronation
  • TTP anterior to LCL
  • Pain with legs in figure of four or cross-legged position
74
Q

What orthotics can help with popliteus tendonitis?

A

Arch supports or medial heel wedges

In order Cuccurullo (91 decks)

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