Ch 47 Knee

Question 1

Joints of the knee

Answer 1

1. Patellofemoral

2. Tibiofemoral

Question 2

Patellofemoral Pain

a) Sing and symptoms
b) Treatment

Answer 2

1. Anterior knee pain (flexion)
2. Positive theater sign
3. ## Pain when squat or descend from stairs
4. Quadraceps strengthening
5. Taping / Braces
6. Cycling
7. Orthotics (pronation/supination)
8. Surgery

Question 3

Position of patella

Answer 3

1. Patella Alta: high riding > tendon rupture of weak quads

2. Patella Baja: low riding > contracture / scar / hypotonic quads

Question 4

ITB syndrome and treatment.

Pain free while runners?

Answer 4

1. Lateral knee pain
2. Tender lateral epicondyle
3. ## Soft tissue swelling
4. ## P.O.L.I.C.E
5. Runners spend more time with knee at angels greater than 30 degrees.

Question 5

Pes Anserinus Syndrom ?

Answer 5

Medial knee pain (medial tibial tuberosity)

1. Semitendenosus tendon
2. Gracillis tendon
3. Sartorius tendon

Question 6

Osteochondritis Dissecans (OCD)

Answer 6

Fragmentation of the articular cartilage with subchondral bone from trauma or idiopathic.

Causes: Pain, effusion, stiffness, joint collapse.

Question 7

Jumper Knee

Answer 7

Insertional tendenopathy of the quadriceps or patellar tendon.

Treatment: P.O.L.I.C.E.

Question 8

Osgood-Schlatter Disease

Answer 8

abnormal insertion of patellar tendon into tibial tubercle. Most common cause of knee pain in children > activity related pain.

Treatment: Rest and gradual increase of activity.

Question 9

Q angel / Patellofemoral angle

How to decrease high Q angle?

Answer 9

1. ASIS > midpoint of patella
2. Tibial tubercle > midpoint of patella
   Normal 13-18 degree
   -
3. Prevent pronation (orthotics)
4. Strength quadriceps (medialis)

Question 10

Two types of knee overuse injury

Answer 10

1. Prayer Knee > Infrapatellar inflammation

2. Housemaid Knee > Prepatellar inflammation

Question 11

Baker Cyst

Answer 11

Herniation of synovial tissue due to weak posterior joint capsule and causes swelling in the popliteal fossa.

Question 12

ACL injury
A. Sign and symptoms
B. Diagnosis (Gold standard)
C. Treatment

Answer 12

A. Pop sign and joint effusion / hemarthrosis.
B. MRI
C. P.O.L.I.C.E

Question 13

Examination of ACL vs PCL

Answer 13

ACL

1. Lachman test (Hyper Lax?)
2. Anterior Drawer Test
3. Pivot Shift Test

PCL

1. Posterior Drawer Test
2. Reverse Pivot Shift Test
3. Posterior Swag Test

Question 14

PCL injury
A. Sign and symptoms
B. Diagnosis (Gold standard)
C. Treatment

Answer 14

A. Pain, posterior swelling, bruising, instability.
B. MRI
C. P.O.L.I.C.E

Question 15

Purpose of knee meniscus

Answer 15

1. Nutrition
2. Support and shock absorption
3. Lubrication and prevent cartilage wear

Question 16

Unhappy Triad

Answer 16

1. ACL
2. MCL
3. Medial meniscus

Question 17

Test for meniscus

Answer 17

1. McMurray Test
   Flex hip and knee, rotate tibia medial-lateral
2. Apley Maneuver
   Patient prone, knee flex 90, rotate tibia medial-lateral + pressure

Question 18

Peroneal nerve palsy post TKR

Answer 18

1. Lateral retractor placement
2. stretch of nerve with correction of deformity.

Tx: surgical exploration and decompression.

Question 19

Types of knee effusion

Answer 19

1. Synovial
2. Purulent
3. Hemarthrosis

Question 20

Types of knee deformaty

Answer 20

1. Genu Valgum
2. Genu Varum
3. Genu Recurvatum