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Chapter 15 Knee Conditions Flashcards

1
Q

What is the normal angle between the femoral and tibial shafts?

A

normal= 180-195 degrees

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2
Q

What is genu valgum?

A

less than 180 degrees, associated with lateral tibial torsion

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3
Q

what is genu varum?

A

greater than 195 degrees, associated with medial tibial torsion

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4
Q

What is genu recurvatum?

A

hyperextension or posterior bowing of the knee

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5
Q

what is patella alta?

A

high-riding patella caused by a long patellar tendon

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6
Q

What is patella baja?

A

low-riding patella caused by a short patellar tendon

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7
Q

What is squinting patella?

A

medial-riding patella caused by hip anteversion or internal tibial rotation

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8
Q

What is frog-eyed patella?

A

lateral-riding patella caused by hip retroversion or external tibial rotation

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9
Q

What do knee contusions result from?

A

result from compressive forces

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10
Q

What could happen to the infrapatellar fat pad in the event of a knee contusion and what are its S/S?

A

Infrapatellar fat pad may become entrapped between the femur and tibia or inflamed during arthroscopy  tender, puffy, fat pad contusion
S/S – locking, catching, giving away, palpable pain on either side of patellar tendon, increase pain with extension

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11
Q

What can lead to the compression of the common peroneal nerve? What are the S/S of its compression?

A

blow to posterolateral aspect of knee ==> temporary or permanent paralysis following compression of this nerve

S/S – shocking feeling of pain down lateral leg, actual damage = tingling/numbing may persist for several minutes, muscle weakness in DF and eversion

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12
Q

What are the general S/S of knee contusions? What are important things to take note of?

A

S/S: localized tenderness, pain, swelling, ecchymosis

if there are sensory changes or motor weakness need to refer to physician

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13
Q

what is knee bursitis caused by?

A

Caused by direct trauma, overuse, infections, metabolic abnormalities, rheumatoid afflictions and neoplasms

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14
Q

What can compressive forces from a direct blow lead to with relation to a knee bursa?

A

Compressive forces from a direct blow  grossly distended, warm bursal sac filled with blood effusion  hemabursa

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15
Q

What happens when there are repeated insults when related to a knee bursa?

A

Repeated insult  chronic bursitis  bursal wall thickens, appears to be distended when filled with fluid

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16
Q

What does the pes anserine bursa develop from?

A

Pes anserine bursa  develops from friction typically (runners, cyclists, swimmers  excessive valgus and tight hamstrings
S/S – swelling and pain

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17
Q

What is a Baker’s cyst?

A

Baker cyst – synovial herniation of the posterior joint capsule or bursitis on the posterior aspect of the knee, internal derangement injuries lead to joint effusion that expands into the bursal sac
Semimembranosus bursa commonly involved

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18
Q

What is an infected bursitis and what should you do in that case?

A

Infected bursitis  abrasions or penetrating injuries  localized and intense redness, increase pain, enlarged regional lymph nodes, spreading cellulitis, fever, malaise  refer to physician

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19
Q

What is the general management of bursitis?

A

Management – ice, compression, NSAIDs, corticosteroid injections if chronic/persistent

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20
Q

In what plane is there instability following an ACL or PCL injury?

A

sagittal plane

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21
Q

In what plane is there instability when there is an MCL or LCL injury?

A

frontal plane

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22
Q

What damages the MCL, posteromedial capsular ligaments, and PCL?

A

lateral or valgus force cause tension on the medial aspect of the knee

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23
Q

What are the S/S of grade 1 MCL sprain?

A

Grade I – mild point tenderness on medial joint line/MCL, little to no joint effusion, full ROM with discomfort, stable joint during valgus stress test

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24
Q

What are the S/S of a Grade 2 MCL sprain?

A

Grade II – positive valgus stress test at 30 degrees, unable to full extend the knee, tenderness and pain over MCL

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25
What are the S/S of a grade 3 MCL sprain?
Grade III – positive valgus stress test with significant joint laxity, positive test in full extension – involvement of MCL and medial joint capsule
26
What damages the LCL, lateral capsular ligaments and PCL?
Medial forces that produce tension on the lateral compartment
27
Why is isolated injury of straight lateral instability rare?
because of stabilization of biceps femoris, IT band and popliteus
28
What are the S/S of LCL sprain (straight lateral instability)?
S/S – same as MCL, sharp lateral knee pain, minimal swelling, subtle instability, positive varus stress test in 30 degrees flexion – ligament damage, positive varus stress test in extension – damage to lateral joint capsule and LCL
29
Is isolated straight anterior instability common?
it is rare, anteromedial or anterolateral laxity occurs
30
what can cause straight anterior instability?
quadriceps/hamstring eccentric muscle strength imbalance
31
What are the S/S of straight anterior instability?
S/S – popping/snapping/tearing sensation, rapid onset of swelling, pain deep in the knee but anterior, either side of patellar tendon, feeling of knee giving away
32
What would be a diagnostic test for a straight anterior instability?
positive lachmann or anterior drawer
33
What are the MOI for a straight posterior instability?
hyperextension, falling on a flexed knee
34
What are the s/s of straight posterior instability?
S/S – mild = intense pain and sense of stretching felt in the posterior aspect of the knee, total rupture = pop/snap felt, autonomic symptoms of dizziness/nausea/faintness, limited knee extension, positive posterior sag
35
What is damaged following anterior ER of the medial tibia condyle on the femur?
damage to medial compartment ligaments and oblique popliteal ligament
36
What is the unhappy triad?
tear of the medial meniscus ACL and MCL
37
What would be the positive diagnostic tests that would indicate an anteromedial rotary instability?
Valgus stress test positive at 0 and 30, positive Slocum or Lachman with tibia ER, cross-over test
38
What is anterolateral rotary instability?
anterior internal subluxation of the lateral tibial condyle on the femur
39
What is the primary structure damaged by an anterolateral rotary instability?
ACL primary structure damaged, IT band and lateral capsule ligaments can also be damaged
40
What are possible MOI for an anterolateral rotary instability?
sudden deceleration and cutting maneuver, most frequent rotary stability of the knee
41
What would be the positive diagnostic tests to indicate an anterolateral rotary instability?
positive slocum with tibia IR, cross-over test
42
What is a posteromedial rotary instability?
medial tibial plateau shifts posteriorly on the femur and opens medially
43
What are the structures damaged with a posteromedial rotary instability?
Severe injury – damage to the superficial MCL, posteromedial capsule, oblique popliteal ligament, both cruciate ligaments
44
What are the positive diagnostic test that would indicate a posteromedial rotary instability?
Positive valgus stress test at 0 degrees, posteromedial drawer test and posteromedial pivot shift test
45
What is a posterolateral rotary instability?
greater posterior translation of the lateral tibial plateau
46
What is the MOI that leads to posterolateral rotary instability?
sudden anteromedial force that brings the knee joint from near-full extension into hyperextension Other MOI: combined hyperextension and ER, contact/non-contact hyperextension, severe varus bending moment, severe tibial ER torque
47
What are the structures involved with posterolateral rotary instability?
PCL, arcuate-popliteal complex, posterolateral capsule, LCL
48
What is the positive diagnostic test that would indicate posterolateral rotary instability?
positive varus stress tests at 0 and 30 degrees
49
What percentage of all grade III knee ligament injuries result in knee dislocations?
approx 20%
50
What ligaments get injured with knee dislocations?
two ligament injuries occur; ACL-MCL, PCL - MCL, ACL-LCL, ACL-PCL
51
A minimum of how many ligaments need to be torn for the knee to dislocate?
A minimum of three ligaments must be torn for the knee to dislocate, most often ACL, PCL and a collateral ligament
52
What are the most common directions of knee dislocations?
most common in anterior or posterior direction
53
What percentage of knee dislocations result in vascular damage and what percentage in nerve damage?
vascular: 20-40% Nerve: 20-30%
54
What is an anatomical structure that we need to be conscious of with a posterior knee dislocation?
popliteal artery
55
What is a risk with posterolateral rotary dislocations?
nerve injury
56
What leads to meniscal conditions?
Compression, tensile forces, shearing forces when the femur rotates on a fixed tibia trap the posterior horns of both menisci Medial meniscus more common
57
What leads to longitudinal meniscal tears?
twisting motion when the foot is fixed, knee is flexed, produces compression and torsion on the posterior peripheral attachment
58
What is a bucket-handle tear of the meniscus?
entire longitudinal segment is displaced medially toward the center of the tibia, locking of knee
59
What leads to horizontal tears of the meniscus?
degeneration, affect posteromedial portion of the meniscus, with age  shearing forces from rotational motions tear the inner substance of the meniscus, locking/pain/instability
60
What is a parrot-beak meniscus tear?
two tears that occur in the middle segment of the lateral meniscus, leading to the characteristic shape of a parrot’s beak, history of previous trauma or cystic pathology
61
Why are meniscal conditions difficult to assess?
not innervated by nociceptors, medial meniscus border 10-30% direct blood supply and 10-25% of the lateral meniscus
62
What are clinical findings with meniscal conditions?
Cutting or rotational maneuver and experiencing sharp pain, pain and joint line tenderness, knee giving out or locking
63
What are diagnostic tests that indicate a meniscal condition?
Thessaly or McMurray test
64
What needs to be done to fix a bucket-handle tear?
excised surgically without removing the total meniscus, regeneration will not occur
65
What is an arthroscopic meniscectomy?
increases rotary stability, can lead to arthritis
66
What is patellofemoral pain syndrome?
pain at the patellofemoral joint without documented instability VMO weak or VL tight
67
Pain results from what in patellofemoral pain syndrome?
Pain results when a tense lateral retinaculum passes over the trochlear groove or when increased patellofemoral stresses are transferred from the articular cartilage to pain fibers in the subchondral
68
What are the S/S of PFPS?
S/S – dull, achy pain in the anterior knee made worse by squatting, sitting in a tight space with knee flexed, stairs, pain, crepitus
69
What is the management of PFPS?
Management – improve strength and flexibility, McConnell taping, recruiting VMO
70
What is chondromalacia patella?
True degeneration in the articular cartilage of the patella that results when compressive forces exceed the normal physical range or when alterations in the patellar excursion produce abnormal shear forces that damage the articular surface
71
What are the characteristics of articular cartilage of the patella?
no nerve endings, should not be considered as the true source of anterior knee pain
72
What are surgical findings with chondromalacia patella?
Surgical finding that represents areas of hyaline cartilage trauma or aberrant loading
73
What are the diagnostic signs that indicate chondromalacia patella?
positive clarke sign or waldron test
74
What are the 4 stages of chondromalacia patella?
4 stages Stage I – softening or blistering of the cartilage Stage II – reveals fissures in the cartilage Stage III - fibrillation of cartilage occurs causing crabmeat appearance Stage IV – cartilage defects with subchondral bone exposed
75
What is patellar instability?
patella has normal or abnormal alignment in the trochlear groove but is displaced by internal/external forces
76
What are clinical findings with congenital malalignment?
VMO dysplasia, vastus lateralis hypertrophy, high and lateral patellar posture, increased Q angle, bony deformity
77
What are S/S of congenital malalignment?
patella slipping during cutting, twisting, pivoting need immediate referral to physician
78
What is the patella plica?
patella plica shelf is a fold in the synovial lining that projects into the joint cavity
79
What kind of trauma causes patella plica syndrome?
direct blow to capsule becomes inflame and thickened from overuse
80
What are S/S of patella plica syndrome?
anterior knee pain, aggravated by quadriceps exercise, crepitus in medial/lateral retinaculum
81
What is patellar tendinitis (Jumper's knee)?
Patellar tendon becomes inflamed and tender from repetitive or eccentric knee extension activities From running and jumping sports
82
What are extrinsic factors leading to patellar tendinitis?
frequency of training, years of play, playing surface
83
What are intrinsic factors leading to patellar tendinitis?
leg length discrepancy, muscle imbalance
84
What are S/S of patellar tendinitis?
insidious onset, sharp/aching pain, present at the beginning and end of activity, tightness in h/s, quads, weakness in DF
85
What is osgood-schlatter disease?
Traction-type injury to the tibial apophysis where the patellar tendon attaches onto the tibial tubercle Girls 8-13 years, boys 10-15 years at beginning of growth spurt
86
What are S/S of osgood-schlatter disease?
pain at tibial tuberosity and enlarged/prominent
87
What is grade 1 osgood-schlatter disease?
Pain after activity that resolves within 24h
88
What is grade 2 osgood-schlatter disease?
pain during and after activity that does not hinder performance and resolves within 24h
89
What is grade 3 osgood-schlatter disease?
continuous pain that limits sport performance and daily activities
90
What is sinding-larsen-johansen disease?
Excessive strain occurs on the inferior patellar pole at the origin of the patellar tendon Children 8-13 years old Pain over inferior patellar pole, gradual onset, running, jumping
91
What is extensor tendon rupture?
Occurs at superior or inferior pole of the patella, tibial tuberosity or within patellar tendon itself Results from powerful eccentric muscle contraction or with severe ligamentous disruption Pain and weakness in knee extension Steroid use – predisposes Referral to physician Total ruptures = surgery
92
What is iliotibial friction syndrome and what are the S/S
Weight bearing increases compression and friction forces over the greater trochanter and lateral femoral condyle Friction between posterior edge of IT band and underlying femoral epicondyle S/S – pain over lateral aspect of the knee after activity especially running/stair climbing
93
What is osteochondritis dissecans?
Fragment of bone adjacent to the articular surface of a joint is deprived of its blood supply, leading to avascular necrosis Cartilage remains healthy

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