Chronic/Overuse Knee Injuries Flashcards

1
Q

What is ITB friction syndrome (ITBFS)?

A

Bursal inflammation at lat epicondyle of femur (usually pinpoint pain)

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2
Q

What tests are used for ITBFS?

A
  • Ober’s

- Palpation of lat epicondyle of femur (one finger test)

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3
Q

What are the support, protect, maintain treatment principles for ITBFS?

A
  • RICE
  • Modify training (stop, no hills)
  • Unload - correct mechanics (feet, tight/weak structures)
  • Cross train for CV system
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4
Q

What are the ‘regain’ treatment principles for ITBFS?

A

ROM: Stretch ITB/TFL complex within symptoms, DTM, roller may help

  • Control: Ensure pelvic tilt not excessive, correct foot posture as indicated
  • Strength: Esp glutes
  • Function: Graduated return to run, usually better 3-4 weeks
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5
Q

What should be considered if ITBFS is not better after 3-4 weeks?

A
  • Cortisone injection
  • SIJ contribution
  • Chondral, meniscal or maybe PFJ contributions
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6
Q

What are Bakers cysts?

A
  • Sign (not diagnosis) of intra-articular injury
  • Lump in popliteal fossa in posterior aspect of knee
  • Commonly with joint effusion
  • Common in children
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7
Q

What intra-articular injuries can be associated with Bakers cysts?

A
  • OA
  • Osteochondral lesion
  • Meniscus tear
  • ACL tear
  • Anywhere where swelling is evident
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8
Q

What should be considered if a Bakers cyst is calcified?

A
  • Sarcoma or haemangioma (NTBM)

- Tumour if cyst does not lie medial to lat gastric (NTBM)

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9
Q

What is Hoffa’s syndrome?

A
  • Intrapatella fat pad irritation

- Presents as anterior knee pain

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10
Q

What is the mechanism of injury for Hoffa’s syndrome?

A
  • Hyperextension, kicking, contusion, arthroscopy
  • Can occur from traumatic injury & become ongoing source of pain
  • Exacerbated by extension, e.g. prolonged standing, straight leg raise
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11
Q

How is Hoffa’s syndrome treated?

A
  • Rest (avoid direct contact & active hyperextension)
  • NSAIDs
  • Taping (V)
  • Usually recovers quickly
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12
Q

What is Osgood-Schlatter’s disease?

A

Apophysitis of tibial tuberosity

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13
Q

What are some of the common tendinopathies of the knee?

A
  • Inferior pole of patella
  • Midportion patella tendon
  • Quads tendon
  • Biceps femoris
  • Pes Anserinus (enthesiopathy)
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14
Q

What is plicas?

A
  • Embryonic remnant - fold of synovium

- Presents as anterior knee pain

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15
Q

What is the treatment for plicas?

A
  • Settle inflammation

- Surgical excision if persistent

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16
Q

What is patellofemoral syndrome (PFS)?

A
  • Maltracking of patella
  • Syndrome may include some or all components:
  • Chondromalacia patella
  • Excessive lateral pressure
  • VMO weakness/timing
  • Biomechanical issues - increased Q angle, overpronation
  • ITB tightness
  • TFL overuse
  • Weak glutes
  • Overweight, adolescent female
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17
Q

What are the treatments for PFS?

A
  • Soft tissue therapy: ITB/TFL release
  • Joint mobilisation medially
  • McConnell taping
  • Strengthening: VMO retraining, glutes strengthening
  • Orthotics (for excessive pronation)
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18
Q

What is a common surgery for chondral defects in the knee?

A

OATS - osteochondral allograft transplant surgery (aka mosaicplasty)
- Take plugs from non-WB portions of femur and insert into WB area

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19
Q

What is a new/developing surgery for chondral defects in the knee?

A

Autologous chondrocyte transfer

  • Stem cells/stabilised chondrocytes harvested & cultured
  • Implanted under protective barrier
  • Immobilised to permit establishment of cells
  • Cells grow new hyaline cartilage
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20
Q

What are the support, protect, maintain treatment principles for chondral injury?

A
  • Treat symptomatically esp joint effusion
  • Protect from further injury
  • Maintain healthy cartilage, muscle bulk & strength with low joint compression
21
Q

What are the ‘regain’ treatment principles for chondral injury?

A
  • ROM: Usually OKC to begin or low joint compression, avoid sustained holds
  • Control: Protect joint by teaching dynamic motor control/stability (cocontraction)
  • Strength: As required by muscle testing
  • Function: Re-training, evidence suggests high muscle loads, low joint loads
22
Q

What are the characteristics of patellofemoral pain?

A
  • Insidious or secondary to another knee injury/trauma
  • Diffuse ache, agg by loaded activities, prolonged sitting
  • History of recurrent crepitus
23
Q

What’s is patella tendinopathy also known as?

A

Jumper’s knee

24
Q

What are the clinical features of patella tendinopathy?

A
  • Anterior knee pain
  • Agg by jumping, changing direction, deceleration
  • Tenderness on palpation
  • Thickening of the tendon
25
What is the most common site of patella tendinopathy?
Deep attachment of the tendon to the inferior pole of the patella
26
How should a patella tendinopathy be examined?
- Palpation - Reproduce pain with functional tests, e.g. squats, hopping - Assess lower limb strength - Ultrasound/MRI
27
What is the treatment for patella tendinopathy?
- Load reduction (reduce training hours, amount of jumping/sprinting) - Correct biomechanics (landing technique) - Soft tissue therapy (hamstrings, quads, calf) - Strength/motor control exercises (glutes, quads, calf)
28
What is the mechanism of Osgood-Schlatter's disease?
- Excessive traction on soft apophysis of tibia tuberosity by patellar tendon - High levels of activity during rapid period of growth
29
What is the mechanism of quads tendinopathy?
- Common in older sports people | - Weightlifters - tendon loaded in deeper squat
30
Which bursa is most commonly affected by bursitis?
Pre-patellar bursa
31
What is the treatment for bursitis?
- NSAIDs | - Aspiration/infiltration (more severe)
32
What is Sinding-Larsen-Johansson syndrome?
- Lesion on the inferior pole of patella at attachment of patella tendon - Less common than Osgood-Schlatters (managed the same)
33
What is a discoid lateral meniscus?
- Disc-shaped anatomical abnormality reported in children | - Can present as chronic snapping knee syndrome
34
What are the clinical features of a degenerative lateral meniscus?
- Gradual onset of lateral knee pain - Quads atrophy - Painful/non-painful lump at lateral joint line
35
What are the risk factors of knee OA?
- Meniscal injury - Knee malalignment - Obesity - Sports participation (wrestling, weight lifting, soccer, football) - Previous knee injury - Genetic predisposition
36
What is excessive lateral pressure syndrome?
- Excessive pressure on lateral patellofemoral joint - Due to tight lateral retinaculum - Affects joint capsule, PF joint, ITB & quads
37
What can excessive lateral pressure syndrome lead to?
- Vertical stress fracture | - Separation of lateral patellar fragment
38
What is the treatment for excessive lateral pressure syndrome?
- PF mobilisation - Soft tissue therapy on retinaculum - Surgical release of retinaculum
39
What is the mechanism of biceps femoris tendinopathy?
- Excessive acceleration & deceleration | - Ass. with running & cycling
40
What are the clinical features of biceps femoris tendinopathy?
- P/L pain - Settles after activity - Morning stiffness - Pain with palpation & resisted flexion esp eccentric - Tightness of hamstrings & glutes
41
What muscles need to be strengthened in treatment of biceps femoris tendinopathy?
- Eccentric strengthening of hamstrings | - Gluteus maximus
42
What needs to be ruled out of a superior tib/fib joint dislocation?
- Peroneal nerve injury - Popliteus tendon injury - Posterolateral corner injury - PCL injury
43
What are the clinical features of a superior tib/fib joint dislocation?
- Prominent fibula head - Lateral knee pain - Swelling around joint - Popping/clicking - Agg by ankle movements & WB
44
How are superior tib/fib joint dislocations managed?
- Immobilisation 2-3/52 | - Strengthening of hamstrings & calfs
45
What are the characteristics of medial meniscus abnormality/degeneration?
- Patient generally sport person over 35 yrs - Clicking & pain with twisting activities - Joint line tenderness, positive McMurray's
46
What is the pes anserinus?
Combined tendinous insertion of sartorial, gracilis & semitendinosus onto tibia
47
What are the mechanisms of pes anserinus tendinopathy?
- Uncommon - Swimmers (particularly breaststroke) - Cyclists - Runners
48
What is the mechanism of gastroc tendinopathy?
- Medial gastroc at posterior femoral condyle | - Excessive hill running/rapid increase in distance