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MSK II > Final Exam Review > Flashcards

Final Exam Review Flashcards

1
Q

what is special about the medial condyle of the femur

A

it is larger, and extends further distally, so it helps with the screw home mechanism

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2
Q

describe the differences between the medial and lateral condyle or plateau about the tibia.

A

the lateral is circular, and the medial is oval and long, and has 3x thicker cartilage

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3
Q

what type of joint is the knee joint

A

hinge

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4
Q

what three joints make up the knee

A

the patellafemoral, tibiofemoral and the tibiofibular.

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5
Q

what kind of joint is the tibiofemoral joint, and what motions does it allow for

A

it is a double condyloid, and it accounts for flexion and extension, and rotation, but no frontal plane movement.

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6
Q

the tibial articular surface/plateau slopes

A

posterioinferiorly

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7
Q

which side absorbs more force and why

A

the medial, and that is because it is thicker and bigger

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8
Q

what are the functions of the meniscus

A

stability, decrease friction, increase contact area, and proprioception. it also attenuates force.

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9
Q

which meniscus is c shaped, and what are its properties

A

the medial, and it is thicker posteriorly

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10
Q

is the MCL and LCL attached to the meniscus

A

only the MCL

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11
Q

what happens in terms of load with a meniscectomy

A

2x more load on the femur, and 6-7x more on the tibial condyle. then it also decreases shock absorption

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12
Q

how are the menisci vascularized

A

as we age, the vascularity decreases. blood will flow from the capsule and synovial membrane.

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13
Q

what are the zones of the menisci

A

red-red: most lateral, and most vascularized, and then good healing
red-white: some vascularization
white-white: inner, no vascularity or healing

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14
Q

the MCL and LCL are taut in

A

extension

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15
Q

theACL attaches where

A

posterior on the lateral femoral condyles.

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16
Q

what are the three bundles of the ACL and where are they lax and taut in

A
  • the anteriomedial (lax in extension, and taut in flexion)
  • posterolateral (lax in flexion and taut in extension)
  • intermediate
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17
Q

the ACL works with ___ to prevent valgus

A

the MCL

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18
Q

the PCL is the strongest in the body (true or false?)

A

true

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19
Q

genu valgum

A

TF angle less than 165. increased lateral forces (lateral meniscus tear)

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20
Q

genu varum

A

TF angle above 180 (bow leg). increased medial compressive forces, and medial meniscus tear

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21
Q

where is the Q angle measured from

A

the ASIS to the mid patella then down to the tibial tuberosity

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22
Q

Q angles in males and females

A

males: 10-14
females: 15-17

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23
Q

knee flexion is _____ WNL and extension is ___

A

130-140

5-10 hyperextension

24
Q

genu recurvatum

A

excessive hyperextension

25
Q

what is the screw home mechanism

A

the last 5 degrees of extension when the tibia laterally rotates, or the femur IR. the medial condyle is bigger, so it has to continue to move on the femur.

26
Q

describe what happens wth flexion and unlocking CKC and OKC

A

CKC the femur will move on the tibia, so there will be lateral rotation of the femur
OKC tibia MR on the femur

27
Q

what does the popliteus do with open and closed kinetic chain knee flexion

A

it will ER the femur with CKC and MR tibia with OKC

28
Q

which facet of the patella bears the most force

A

the middle facet

29
Q

what is the posterior surface of the patella made of

A

hyaline cartilage

30
Q

when is the first consistent Patellafemoral contact

A

10-20 degrees knee flexion

31
Q

what happens to patellafemoral contact by 90 degrees

A

all facets are in contact except for the odd facet

32
Q

at 135 degrees, what is the contact of the patellafemoral joint

A

the odd and lateral facets

33
Q

where is the greatest patellafemoral joint compression

A

90 degrees knee flexion

34
Q

what happens to patellafemoral contact with full quad extension

A

there is little PF contact. This is why quad sets are so safe

35
Q

what is the PF forces like at foot strike with knee in 10-15 degrees flexion, 60 knee flexion and 130 knee flexion

A

at knee 10-15, 50% BW
60 degrees knee flexion 3.3x BW
130 7.8x BW

36
Q

what provides stability to the PF joint

A

the transverse are the VL and VM, the medial and lateral retinaculum, and the MPFL. then the quads and patella tendon. ITB too

37
Q

what is the most common meniscal tear

A

the longitudinal, then bucket handle

38
Q

what is the MOI of a meniscus tear

A

twisting

39
Q

what is a meniscus tear S and S

A 
pain with movement and better with rest
locking
joint line tenderness
acute effusion 
sudden onset less 40 years old
chronic, no MOI over 50
40
Q

what kind of meniscus tear has locking

A

bucket handle

41
Q

what kinds of things give you a good prognosis for a meniscus tear

A

age less than 35, peripheral damage, longitudinal tear, short, acute injury, stable knee

42
Q

bad prognosis of meniscus tear

A

older, central damage, complete tear, bucket handle, chronic and unstable.

43
Q

what are some findings associated with a meniscus injury

A

joint line tenderness, effusion, (+) McMurrays, Apley’s, Squat. quad inhibition (can’t fully /)

44
Q

is there a difference between surgery and PT for meniscus tear

A

no, try PT first

45
Q

what are the three ways to manage a meniscus tear

A 
the debridement (good RTF/ADL, restore gait, decrease swelling)
repair (traumatic in vascular zone, and longer than 8mm)
transplant: cadaver, this is not very common
46
Q

what are the goals with a menisci tear

A

to know the surgery, cadaver, graft type, rest, WB status, don’t push ROM, restore gait, function and strength and proprioception

47
Q

what are some characteristics of articular cartilage damage

A

palpation, malalignment, painful crepitis, catching, locking and grinding, quad atrophy, weather changes, pain and a deep dull ache

48
Q

what are the four surgical management techniques for the articular cartilage damage

A
  • debridement/lavage: clean it up, no function restored, little difference in improvement of pain
  • microfracture: pick holes and induce blood flow, replaced with fibrocartilage, and WB controlled. Good for sedentary people
  • ACI (autologous chondrocyte implant): 2 parts, one you need to harvest some cartilage, and digest it with enzymes, then you release chondrocytes, and then you implant them with a periosteal flap
  • Osteochondral autograft transplantation system (OATS): full thickness defect, remove a plug of bone from a NWB surface, and fit the plug into the lesion, like a mosaic.
49
Q

what are some rehab principles of articular cartilage surgeries

A

know the procedure and the WB status, and PROM like a CPM 24/7, then you want slow and progressive, and you hardly return to sport, ADL is the focus.

50
Q

what is the pain generator in knee OA. What structure causes pain

A

the articular cartilage, hyaline. it usually bears and distributes forces and friction between surfaces/

51
Q

what are risk factors of knee OA:

A
  • genetics (bone, chondrocytes and function)
  • BMD: higher= more OA (obesity)
  • occupation: squatting, lifting heavy and kneeling.
  • physical activity: no evidence that increased activity increases risk
  • age (Increase, increase risk)
  • sex (70/30 female to male)
  • obesity: increase in incidence and progression
  • previous knee injury (ACL or meniscus)
  • knee alignment: varum and valgum on medial and lateral compartments.
52
Q

if you have a leg length discrepancy, you are ___ more likely to have OA

A

2X

53
Q

what are we looking for on imaging related to knee OA

A

osteophytes, joint space narrowing, sclerotic changes in subchondral bone.

54
Q

what are the grades of knee OA

A

0: normal
1: minute osteophyte formation
2: definite osteophyte with unimpaired space
3: same with mod narrowing
4: same with severe narrowing, and sclerosis and flat plateau

55
Q

what are the ARC criteria for knee OA with and without radiograph

A

clinic and radiograph: knee pain and 1/3 of wither age over 50, stiff in morning less 30 min, crepitis and osteophytes
just clinic: knee pain and 3/6: age over 50 morning stiff, crepitis, tenderness, bony enlargement, no palpable warmth

56
Q

what are some sources of knee OA

A

not articular cartilage, because it is not innervated. more like synovium, bone, and nerves.

MSK II (2 decks)

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