Knee 1 Flashcards
knee pain lifetime prevelence
45%
Red flags for lower extremity injuries
- Ottawa ankle rules
- Ottawa knee rules
- dislocation of tibiofemoral jt
- legg calves perth, slipped capital, congenital dysplasia
Ottawa knee rules
- > 55
- knee flex <90
- Tenderness patella/fib head
- inability to walk 4 steps
What forces does the med and lat meniscus withstand
med- compressive
lat- torsional forces
What part of the menisci are typically pain generators an what lig can be a pain generator
post parts of menisci more vulnerable to injury coronary lig (attach menisci to post tin plates) is innervated and can be pain generator
2 biomechanics knee movements
rocking- first 15-18
gliding- 15-135
What is the screwhome mechanism of the knee when non weight bearing and weight bearing
non- upon ext of knee, tibia rotates ext relative to femur
weight- upon ext of knee, femur rots int relative to tib
How do the menisci move during flexion
move post during flexion of knee
Ratio of med to lat menisci injuries
5:1
What injuries are the lat meniscus more associated with
Discoid meniscus
meniscal cyst
MOI for meniscal injury (3)
compression
torsional
combo of compression/torsional force
What type of meniscus tear causes inability to fully extend especially during walking
Bucket handle tear
Symptoms of meniscal injury
- hx of trauma (knee twisting)
- severe pain acutely
- pain localized to jt line (mc)
Signs of meniscal injury
- effusion (capsular)
- Decreased ROM (flex/ext- ext lag)
- may not be able to fully weight bear
What combo of tests should be used for meniscus injury
Mcmurrays, JLT and apleys
what is the gold standard imaging for meniscal lesions
mri
what is the prognosis of partial and total meniscectomy
partial- good prognosis
total- increased incedence of oa
mc and 2nd mc moi for acl injury in contact sports
- clipping- valgus loaf and ext rot of tibia
2. Hyperextension
3 common moi for acl injury in non contact sport
- skiing injury (digging tip)- ext rot + valgus
- deceleration injury- ant force on prox tibia due to quad contraction
- hyperextension
symptoms of ACL tear and what does 75% of cases show
- loud snap/pop
- immediate onset of pain (or no pain?)
- 75% of cases w hemarthrosis
signs of ACL tear
- unable to weight bear
- large knee effusion
- decreased ROM
- ACL tests +
what is the 3 degrees of ACL tear
grade I- ant translation of tibia up to 5mm
grade II- ant translation of tibia up to 5-1cm
grade III- ant translation >1cm
conservative tx of grade 1/2 acl tears
-rest/ice
-pain modalities
-ultrasound
-mobs
-bracing
3-6 weeks active rehab
prognoisis of acl rehab (time line as well)
- good to fair
- 5-8 months if they require surgery
What gender is more susceptible to acl injuries and what are the intrinsic reasons for it
intrinsic- Smaller intercondylar notches, loose jointedness, effect of horomones on ligamentous tissue (no apparent relation between q angle and ACL injury)
Cyclops lesion and sign for it
complication of acl reconstruction
-rounded fibrous mass sitting in the ant intercondylar notch
sign- may have extension lag
What is a segond fx and what is it associated w
avulsion fx of the knee which involves the lat aspect of tibial plateau
(associated w ant cruciate lig disruption)
MOi, hx, signsof PCL tear
moi- post force on prox tibia
vague symptoms but often present with patellofemoral symptoms
MILD swelling, nearly full rom
Non operative vs operative PCL
non- treatment success 85% for grade 1/2
opperative- early PCL reconstruction surgeries yield best results
What do you need to rule out in mcl/lcl lesions
xray to rule out fx and pellegrini sited lesion
All 3 grades of mcl injury require what type of treatment
non operative**
rice, knee brace, electrotherapy, rom ex, strengthening, closed chain ex
treatment of LCL injuries
grade 1/2- non operative (rice, knee brace, ex etc)
Grade 3- Operative
