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MSK 2 > Knee > Flashcards

Knee Flashcards

1
Q

MOI for patella fracture

A
  • fall onto anterior knee

- sudden quad activation - usually as the knee is flexing

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2
Q

Symptoms and physical exam of patella fracture

A

Symptoms

  • painful/inability to extend knee
  • anterior knee pain

Physical examination

  • palpable gap at fx site
  • local tenderness
  • painful MMT > AROM knee extension
  • painful end range flexion ROM
  • antalgic gait
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3
Q

What are signs of antalgic gait?

A
  • diminished stance time
  • lift off pattern/flat foot instead of toe off
  • decreased knee extension during gait
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4
Q

______ tendon ruptures are common for < 40 y/o

A

patella

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5
Q

_______ tendon rupture common with > 40 y/o

A

quad

- males 4-8x more likely

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6
Q

MOI of quad and patellar tendon

A
  • eccentric overload extensor trauma
  • force of quad while the knee is flexing. ex: landing from a jump

quad - commonly related to regaining balance/ rapid quad contraction
patellar - jump landing common

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7
Q

Symptoms and physical exam of patella and quad tendon rupture

A

Symptoms
- anterior knee pain

Physical Exam

  • absent AROM knee extension vs painful AROM knee extension
  • painful knee flexion
  • palpable defect
  • antalgic gait vs unable to ambulate
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8
Q

What is Osgood Schlatter disease? Who is common to get this?

A
  • apophysitis (calcification) of tibial tubercle
  • adolescent athlete - repetitive loading of knee into flexion
  • male - 10-15 y/o
  • female - 8-13 y/o
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9
Q

Symptoms and physical exam of Osgood Schlatter

A

Symptoms

  • anterior knee pain
  • aggravated w/ activity or resisted knee extension

Physical Exam

  • local TTP
  • prominent tibial tubercle
  • pain at end range knee flexion
  • painful MMT w/ knee extension > AROM
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10
Q

What is the most common site of osteochondritis dissecans?

A

lateral aspect of medial condyle

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11
Q

Who is common to get osteochondritis dissecans?

A
  • males > females
  • greatest 10-20 y/o
  • active individuals
  • common bilateral
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12
Q

MOI of osteochondritis dissecans. What else occurs?

A
  • traumatic MOI most common

- hemarthrosis - blood in the joint within 2 hours if traumatic

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13
Q

Symptoms of osteochondritis dissecans

A

Symptoms

  • non-specific knee pain
  • aggravated w/ activity and improves w/ rest
  • stiffness/swelling w/ activities
  • grinding, locking, catching
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14
Q

Physical Exam findings of osteochondritis dissecans

A
  • TTP femoral condyle/medial and lateral joint lines
  • antalgic gait
  • knee effusion - multidirectional ROM loss
  • limited/painful knee ROM (flexion/extension)
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15
Q

Symptoms and physical exam of meniscus lesion

A

Symptoms

  • catching, locking, giving way at the knee
  • local knee pain

Physical Exam

  • pain at end range knee extension
  • pain/limited flexion ROM
  • painful/weak flexion and extension resistive testing
  • joint line tenderness
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16
Q

Why should you check history of an older patient who has gradual onset of knee pain?

A

Knee OA incidence is high following ACL injury

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17
Q

Physical exam findings of ACL lesions

A
  • weight shifted posture
  • knee joint effusion
  • antalgic gait
  • A/PROM painful/limited all planes
  • Boggy/guarded endfeel
  • weak MMT and painful in all planes
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18
Q

Physical exam findings of PCL sprain

A
  • limited knee extension in stance phase
  • knee effusion
  • limited/painful knee extension and flexion ROM
  • pain w/ resistive testing of extension > 90 deg
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19
Q

What is one clinical correlation of ACL tears that can be looked at in the clinic?

A

quad-hamstring ratio

- decreased hamstring or core strength

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20
Q

Symptoms of PCL injury

A
  • local posterior knee pain aggravated w/ deceleration and kneeling
  • feelings of LE giving way/instability
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21
Q

Common MOI for MCL sprain. Who most commonly get MCL injury?

A
  • valgus force to knee
  • rotary trauma - quick directional change

younger males are most commonly injuried

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22
Q

MCL injury symptoms and physcial exam

A

Symptoms

  • medial knee pain
  • aggravated w/ activity, change in direction, valgus force at knee

Physical exam

  • swelling/bruising and local TTP
  • antalgic gait
  • limited/painful A/PROM
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23
Q

Symptoms and physical exam of LCL sprain

A

Symptoms

  • lateral knee pain
  • aggravated w/ directional change during ambulation

Physical Exam

  • local lateral knee effusion and TTP
  • guarded/boggy end-feel w/ end range ROM flexion/extension
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24
Q

What predisposes someone to patellofemoral instability?

A
  • small patella, shallow groove for patella
  • lateral tilt and lateral displacement toward extension (30 deg)
  • patella alta/baja
  • quad muscle imbalance
  • generalized ligamentous laxity
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25
Q

There is a high occurrence for what after patellar dislocation?

A

condyle articular cartilage injury

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26
Q

Symptoms and Physical exam of patellofemoral instability

A

Symptoms

  • giving way of LE (reflex inhibition)
  • peri-patella pain

Physical Exam

  • peripatellar tenderness
  • hypermobility of patellofemoral
  • apprehension sign
  • swelling
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27
Q

Clinical correlations to patellofemoral pain syndrome

A
  • quad weakness/muscle imbalance
  • lateral retinaculum tightness (genuvalgum)
  • increased Q angle
  • hip abduction/ER weakness
  • altered foot/ankle kinematics
  • increased femoral angle of inclination
  • increased anteversion
  • limited hip extensor endurance
  • subtalar pronation (IR of tibia)
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28
Q

History of PFPS

A
  • athletes
  • female gender
  • insidious onset
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29
Q

Symptoms of PFPS

A
  • anterior knee pain
  • aggravated w/ sitting, stair ambulation, inclined walking, squatting
  • knee crepitus
  • catching of the knee (degeneration of underside of patella)
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30
Q

Physical Exam of PFPS

A
  • patella alta/baja
  • abnormal Q angle
  • painful squat
  • swelling
  • painful/limited knee flexion/extension
  • painful/weak knee extension
  • Hip ER/Abduction weakness
  • painful/hyper PF joint mobility testing
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31
Q

Symptoms and Physical Exam of knee OA

A

Symptoms

  • retropatellar pain
  • aggravated by w/b activities, squatting, stairs, prolonged sitting
  • Crepitus

Physical Exam

  • antalgic gait
  • swelling and TTP joint lines
  • painful/limited knee ROM
  • painful/limited knee resistive testing
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32
Q

Arthrofibrosis history

A
  • traumatic injury

- progressive increase in pain and knee ROM limitatins

33
Q

Symptoms and physical exam of Arthrofibrosis

A

Symptoms

  • stiffness (worse in morning)
  • knee swelling
  • crepitus
  • diffuse knee pain

Physical Exam

  • limited knee extension during stance
  • limited/painful knee ROM
  • firm end feel w/ PROM
  • hypomobile knee and patella joint
  • swelling
  • weak/painful knee extension
34
Q

How much hyperextension is genu recurvatum? Where is the stress placed?

A

> 10 degrees

  • excessive stress on posterior knee structures
35
Q

What does genu recurvatum predispose someone to?

A
  • ACL injury
  • compressive injury anteriomedial tibiofemoral joint
  • tensile loading posterolateral joint supporters
  • posterior corner capsulo-ligamentous avulsion injuries
36
Q

What should be checked in a patient w/ genu recurvatum?

A

distal pulses for nerve or vascular compression

37
Q

What is jumper’s knee?

A

patella tendinopathy

38
Q

Symptoms and physical exam of patella tendinopathy

A

Symptoms

  • anterior knee pain
  • aggravated w/ jumping/extensor mechanism

Physical Exam

  • TTP patellar tendon
  • painful squat
  • pain at end range flexion
  • pain during knee extension MMT
39
Q

In what knee position will someone w/ IT band friction likely have issues?

A

30 deg of knee flexion

40
Q

Correlations of IT band friction syndrome

A
  • prominent femoral epicondyle

- leg length discrepancy

41
Q

history of IT band friction syndrome

A
  • long distance runners
  • downhill skiers, jumping spots, weight lifters, cycling
  • insidious/progressive onset
42
Q

Symptoms and physical exam of IT band friction syndrome

A

Symptoms

  • lateral knee pain
  • aggravated w/ activity/ repetitive knee flexion/extension and stairs

Physcial Exam

  • local TTP
    • Ober’s test
  • hip ROM painful end range ADDuction
  • potentially painful hip abduction MMT
43
Q

When should plica syndrome be considered?

A

after all other diagnoses have been ruled out

44
Q

Baker’s cyst physical exam

A
  • local swelling proximal to popliteal fossa
  • pain knee flexion/extension ROM
  • prominence of cyst increases w/ resisted knee flexion
45
Q

Superficial fibular nerve potential areas of compression

A

trauma posteriolateral knee, compartment syndrome

- dog hit side of knee or tackle to outside of knee

46
Q

motor distribution of superficial fibular nerve

A

Weakness w/ eversion

- fibularis longus and brevis

47
Q

Sensory distribution of superficial fibular nerve

A

distal 2/3 lateral leg/ankle/dorsal foot

48
Q

joint line tendernes indicates what?

A

meniscus lesion

49
Q

Thessaly test

A
  • test to rule out meniscus lesion

- standing on 1 leg and pivot at full extension and 30 deg flexion

50
Q

Dynamic test

A
  • lateral meniscus lesion

- figure 4 position and PROM to adduction and IR of hip

51
Q

Mcmurray’s test

A
  • meniscus lesion

- Flex knee then apply ER rotation while palpating joint line and extend, then again with IR rotation

52
Q

Appley’s test

A
  • meniscus lesion
  • pt in prone, flex knee to 90 and compress and rotate. Then distract and rotate
    • if more pain w/ compression and distraction alleviates pain
53
Q

What is the gold standard for confirming ACL tears? What position is the knee in?

A

Lachman’s test

- knee flexed 15 degrees

54
Q

What is the anterior and posterior drawer testing? What is the position of the knee

A
  • anterior drawer - ACL integrity
  • posterior drawer - PCL integrity
  • knee in 90 deg flexion in hook lying and therapist sitting on feet
55
Q

Pivot shift test

A
  • ACL integrity, rotary stability

- listening for audible pop of tibia relocating onto femoral condyle due to no ACL stopping the motion

56
Q

Clarke’s sign

A
  • Patellofemoral pain syndrome

- patient in full knee extension and pressure provided to quad tendon as patient contracts

57
Q

Pittsburgh Knee Decision Rule

A

1) Pt Hx blunt trauma or fall
2) Inability to bear weight x 4 steps
3) age < 12 or > 50

Criterion 1 or Criterion 1 + 2 or 3 - refer for imaging

58
Q

Ottawa Knee Decision Rule

A

1) TTP head of fibula
2) inability to bear weight x 4 steps
3) age > 55
- inability to flex knee 90 deg
- isolated TTP of patella

Any observed - refer for imaging

59
Q

Arthroscopic lavage and debridement

  • want full extension ROM by week ____
  • want full flexion ROM by week ____
A

full extension ROM by week 1

full flexion ROM by week 3

60
Q

how long should you avoid loading of microfracture lesion?

A

~ 6-12 weeks

61
Q

How long is the protection phase after a meniscus repair?

A

~ 6 weeks

62
Q

What is the gold standard for ACL reconstruction?

A

double-bundle semitendinosus and gracilis autograft

63
Q

immediate post-op ACL phase

- weeks, ROM, muscles/exercises

A
  • week 1
  • knee A/PROM 0-90 deg
  • active quad contraction
64
Q

early post-op phase ACL

- weeks, ROM, muscles/exercises

A
  • week 2
  • knee flexion > 110 deg, full kne extension during gait
  • no extension lag w/ SLR
  • stair climb and cycling
65
Q

When can you start tibiofemoral mobs after ACL reconstruction?

A

around week 3

66
Q

Intermediate post-op ACL

- weeks, ROM, muscles/exercises

A
  • weeks 3-5
  • knee flexion ROM within 10 deg of nonaffected LE
  • quad strength 60% of nonaffected LE
  • closed chain exercises, step up and squats
67
Q

late phase-op phase ACL

- weeks, ROM, muscles/exercises

A
  • weeks 6-8
  • full knee ROM
  • quad strength > 80% of nonaffected LE
  • normal gait
68
Q

transitional phase ACL

- weeks, ROM, muscles/exercises

A
  • weeks 9-12
  • full knee ROM
  • maintain/improve quad strength
  • hop test > 85% of nonaffected side (wk 12)
69
Q

patella and quad tendon rupture repair first 3 weeks

A

protection, pain/inflammatory management

70
Q

patella and quad tendon rupture repair weeks 3-6

A
  • light loading
  • ROM 0-45
  • active knee flexion to 45 deg
  • gait w/ AD
  • hip muscle performance
71
Q

patella and quad tendon rupture repair weeks 7-12

A
  • progression of loading to full w/b
  • hinge commonly locked 0-60 flexion
  • progressive CKC
  • knee extensor activation/coordination
72
Q

patella and quad tendon rupture repair weeks 9-12

A
  • single leg CKC exercises

- increase tensile loading - max knee extension activation

73
Q

What is the TKA gold standard?

A

medial parapatellar (paramedian)

74
Q

Medial parapatellar (paramedian) TKA Advantages and Disadvantages

A

Advantages

  • great exposure for the surgeon
  • optimal for alignment

Disadvantages
- compromises quad muscle tendon (quad weakness)

75
Q

Subvastus TKA Advantages and Disadvantages

A

Advantages

  • spares quad
  • better post-op flexion
  • less pain and higher pt satisfaction
  • better patella tracking
  • faster ADL recovery

Disadvantages
- more technically complicated

76
Q

Midvastus TKA Advantages and Disadvantages

A

Advantages
- minimizes quad trauma

Disadvantages

  • disrupts VMO
  • no evidence to suggest any better outcomes than paramedian
77
Q

Lateral TKA Advantages and Disadvantages

A

Advantages

  • great exposure to structures that may be released
  • allows for correction of malalignment

Disadvantages

  • less medial visualization
  • more technically complicated
78
Q

Minimally invasive TKA Advantages and Disadvantages

A

Advantages

  • avoids quad trauma
  • avoids patellar disruption

Disadvantages
- a greater technical challenge

MSK 2 (8 decks)

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