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OCS Prep > Knee > Flashcards

Knee Flashcards

1
Q

medial collateral ligament

A

-resists valgus stress
- gr II, III typically involve meniscus

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2
Q

lateral collateral ligament

A
  • resists varus stress
  • stronger than MCL
  • taut from 0-30 degrees
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3
Q

ACL

A
  • restraint for anterior translation of tibia on femur
    -attachments with ant-medial horn of meniscus
  • anterior-media bundle: most taut in flexion
  • posterior-lateral bundle: most taut in extension
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4
Q

PCL

A
  • anterior lateral bundle: most taught in flexion
  • posterior medial bundle: most taut in extension
  • main restraint of posterior tibial translation or anterior femoral translation
  • also limits femoral external rotation or tibial internal rotation
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5
Q

collateral ligament injury s/sx

A
  • varus/valgus trauma
  • varus/valgus stress testing will be positive (MCL may be associated with ACL and meniscal symptoms)
  • swelling, ecchymosis
  • joint effusion if meniscal involved
  • tenderness to palpation of ligament
  • difficulty with pivoting and cutting
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6
Q

MCL exam

A
  • valgus stress test
  • knee flexed to 20-30, + if laxity or pain, SN of .86
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7
Q

LCL exam

A
  • varus stress test, + is presence of laxity or pain
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8
Q

ACL s/sx

A
  • severe pain with joint effusion
  • popping, giving way, buckling
  • continued effusion
  • quad inhibition
  • limited ROM
  • flexed knee gait
  • 80% non-contact injury
  • contact- 20%
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9
Q

ACL exam

A
  • gold standard is lachmans
    — thought to test more of posterior bundle
  • anterior drawer test
    — thought to test more anterior bundle
  • pivot shift test
    — highly specific
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10
Q

PCL s/sx

A
  • posterior knee pain
  • not as much effusion
  • flexion beyond 90 may increase pain
  • difficulty squatting, descending stairs, running
  • not as much problem with quad inhibition
    • sag sign (100 SP), + posterior drawer, reduced palpation of tibial plateau step up

MOI
- hyperflexion
- fall on flexed knee with foot in plantarflexion
- step in pot hole
- dashboard injury

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10
Q

PCL s/sx

A
  • posterior knee pain
  • not as much effusion
  • flexion beyond 90 may increase pain
  • difficulty squatting, descending stairs, running
  • not as much problem with quad inhibition
    • sag sign (100 SP), + posterior drawer, reduced palpation of tibial plateau step up

MOI
- hyperflexion
- fall on flexed knee with foot in plantarflexion
- step in pot hole
- dashboard injury

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11
Q

Knee pain and mobility impairments CPG recommended physical performance measure

A

LVL C- single legged hop tests, that can identify patient’s baseline status relative to pain, function, side to side asymmetries, test return to sport

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12
Q

Knee pain and mobility impairments CPG recommended physical impairment measures

A

Level B- meniscus
- modified stroke test
- knee AROM
- max isometric quad strength
- forced hyper extension
- knee PROM
- McMurray’s
- joint-line tenderness

Level D- articular cartilage
- modified stroke test
- knee AROM
- max quad strength
- joint line tenderness

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13
Q

Knee pain and mobility impairments CPG recommendation for progressive knee motion

A

Level B: early progressive active and passive knee motion following surgery for both meniscus and articular cartilage

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14
Q

Knee pain and mobility impairments CPG recommendation for progressive weightbearing

A

Level C: meniscus, early progressive weightbearing
Level B: stepwise progression of weightbearing to full bearing by 6-8 weeks after MACI for articular cartilage lesion

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15
Q

Knee pain and mobility impairments CPG recommendation for progressive return to activity

A

Level C: may utilize progressive return to activity following meniscal repair
Level E: may need to delay return to activity depending on type of articular cartilage surgery

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16
Q

diagnosis of patellafemoral pain

A
  • presence of retropatellar or peripatelllar pain (LVL A)
  • reproduction of pain with squatting, stairs, prolonged sitting, or other functional activities that load the PFJ in a flexed position (LVL A)
  • exclusion of all other conditions (LVL B)
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17
Q

PFP categories

A
  • overuse/overload without other impairment
  • muscle performance deficits
  • movement coordination deficits
  • mobility impairments
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18
Q

Overuse/overload without other impairment PFP

A
  • pain primarily due to overuse/overload
  • patient presents with history suggesting an increase in magnitude or frequency of PFJ loading at a rate that surpasses the ability of his tissues to recover
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19
Q

muscle performance deficits PFP

A
  • may respond favorably to hip and knee resistance exercises
  • patient presents with lower extremity muscle performance deficits in hip and quad
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20
Q

Movement coordination deficits PFP

A
  • may respond favorably to gait training and movement re-education interventions leading to improvements in kinematics and pain
  • patient presents with with excessive or poorly controlled knee valgus during a dynamic task, but not due to weakness
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21
Q

Mobility impairments PFP

A
  • hypermobile or hypomobile structures
  • higher than normal foot mobility or flexibility deficits of 1 or more of the following (hamstrings, quad, GS complex, lateral retinaculum, ITB
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22
Q

Meniscus hx and MOI

A
  • twisting injury
  • pain worse with movement, better with rest
  • may complain of locking
  • joint line tenderness
  • acute effusion (within 2 hours)
  • acute: sudden onset in people <40
  • chronic: no specific MOI in people >50
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23
Q

good prognosis for meniscus

A
  • age <35
  • peripheral damage
  • longitudinal tear
  • short tear
  • acute injury
  • stable knee
24
Q

poor prognosis for meniscus

A
  • older patient
  • central damage
  • complete tear
  • bucket handle tear
  • chronic injury
  • unstable knee
25
Q

meniscus hallmark findings

A
  • joint line tenderness: good SN
  • effusion: mild to mod over 1-2 days
  • positive entrapment test: mcMurray’s, apley’s, squat
  • quad inhibition: atrophy over first week or two following injury
26
Q

microfractures for articular cartilage

A
  • encourage blood flow
  • replaced with fibrocartilage (not the same as hyaline cartilage)
  • WB is controlled
  • not great for active people
  • good short term outcomes
27
Q

ACI (autologous chondrocyte implantation

A
  • small biopsy of autologous cartilage is harvested
  • cartilage is enzymatically digested in lab to release chondrocytes
  • chondrocytes cultured and implanted in second surgery
28
Q

Osteochondral autograft transplantation system

A
  • full thickness defects
  • remove plug from NWB surface
  • “press-fit” plugs implanted into lesion
  • need CPM if mosiac is done to smooth out surface
29
Q

outcome measures for PFP

A

Lvl A:
- AKPS
- KOOS
- visual analog scale
- EPQ

30
Q

exercise for PFP

A

LVL A
- hip and knee targeted exercises
- hip before knee in early stages

31
Q

paterllar taping for PFP

A

LVL B
- may use taping with exercise to reduce pain and enhance outcomes in short term

32
Q

Bracing for PFP

A

LVL B
- should not use orthoses for PFP

33
Q

foot orthoses for PFP

A

LVL A
- for patients with greater than normal pronation to reduce pain but only for short term
- should be combined with exercise
- no evidence on custom versus prefabricated

34
Q

biofeedback for PHP

A

LVL B
- should not use EMG based feedback for quad

LVL B
- should not use visual biofeedback for lower extremity alignment

35
Q

running gait retraining PFP

A

LVL C
- forefoot strike pattern
- cueing to increase running cadence
- cueing to reduce peak hip adduction while running

36
Q

BFR + high rep knee exercise PFP

A

LVL F
- may use for those with limiting painful resisted knee extension

37
Q

needling PFP

A

LVL A
- should not use TPDN

LVL C
- may use acupuncture

38
Q

manual therapy PFP

A

LVL A
- should not use manual therapy alone

39
Q

biophysical agents PFP

A

LVL B
- should not use biophysical agents (ultrasound, cryotherapy, phono/ionto, estim, laser)

40
Q

patient education PFP

A

LVL F
- may educate on load management, body weight, adherence to active treatments

41
Q

combined interventions PFP

A

LVL A
- should combine physical therapy interventions

42
Q

Anteromedial rotary instability test

A
  • slocum test (PMC)
43
Q

anterolateral rotary instability tests

A

-jerk test of hughston
- losee test
- side-lying test of slocum
- flexion rotation drawer test

44
Q

posterolateral rotary instability tests

A
  • dial test at 30 and 90 (prone external rotation test)
  • reverse pivot shift test
  • posterolateral drawer test
  • external rotation recurvartum test
  • posterolateral external rotation test
45
Q

J sign

A

for patellar tracking

46
Q

ottowa knee rules

A
  • 55 years or older
  • isolated tenderness of patella
  • tenderness at head of fibula
  • inability to flex 90 degrees
  • inability to bear weight both immediately and in ED for 4 steps (unable to transfer weight twice onto each lower limb
47
Q

CPM
knee ligament sprain

A

LVL C
- may use cpm immediately postop to decrease pain for ACL

48
Q

early weightbearing
knee ligament sprain

A

LVL C
- may implement early weightbearing within 1 week for ACL

49
Q

knee bracing
knee ligament sprain

A

LVL C
- may use functional knee bracing for ACL deficiency

LVL D
- should document patient preference in decision to use knee bracing following ACL reconstruction

LVL F
- may use appropriate knee bracing for acute PCL, severe MCL, or PLC injuries

50
Q

immediate versus delayed mobilization
knee ligament sprain

A

LVL B
- should use mobilization within 1 week after ACL reconstruction to increase joint ROM, reduce joint pain, reduce risk of adverse responses of surrounding soft tissue structures

51
Q

cryotherapy
knee ligament sprain

A

LVL B
- should use cryotherapy immediately following ACLR to reduce postop knee pain

52
Q

supervised rehab
knee ligament sprain

A

LVL B
- should use exercises and proved and supervises HEP

53
Q

therapeutic exercises
knee ligament sprain

A

LVL A
- WB and NWB concentric and eccentric should be implemented within 4-6 weeks, 2-3 times per week for 6-10 months

54
Q

NMES
knee ligament sprain

A

LVL A
- should be used for 6-8 weeks following ACLR to augment muscle strength to enhance short term functional outcomes

55
Q

neuro re-ed
knee ligament sprain

A

LVL A
- should be incorporated with muscle strengthening exercises in patients with knee stability and movement coordination impairments

56
Q

risk factors for osgood schlatters

A
  • male gender
  • male: 12-15
  • female: 8-12
  • sudden skeletal growth
  • repetitive activities like jumping and sprinting
57
Q

osgood schlatters presentation

A
  • anterior knee pain with or without swelling which can be bilateral or unilateral
  • starts as dull ache over tibial tubercle
  • insidious
  • improves with rest and subsides minutes to hours after stopping activity
  • worse with running, jumping, knee trauma, kneeling, squatting
  • enlarged prominence
  • poor flexibility of quad and hamstrings
58
Q

treatment of osgood schlatters

A
  • may last for 2 years until apophysis fuses
  • relative rest, activity modification
  • ice and NSAIDS for pain relief
  • can use knee pad to protect tibial tubercle
  • quad and hamstring stretching and strengthening

OCS Prep (11 decks)

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