Knee Flashcards
what is the source of common muscular injury in lower extremity?
hamstring & quads
what is common MOI of muscular knee pathology?
eccentric contraction
most likely at musculotendinous junction
where are come common location of muscular knee injuries?
Origin of muscle
Musculotendinous Junction
Muscle Belly
Insertion of muscle
what is a 1st degree strain?
stretching of musculotendionous unit & involves tearing a few muscle fibers
what is a 2nd degree strain?
more sever tear w/o complete disruption of musculotendinous junction
what is a 3rd degree strain?
complete tear of musculotendinous unit
what are some risk factors to knee pathology?
Inadequate flexibility
Inadequate strength or endurance
Muscle Fatigue
Poor running technique
premature return to sport
what is the clinical picture of muscular knee pathology?
Pain in posterior or anterior thigh
Tenderness over injury site
Ecchymosis
Palpable mass
Pain w/ movement & resistance
how is muscular knee pathology diagnosed?
Clinical picture
May require x-rays if avulsion injury is suspected
what is a differential diagnosis for muscular knee pathology?
lumbar radiculopathy
what are some treatment options for muscular knee pathology?
PT
NSAIDs
Surgical intervention
what is a grade 1 sprain of ligament?
few fibers torn
what is a grade 2 sprain of ligament?
apron 1/2 fibers torn
what is a grade 3 ligament sprain?
all fibers torn
where does the ACL originate and go to?
tibial plateau (just ant & medial to tibial eminence) then extends from tibia superiorly, laterally & posteriorly to posterior aspect of medial wall of lateral femoral condyle
where does the PCL originate & go to?
tibial plateau posteriorly & laterally
extend from tibia superiorly & medially to attach on medial femoral condyle
true or false both PCL & ACL are intra-articular but extra synovial?
true
what population is more likely to experience ACL pathology?
Females 2-8x more than males
14-29 yr old
what is entailed in an autograft ACL?
Middle 1/3 patellar tendon
Semitendinosus/gracilis tendon graft (hamstring)
Quads tendon graft
what is an entailed in an autograft for ACL?
cadaveric graft
patellar tendon or achilles
when is PT indicated for PCL injury?
partial tears or complete tears w/ no other damage
when is a PCL repair indicated?
Injury is avulsion of ligament
When other structures are involved
what are the rotary instabilities at the knee?
Anteromedial, Anterolateral, Posteromedial, posterolateral
where does the MCL attach?
proximally to medial femoral condyle & distally to medial aspect of tibia
Deep fiber originate from medial joint capsule & attach to medial meniscus
Ligament taut throughout range
when is the MCL taut?
through knee range
when is the LCL taut?
in extension
when is LCL loose?
flexion
what may also result from LCL moi?
traction injury to fibular nerve
when are PT/rehab regimens effective for bakers cyst?
pts w/ minimal sxm & setting of smaller degenerative meniscal tears
what does PT entail for treatment of plica syndrome?
- Taping, exercise therapy, activity modification
- Intra-articular steroid injection
- Surgical excision
which is dangerous: Chronic or acute compartment syndrome?
acute - Require immediate medical attention
what can happen in acute compartment syndrome is left unattended?
permanent muscle damage
what does patella Alta mean?
high patella
what does patella Baja mean?
low patella
what is chondromalacia?
softening & subsequent tearing, fissure & erosion of hyaline cartilage on underside of patella
what are the risk factors for chondromalcia?
Previous patellar injury
-Patellar position
- Q-angle
what are the normal values of Q angle in males & females?
18 females
13 males
what does a larger Q angle indicate?
higher likelihood of lateral patellar tracking
when exercising someone w/ chrondromalcia what should you focus on?
hip & quad strength & flexibility
what is the recurrence rate of PFPS and why?
70-90% b/c they stop their exercises eventually
what kind of outcomes are associated w/ PFPS?
poor w/ longer duration of sxm, higher baseline pain severity
what is patellar tendinopathy?
- Anterior knee pain localized at inferior pole of patella
what is the prognosis of osgood schlatters?
resolution of sxm w/ decreased activity in 2-3 wks to 2-3 months
what do we use to screen for fractures?
Ottawa knee rules & Pittsburg decision rule
what do the Ottawa knee rules say?
Refer in injury was traumatic and any of the following pt presents:
- >55
-Tenderness to fibula head
-isolated tenderness of patella
-Inability to flex knee to 90
-Inability to walk 4 WB steps
what does the Pittsburgh Decision rules say?
- MOI was blunt trauma or fall & one one the following
- Age <12 or >50
- Inability to walk 4 WB steps
- Age <12 or >50
what is a distal femoral shaft fracture?
Disruption of distal femoral shaft
Often displaced fx and/or comminuted
what may a distal femoral shaft Fx lead to/
massive internal hemorrhage then shock
what are some distal femoral Fx complications?
Mal-Union (rotated or shortened limb)
Joint and/or soft tissue adhesions
Post traumatic DJD
what are some complication of proximal tibia fx?
Intra-articular & peri-articular adhesions
DJD
where is a proximal tibia fx common in adults?
medial & lateral tibial plateau
where is proximal tibia fx common in children?
Epiphyseal growth plate & metaphysical region
what is the pathophysiology of a proximal tibial plateau?
-Split (younger) or Depression Fx (older)
-Common lateral plateau
-May contribute to ACL tear
which way does the patellar normally dislocate?
Lateral
what are the risk factors for patellar dislocation?
- Increase Q angle
- Weak VMO
what is the joint progression of OA?
- Loss of cartilage
- Bony sclerosis, increased subchondral bone growth
- Bone cysts
- Osteophyte formation
