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OCS Prep > Knee > Flashcards

Knee Flashcards

1
Q

Why is normal 10 deg Valgus at the knee present?

A

Medial Femoral Condyle Extends longer distally than does the Lateral Femoral Condyle

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2
Q

Why does the Lateral Femoral Condyle Extend Longer Anteriorly than the Medial Femoral Condyle?

A

Prevent Lateral Translation of the Patella

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3
Q

What structures are the Lateral and Medial Meniscus attached to in order to allow for Posterior Translation during knee flexion?

A

Lateral- Popliteus
- Medial- Semimembranosus

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4
Q

In what knee position are the MCL and LCL Taut?

A

Extension

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5
Q

In what knee position are the bundles of the ACL Taut?

A

Post-Lat Bundle- Extension
- Ant-Med Bundle- Flexion

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6
Q

What are the important stabilizing structures of the Posterolateral Corner?

A
  • Lateral Collateral Ligament
  • Popliteus Tendon
  • Popliteofibular Ligament
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7
Q

Describe Hughstons Tests for knee Ligamentous Laxity

A
  • Similar to Post Drawer, but with Tibia in ER or IR approx 15 deg
  • ER tests Posterolateral Corner
  • IR tests Posteromedial instability
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8
Q

Describe Slocums Tests for Knee Ligamentous Laxity

A

Similar to Ant Drawer, but with Tibia in IR or ER approx 15 deg

  • IR tests Anterolateral Instability
  • ER tests Anteromedial Instability
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9
Q

What are common Tests used to diagnose Posterolateral Corner Injury?

A
  • Dial Test
  • Hughstons Test (Posterolateral Drawer)
  • Varus Stress Test
  • External Rotation Recurvatum Test
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10
Q

Disruption of the Infrapatellar Bursa may cause what type of patellofemoral abnormality?

A

Patella Baja

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11
Q

What is a lateral blowout sign of the knee?

A

Swelling over the Lateral Joint Line following an injury
- Occurs because the capsule is very thin on the lateral side of the knee

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12
Q

What is the role of the Posterior Oblique Ligament of the knee?

A
  • Primary Ligamentous Structure on the Posterior Medial side of the knee
  • Controls Anterior Medial Rotary Instability
  • Provides static resistance against Valgus when the knee moves into full extension
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13
Q

What is the role of the arcuate complex?

A

Comprised of the LCL, Arcuate Ligament, and popliteus
- Controls Internal Rotation of the Femur on the Tibia during closed chain activity

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14
Q

What bony factors can result in lateral tracking of the patella?

A
  • Dysplastic Patella
  • Patella Alta
  • Shallow Intercondylar Groove
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15
Q

What Soft tissue factors can result in lateral tracking of the patella?

A

Tight Lateral Retinaculum
- Tight IT Band

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16
Q

What is Patella Alta?

A

Cephalad position of the Patella

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17
Q

What is Lateral Pressure Syndrome?

A

Caused by tight lateral retinaculum tightness ,pulling the patella laterally

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18
Q

What is the difference between Osgood Schlatters and Sinding Larsen Johannson?

A
  • Both are Apophysitis
  • Osgood Schlatter is of the Tibial Tubercle
  • Synding Larsen Johannson is of the distal pole of the patella
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19
Q

What is Hoffas Fat Pad Disease?

A
  • Pain and swelling of the infrapatellar fat pad
  • Usually from trauma to anterior knee
  • TTP Medial and Lateral Joint Lines
20
Q

What is Housemaids Knee?

A
  • Prepatellar Bursitis
  • Usually in pnts who work while kneeling
  • Repetitive blunt trauma to Anterior Knees
21
Q

What is the typical MOI of Patellar Dislocation?

A

External Rotation of Tibia Combined with Valgus stress the knee

22
Q

What are Contraindications for meniscal surgery?

A
  • Tears that do not heal well with or without surgery as below
  • Tears > 3 cm
  • Transverse Tears
  • Tears with secondary lesions that extend into the avascular portion
23
Q

What is a Fibrin Clot?

A

Placed at the meniscal injury to form a wound hematoma and encourage healing

24
Q

What is a Meniscal Cyst?

A
  • Ganglion Like Formations secondary to central degeneration of the meniscus
  • Occur more often in lateral meniscus
25
Q

What is a diskoid meniscus?

A

Congenital deformity of the shape of the meniscus
- May abnormally affect the contact force through the meniscus

26
Q

What is a Segund Fracture?

A
  • Avulsion of the Anterolateral Margin of the lateral tibial plateau
  • Associated with ACL tears
27
Q

At what range of motion is the ACL Stressed the most in the open chain?

A
  • During Knee Extension from 45-20 deg with most stress at 20
  • Virtually no stress on ACL in full extension
28
Q

What amount of Quadriceps Strength is required to return to activity after ACL repair?

A

50% for jogging
65% for sports agility
80% for full return to sports

29
Q

With Medial Knee instability in a 10 year old after a valgus injury, what might be the cause?

A

Suspect Epiphyseal Plate Injury
- MCL is stronger than the Physes in youth and instability can be other than ligamentous in this population

30
Q

What are some commonly associated injuries of Distal Femoral Fracture?

A
  • Peroneal Nerve Palsy
  • Ipsilateral Hip Fracture or Dislocation
  • Vascular Injury
  • Damage to Quadriceps
31
Q

What are primary restraints to Valgus Stress?

A

MCL is primary
- PCL plays supportive role

32
Q

What are the bundlles of the ACL and in what positions are they most taut?

A

Posterlateral Bundle, Taut in Extension
- Anteromedial bundle, Taut Throughout Flexion

33
Q

Describe the bundles of the PCL

A
  • Anterolateral Bundle- Large, 95% of PCL, Taut in Flexion
  • Posteromedial Bundle- Small, 5%, Taut in Extension
  • Anterolateral the priority during reconstruction
34
Q

What are common MOI’s for Isolated PCL Injury?

A

Hyperflexion
- Direct Posterior Translation of Tibia such as a dashboard injury (often resullts in injuries to secondary restraints)

35
Q

How does the KOOS Functional Outcome Measure differ from the WOMAC

A

KOOS more responsive to those of higher activity level
- WOMAC designed to assess patients with OsteoArthritis of the Knee

36
Q

How do you perform Fluid Wave Grading of Knee Effusion?

A
  • Swelling pushed up the medial knee distally to proximally
  • Then sweep the hand back down toward lateral knee and watches for swelling
  • Graded Trace, 1+, 2+, 3+
37
Q

What structures might be implicated with Valgus Stress testing at different degrees of knee flexion?

A
  • At Full Extension- if opening > 5 mm, PCL and ACL may be involved
  • At 30 Deg Flexion- if opening > 10 mm, ACL may be involved
38
Q

What structures might be implicated with Varus Stress testing at different degrees of knee flexion?

A

In Full Extension- LCL, ACL, and PCL may be involved
- 30 deg Flexion- Primarily LCL

39
Q

What is the Posterolateral Corner Comprised of?

A
  • Arcuate Ligament
  • LCL
  • Popliteal Tendon
  • Lateral Head of Gastrocnemius
40
Q

What are the 5 measures of the Meniscal Pathology Composite Score?

A
  • History of Catching or Locking
  • Joint Line Tenderness
  • Pain with forced Hyperextension
  • Pain with Maximal Passive Flexion
  • Pain or Audble click with McMurray
41
Q

What is a “Sage Sign”?

A
  • Greater than 25-50% displacement of patellar width of the patella with lateral and medial passive movement
  • Indicative of Laxity of supporting tethers
42
Q

What is a “Sage Sign”?

A
  • Greater than 25-50% displacement of patellar width of the patella with lateral and medial passive movement
  • Indicative of Laxity of supporting tethers
43
Q

Describe a Patellar Apprehension Test

A
  • in 20-30 deg of knee flexion, the patella in manually subluxed
  • Excessive movement and patient expressions of concern are positive and indicative of excessive laxity or history of subluxations
44
Q

Describe the Patellar Tilt Test

A
  • Tests flexibility of Lateral Retinaculum
  • Knee at 20 deg flexion, attempt to tilt the lateral edge up, normal just above horizontal but with tight retinaculum, no movement
45
Q

What is the role of Patellar Movement during Knee Flexion and Extension?

A

During Flexion, patella glides inferiorly
- During Extension, patella glides superiorly

46
Q

What is the purpose of a NotchPlasty?

A

Allows for increased space in the Joint
- Prevents roof and lateral wall impingement

47
Q

What are the most common procedures for patella realignment?

A

HIgh Tibial Osteotomies
- Fulkerson, Hauser, Elmslie Trillat

OCS Prep (13 decks)

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