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Musculoskeletal > Knee > Flashcards

Knee Flashcards

1
Q

definition: Primary restraint to posterior translation of the tibia on the femur. Also helps restrain IR of tibia on femur and helps prevent posteromedial instability of the knee

A

PCL

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2
Q

What are the 2 bundles of the PCL? What positions are they taut in?

A

Anterolateral: Taut in knee flexion
Posteromedial: Taut in knee extension

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3
Q

The PCL is ___% thicker and ___x the tensile strength as the PCL.

A

50% thicker and 2x the tensile strength

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4
Q

The PCL has (poor/good) vascularity for healing

A

poor vascularity

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5
Q

definition: Primary stabilizer of the medial knee and restraint to valgus forces of the knee and excess tibial ER .

A

MCL

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6
Q

What are the attachment sites for the superficial band of the MCL?

A

Thick, flat band which runs from medial femoral condyle to the medial surface of tibia 6cm below the joint line. Blends with the posteromedial capsule

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7
Q

What are the attachment sites of the deep band of the MCL?

A

Continuation of joint capsule and attaches to medial meniscus

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8
Q

Anterior fibers of the MCL are taut in ___.

A

FLX

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9
Q

Posterior fibers of the MCL are taut in ___.

A

EXT

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10
Q

The MCL has (poor/better) vascularity for healing.

A

better vascularity

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11
Q

The MCL in (intraarticular/extraarticular)

A

extraarticular

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12
Q

The PCL is (intraarticular/extraarticular)

A

intraarticular

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13
Q

definition: Primary stabilizer of the lateral knee and restraint to varus forces of the knee.

A

LCL

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14
Q

The LCL is most taut at ___ degrees of ___ and _____.

A

25 degrees of FLX and full knee EXT

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15
Q

The LCL has (poor/better) vascularity for healing.

A

better vascularity

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16
Q

What percent of the medial meniscus is vascularized (Red-red zone)?

A

10-30%

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17
Q

What percent of the lateral meniscus is vascularized?

A

10-25%

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18
Q

The inner __-__% of both menisci are avascular.

A

60-75%

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19
Q

What are the functions of the Menisci?

A
  • load transmission
  • shock absorption
  • lubrication
  • stability
  • proprioception
  • guiding movement
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20
Q

The menisci transmit ___% of joint load when the knee is EXT and ___% of joint load when the knee is FLX

A

50% in EXT
90% in FLX

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21
Q

___% of load from shock absorption with WB is through the medial meniscus

A

70%

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22
Q

During knee flexion, the menisci move ____ with the femoral condyles as they roll _____ on the tibial plateaus

A

move posteriorly with the femoral condyles as they roll posteriorly on the tibia

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23
Q

During knee extension, menisci move ____ with the femoral condyles as they roll ___ on the tibial plateaus

A

move anteriorly with the femoral condyles as they roll anteriorly on the tibia

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24
Q

What meniscus is larger and thicker?

A

medial

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25
Q

The medial meniscus is wider (anteriorly/posteriorly)

A

posteriorly

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26
Q

Where does the medial meniscus attach?

A

MCL and joint capsule

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27
Q

The posterior horn of the medial meniscus blend with the ____.

A

semimembranosus tendon

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28
Q

What is the shape of the lateral meniscus?

A

C-shape

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29
Q

What meniscus is more mobile?

A

Lateral meniscus

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30
Q

Arthrokinematics of the tibiofemoral joint with FLX.

A

Concave tibial plateaus roll and glide posteriorly on convex femoral condyles

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31
Q

Arthrokinematics of the tibiofemoral joint with EXT.

A

Concave tibial plateaus roll and glide anteriorly on convex femoral condyles

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32
Q

What is the OPP of the tibiofemoral joint?

A

25 degrees of FLX

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33
Q

What is the CPP of the tibiofemoral joint?

A

Full EXT and tibial ER

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34
Q

What is the capsular pattern of the tibiofemoral joint?

A

FLX is more restricted than EXT

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35
Q

What is the most common cause of knee disability in the US?

A

Knee OA

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36
Q

What are the s/s of knee OA?

A
  • Thinning and degeneration of articular cartilage
  • Decreased joint space, osteophyte formation  response to stress
  • Bony overgrowth of femoral condyles (Moderate  late OA)
  • Increased likelihood if previous knee meniscectomy surgery
  • anteromedial knee pain
  • swelling around the knee after WB
  • limited AROM/PROM
  • decreased step/stide length
  • antalgic gait
  • decreased strength
  • tight HS and hip FLX
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37
Q

What patient population commonly has knee OA?

A

Females 60 y/o

obese patients

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38
Q

What are the aggs of knee OA?

A
  • squatting
  • stairs
  • walking
  • standing
  • sit to stands
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39
Q

What provides relief to those with knee OA?

A

sitting, rest, NSAIDS

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40
Q

definition
Patellar mal-tracking due to:
Valgus collapse (hip adduction/IR) of femur during WB due to Glut med weakness or inhibition

A

patellofemoral pain syndrome (PFPS)

41
Q

The patella articulates with what part of the femur?

A

intercondylar groove

42
Q

What is the patient population that commonly has PFPS?

A

younger, active individuals

43
Q

What are the s/s of PFPS?

A
  • anterior knee pain around the patella
  • cracking/popping during squatting
  • full and pain-free ROM
  • femoral valgus collapse with squatting
    (+) forward/lateral step down test
    (+) TTP
  • strength loss of hip EXT, ABD, and ER
    (-) neuro
  • lateral tracking of patella during stepping and squatting
44
Q

What are aggs of PFPS?

A
  • resisted knee EXT
  • squatting
  • stairs
  • running
  • jumping
45
Q

What provides relief of PFPS?

A

rest
knee brace

46
Q

What is one of the most common ligamentous injuries in young athletes?

A

ACL

47
Q

What other ligamentous injuries can accompany ACL tears? What is it called if you have all 3?

A

MCL tear, medial meniscal tear

Unhappy triad

48
Q

(true/false) the ACL heals easily.

A

False (it has a lack of vascularity so it has poor healing)

49
Q

(Men/women) are more likely to tear their ACL.

A

women (2-8x more likely) –> 14-29 y/o

50
Q

72% of ACL tears occur as a result of what?

A

As a result of noncontact

  1. sudden valgus collapse
  2. sudden deceleration in anticipation of a change in direction with the knee close to full EXT
  3. abrupt change in direction with a fixed foot and full knee EXT
51
Q

ACL tear MOI is often from ___ force or contact with knee in ___ or ____.

A

valgus force

knee EXT or hyperEXT

52
Q

What is a description commonly given when describing an ACL tear?

A

popping sound at time of injury and a “giving out sensation”

immediate pain and swelling

53
Q

What are common findings with ACL tears?

A
  • swelling
  • limited AROM/PROM due to pain and muscle guarding
  • inhibition/atrophy of quads
  • decreased WB and SLS due to instability
    (+) lachman test
    (+) anterior drawer test
54
Q

____% of patients who did not get ACL reconstruction surgery did well with rehab.

A

83%

55
Q

definition: tissue used from a cadaver for reconstruction

A

allograft

56
Q

definition: tissue used from the patient for reconstruction

A

autograft

57
Q

What are the 4 stages of graft/implant healing after ACL reconstruction surgery?

A
  1. necrosis (3 weeks)
  2. Revascularization (first 6-8 weeks after)
  3. cellular proliferation
  4. collagen formation, remodeling, maturation
58
Q

When are ACL reconstruction grafts the weakest after surgery?

A

weeks 6-8

59
Q

ACL rehabilitation typically has 4 phases of rehab over a course of ___ months.

A

9 months

60
Q

When does a person return to running after ACL reconstruction?

A

between months 4-6

61
Q

What sign has shown to be the single most predictor of ACL injury status when assessing for preventative measure?

A

ER strength

62
Q

___ and ___ strength are very important to prevent valgus force of the knee

A

hip ABD/ER

63
Q

What is the common MOI for PCL tears?

A

Trauma (ex: dashboard injury)

64
Q

What are common findings with PCL tears?

A
  • popping
  • posterior knee pain aggravated with kneeling
  • pain and decreased ROM reported with end-range knee FLX
  • decreased SLS
  • MINIMAL swelling
  • possible instability
    (+) posterior drawer test
    (+) sag sign
65
Q

Those with PCL tears report of minimal pain with knee ____.

A

EXT

66
Q

When do MCL tears commonly occur?

A

During athletic activity
- valgus contact, tibial ER, or combined valgus and ER to the knee

67
Q

(True/false) MCL tears have better vascularity/healing compared to other ligamentous tears

A

true

68
Q

Grades I and II MCL tears can occur without trauma due to chronic medial knee stress caused by what?

A
  • medial knee OA
  • valgus loading to medial knee from pes planus, hip ABD/ER weakness, decreased hip ROM, etc
69
Q

What are common findings with MCL tears?

A
  • medial knee pain
    (+) valgus stress test
    (+) TTP over MCL
  • medial knee swelling
  • pain with tibial ER
  • can see (+) meniscal testing and HS irritation due to attachment sites
70
Q

When are MCL reconstruction injuries most commonly indicated?

A

if there is a severe rupture

71
Q

What force causes an LCL tear?

A

varus force

72
Q

LCL has (better/worse) healing capacity than the ACL/PCL

A

better healing

73
Q

What are common findings of LCL tears?

A
  • lateral knee pain and swelling
  • TTP over LCL
  • pain with tibial IR
  • instability
74
Q

When are LCL reconstruction injuries most commonly indicated?

A

if there is severe rupture or damage to the fibular head

75
Q

What are risk factors for meniscal tears?

A
  • repetitive squatting, kneeling, crawling, driving, and stair-climbing
  • increased time between ACL tear and reconstruction surgery
  • age
76
Q

What are the MOIs of meniscal tears?

A
  • acute injury due to sudden twisting/change of direction when WB
  • often occurs in conjunction with ligamentous tears due to a blow to the knee
77
Q

Classification of meniscal tear: tear in the longitudinal direction of the meniscus near the periphery.

Tend to be more unstable resulting in a dislocation of the central part of the meniscus (bucket handle tear)

A

longitudinal tear

78
Q

Classification of meniscal tear: vertical tear that starts in the central margin

A

radial tear

79
Q

Classification of meniscal tear: Oblique vertical tear causing a flap

A

flap tear

80
Q

What are the 4 types of meniscal tears?

A

longitudinal
horizontal
flap
radial

81
Q

As we age menisci become (loose/stiff) and fibrous tissue (increases/decreases)

A

stiff, increases

loses elasticity

82
Q

Menisci have an increased potential for tearing with ___ forces.

A

torsional

83
Q

What are common findings of meniscal tears?

A
  • clicking, popping, and swelling along tibiofemoral joint line
  • pain with turning and knee ROM
  • decreased knee ROM
    (+) TTP over tibiofemoral joint line
    (+) Thessaly test
    (+) McMurray’s test
    (+) apley’s compression test
84
Q

(true/false) If a medial meniscal tear extends anteriorly beyond the MCL… the unstable meniscal fragment cannot always move back into its original position. This can cause the knee to lock in a flexed position

A

true

85
Q

Which menisci is more mobile?

A

lateral

86
Q

What is a common symptom for lateral meniscal tears?

A

clicking

87
Q

(true/false) Lateral meniscus tear is more likely going to cause locking of the knee

A

FALSE (Less likely)

88
Q

Insurance companies recommend __-___ weeks of PT before authorizing surgery for meniscal tears.

A

4-6 weeks

89
Q

definition: Removal of injured portion of meniscus

A

Meniscal Debridement/Menisectomy

90
Q

There should be (delayed/immediate) WB following a menisectomy/meniscal debridement

A

immediate WB for quicker recovery

91
Q

After a meniscal repair, patients will be ___ or ___ with crutches for 2-6 weeks following surgery.

A

NWB or PWB w/ crutches

92
Q

Recovery for meniscal repairs can last up to ___ weeks.

A

18 weeks

93
Q

definition: Occurs due to retrograde ossification of the tibial tubercle which produces an apophysitis.

A

osgood schlatter disease

94
Q

If Osgood Schlatter disease is left untreated, it can progress to ____.

A

osteonecrosis

95
Q

When does Osgood Schlatter disease occur in a person’s life?

A

Boys 12-14 y/o
Girls 10-12 y/o

skeletally immature individuals during growth spurts

96
Q

What are common findings with Osgood Schlatter disease?

A

(+) TTP over patellar tendon at the tibial tuberosty
- insidious onset of anterior knee pain
- prominent tibial tuberosity
- aggs: during and after sports
- pain with resisted knee EXT and/or Knee FLX PROM

97
Q

definition: Apophysitis of the inferior pole of the patella where patella attaches

  • Calcification of inferior patellar pole due to traction forces
A

sinding-larson-johansson syndrome

98
Q

What are common findings for sinding-larson-johansson syndrome?

A

Pain and TTP directly over patellar tendon and inferior pole of patella

Musculoskeletal (23 decks)

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