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
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
3
Q
The PCL is ___% thicker and ___x the tensile strength as the PCL.
A
50% thicker and 2x the tensile strength
4
Q
The PCL has (poor/good) vascularity for healing
A
poor vascularity
5
Q
definition: Primary stabilizer of the medial knee and restraint to valgus forces of the knee and excess tibial ER .
A
MCL
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
7
Q
What are the attachment sites of the deep band of the MCL?
A
Continuation of joint capsule and attaches to medial meniscus
8
Q
Anterior fibers of the MCL are taut in ___.
A
FLX
9
Q
Posterior fibers of the MCL are taut in ___.
A
EXT
10
Q
The MCL has (poor/better) vascularity for healing.
A
better vascularity
11
Q
The MCL in (intraarticular/extraarticular)
A
extraarticular
12
Q
The PCL is (intraarticular/extraarticular)
A
intraarticular
13
Q
definition: Primary stabilizer of the lateral knee and restraint to varus forces of the knee.
A
LCL
14
Q
The LCL is most taut at ___ degrees of ___ and _____.
A
25 degrees of FLX and full knee EXT
15
Q
The LCL has (poor/better) vascularity for healing.
A
better vascularity
16
Q
What percent of the medial meniscus is vascularized (Red-red zone)?
A
10-30%
17
Q
What percent of the lateral meniscus is vascularized?
A
10-25%
18
Q
The inner __-__% of both menisci are avascular.
A
60-75%
19
Q
What are the functions of the Menisci?
A
- load transmission
- shock absorption
- lubrication
- stability
- proprioception
- guiding movement
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
21
Q
___% of load from shock absorption with WB is through the medial meniscus
A
70%
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
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
24
Q
What meniscus is larger and thicker?
A
medial
25
The medial meniscus is wider (anteriorly/posteriorly)
posteriorly
26
Where does the medial meniscus attach?
MCL and joint capsule
27
The posterior horn of the medial meniscus blend with the ____.
semimembranosus tendon
28
What is the shape of the lateral meniscus?
C-shape
29
What meniscus is more mobile?
Lateral meniscus
30
Arthrokinematics of the tibiofemoral joint with FLX.
Concave tibial plateaus roll and glide posteriorly on convex femoral condyles
31
Arthrokinematics of the tibiofemoral joint with EXT.
Concave tibial plateaus roll and glide anteriorly on convex femoral condyles
32
What is the OPP of the tibiofemoral joint?
25 degrees of FLX
33
What is the CPP of the tibiofemoral joint?
Full EXT and tibial ER
34
What is the capsular pattern of the tibiofemoral joint?
FLX is more restricted than EXT
35
What is the most common cause of knee disability in the US?
Knee OA
36
What are the s/s of knee OA?
- 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
37
What patient population commonly has knee OA?
Females 60 y/o
obese patients
38
What are the aggs of knee OA?
- squatting
- stairs
- walking
- standing
- sit to stands
39
What provides relief to those with knee OA?
sitting, rest, NSAIDS
40
definition
Patellar mal-tracking due to:
Valgus collapse (hip adduction/IR) of femur during WB due to Glut med weakness or inhibition
patellofemoral pain syndrome (PFPS)
41
The patella articulates with what part of the femur?
intercondylar groove
42
What is the patient population that commonly has PFPS?
younger, active individuals
43
What are the s/s of PFPS?
- 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
What are aggs of PFPS?
- resisted knee EXT
- squatting
- stairs
- running
- jumping
45
What provides relief of PFPS?
rest
knee brace
46
What is one of the most common ligamentous injuries in young athletes?
ACL
47
What other ligamentous injuries can accompany ACL tears? What is it called if you have all 3?
MCL tear, medial meniscal tear
Unhappy triad
48
(true/false) the ACL heals easily.
False (it has a lack of vascularity so it has poor healing)
49
(Men/women) are more likely to tear their ACL.
women (2-8x more likely) --> 14-29 y/o
50
72% of ACL tears occur as a result of what?
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
ACL tear MOI is often from ___ force or contact with knee in ___ or ____.
valgus force
knee EXT or hyperEXT
52
What is a description commonly given when describing an ACL tear?
popping sound at time of injury and a "giving out sensation"
immediate pain and swelling
53
What are common findings with ACL tears?
- 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
____% of patients who did not get ACL reconstruction surgery did well with rehab.
83%
55
definition: tissue used from a cadaver for reconstruction
allograft
56
definition: tissue used from the patient for reconstruction
autograft
57
What are the 4 stages of graft/implant healing after ACL reconstruction surgery?
1. necrosis (3 weeks)
2. Revascularization (first 6-8 weeks after)
3. cellular proliferation
4. collagen formation, remodeling, maturation
58
When are ACL reconstruction grafts the weakest after surgery?
weeks 6-8
59
ACL rehabilitation typically has 4 phases of rehab over a course of ___ months.
9 months
60
When does a person return to running after ACL reconstruction?
between months 4-6
61
What sign has shown to be the single most predictor of ACL injury status when assessing for preventative measure?
ER strength
62
___ and ___ strength are very important to prevent valgus force of the knee
hip ABD/ER
63
What is the common MOI for PCL tears?
Trauma (ex: dashboard injury)
64
What are common findings with PCL tears?
- 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
Those with PCL tears report of minimal pain with knee ____.
EXT
66
When do MCL tears commonly occur?
During athletic activity
- valgus contact, tibial ER, or combined valgus and ER to the knee
67
(True/false) MCL tears have better vascularity/healing compared to other ligamentous tears
true
68
Grades I and II MCL tears can occur without trauma due to chronic medial knee stress caused by what?
- medial knee OA
- valgus loading to medial knee from pes planus, hip ABD/ER weakness, decreased hip ROM, etc
69
What are common findings with MCL tears?
- 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
When are MCL reconstruction injuries most commonly indicated?
if there is a severe rupture
71
What force causes an LCL tear?
varus force
72
LCL has (better/worse) healing capacity than the ACL/PCL
better healing
73
What are common findings of LCL tears?
- lateral knee pain and swelling
- TTP over LCL
- pain with tibial IR
- instability
74
When are LCL reconstruction injuries most commonly indicated?
if there is severe rupture or damage to the fibular head
75
What are risk factors for meniscal tears?
- repetitive squatting, kneeling, crawling, driving, and stair-climbing
- increased time between ACL tear and reconstruction surgery
- age
76
What are the MOIs of meniscal tears?
- 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
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)
longitudinal tear
78
Classification of meniscal tear: vertical tear that starts in the central margin
radial tear
79
Classification of meniscal tear: Oblique vertical tear causing a flap
flap tear
80
What are the 4 types of meniscal tears?
longitudinal
horizontal
flap
radial
81
As we age menisci become (loose/stiff) and fibrous tissue (increases/decreases)
stiff, increases
loses elasticity
82
Menisci have an increased potential for tearing with ___ forces.
torsional
83
What are common findings of meniscal tears?
- 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
(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
true
85
Which menisci is more mobile?
lateral
86
What is a common symptom for lateral meniscal tears?
clicking
87
(true/false) Lateral meniscus tear is more likely going to cause locking of the knee
FALSE (Less likely)
88
Insurance companies recommend __-___ weeks of PT before authorizing surgery for meniscal tears.
4-6 weeks
89
definition: Removal of injured portion of meniscus
Meniscal Debridement/Menisectomy
90
There should be (delayed/immediate) WB following a menisectomy/meniscal debridement
immediate WB for quicker recovery
91
After a meniscal repair, patients will be ___ or ___ with crutches for 2-6 weeks following surgery.
NWB or PWB w/ crutches
92
Recovery for meniscal repairs can last up to ___ weeks.
18 weeks
93
definition: Occurs due to retrograde ossification of the tibial tubercle which produces an apophysitis.
osgood schlatter disease
94
If Osgood Schlatter disease is left untreated, it can progress to ____.
osteonecrosis
95
When does Osgood Schlatter disease occur in a person's life?
Boys 12-14 y/o
Girls 10-12 y/o
*skeletally immature individuals during growth spurts*
96
What are common findings with Osgood Schlatter disease?
(+) 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
definition: Apophysitis of the inferior pole of the patella where patella attaches
- Calcification of inferior patellar pole due to traction forces
sinding-larson-johansson syndrome
98
What are common findings for sinding-larson-johansson syndrome?
Pain and TTP directly over patellar tendon and inferior pole of patella
