Knee

Question 1

Popliteus

Answer 1

Locks and unlocks the knee
Important muscle for resisting posterior translation of the knee

Question 2

High specificity knee special tests

Answer 2

Lateral joint line tenderness for meniscus injury Sp = 0.97
Thessaly at 20 degrees flexion Sp = 0.95-0.96

Pivot shift most Sp for ACL injury

Question 3

Valgus stress test at 0 degrees

Answer 3

Normal separation 1-2 mm
Nearly normal separation 3-5mm
Abnormal separation 6-10mm
Very abnormal separation > 10mm

Question 4

Tibial external rotation
Injury grades

Answer 4

Grade 1: Tibial ER asymmetry < 5 degrees
Grade 2: 5-10 degree asymmetry
Grade 3: > 10 degree asymmetry

Question 5

Kaltenborn traction

Answer 5

Gr 1: used to neutralize joint pressure without any separation of joint surfaces
Gr 2: separates articulating surfaces taking up slack or eliminating play within the joint capsule
Gr 3: stretches joint capsule and soft tissues, similar to grades 3-4 oscillatory techniques and a grade for high velocity low amplitude technique

Question 6

Ottawa knee rules

Answer 6

Radiograph required only if one of these or more are present along with the pain.
55 or higher
Tenderness at the head of the fibula
Isolated tenderness of the patella.
Inability to flex knee to 90°
Inability to bear weight both immediately after injury and for four steps during evaluation

(Valid for 18 years old+)

Question 7

Risk factors of knee OA

Answer 7

Women
Increased BMI
history of knee injury that changes biomechanics
Early degenerative changes

Question 8

Acl and rotational stability

Answer 8

Posterolateral bundle of ACL plays greatest role in rotational stability

Question 9

Structures stabilizing posteromedial knee capsule

Answer 9

Posterior oblique ligament, oblique popliteal ligament, semimembranosus

Question 10

Structures stabilizing posterolateral knee capsule

Answer 10

Arcuate ligament

Question 11

Hughston’s drawer sign

Answer 11

Similar to posterior drawer test, but adds internal rotation of tibia to test if there is excessive motion of posteromedial knee

Question 12

Reverse lateral pivot shift test

Answer 12

Looks for PCL and posterolateral corner injuries

Question 13

Lachmans test

Answer 13

High sensitivity for ruling out ACL tear when negative

Question 14

Meniscus injury
Clinical presentation

Answer 14

MOI often involves a planted twist of knee
Effusion occurs over several hours (not immediately)
Joint line tenderness is fairly specific for meniscus injury