Knee Flashcards
Patellofemoral joint reaction force is influenced by two things
Quadriceps force & knee angle
During knee flexion and extension, the patella is pulled superiorly by ___________ and inferiorly by ____________
Quadriceps tendon / patellar tendon
Combination of quadriceps tendon and patellar tendon pulls produces __________ of patella on femur, it varies with knee flexion.
Posterior compressive force
In extension, there is small contact area between patella and femur, minimal posterior compressive vectors of __________ and ___________ muscles maintains low joint stress.
Vastus medialis and Vastus lateralis
The frontal plane patellofemoral joint stability is unique in its potential for
- frontal plane instability near full extension
- degenerative changes resulting from PFJ stress
What are the longitudinal stabilizers of the knee, providing medial & lateral stability of patella during flexion
- quadriceps tendon
- patellar tendon
- patellotibial ligament
- capsule
What are the transverse stabilizers of the knee
- superficial portion of extensor retinaculum
- medial and lateral patellofemoral ligament
- large lateral lip of femoral sulcus
The medial and lateral patellofemoral ligament attach the patella to the _________ medially and _______ laterally.
Adductor tubercle / IT band
An umbrella term used for pain arising from the patellofemoral joint itself or adjacent soft tissue
Patellofemoral pain syndrome
Patellofemoral pain syndrome causes posterior knee pain which could be misleading because the pain can be felt in all aspects of the knee including the popliteal fossa. True or false
False, anterior knee pain
What are synonyms to PFPS
Patellofemoral joint pain & anterior knee pain
What are the muscular etiologies of PFPS
- quadriceps weakness
- hamstring tightness
- calf muscles tightness
- hip muscle weakness or tightness
- tight IT band
What are remote factors of PFPS
- femoral internal rotation
- knee valgus
- tibial rotation
- subtalar pronation
- muscle strength & inflexibility
What are local factors to PFPS
- patella position
- soft tissue tension
- neuromuscular components of medial and lateral vasti
What are other diagnosis that may be used for pain at or around the kneecap
- chondromalacia patallae
- patellar tendonitis
- fat pad irritation
Symptoms of chondromalacia patella occur after prolonged 90 degrees of knee flexion sitting position or are aggravated by activity, what are examples of these symptoms
- crepitation
- sense of tightness or “fullness” in knee area
- quadriceps muscle strength may cause the leg to “give out”
- mild swelling
Actual fraying and damage to the underlying patellar cartilage is called
Chondromalacia patella
also known as jumpers knee, most common in athletes who’s sport involves frequent jumping such as basketball and volleyball, however even people who don’t participate in jumping sports can get it, what is it ?
Patellar tendinitis
What is the main symptom of patellar tendinitis and when can it be felt most
Pain (usually between kneecap and tibial tuberosity) / climbing stairs or rising from a chair
How do we prevent patellar tendinitis
- don’t play through pain
- strengthen your muscles (eccentric exercises)
- improve your technique
What are other names used for fat pad irritation
Hoffa’s syndrome & fat pad impingement
Examination test to assess for medial patellar glide, performed in 30 degrees knee flexion, this assesses for what ?
Limitation of mobility in the superficial lateral patellar retinaculum
Examination test to assess for superior patellar glide, performed in 30 degrees knee flexion, this assesses for what ?
Limitation of mobility of the inferior patellar tendon and soft tissue structures
Examination test to assess for inferior patellar glide, performed in 30 degrees knee flexion, this assesses for what ?
Limitation of mobility of the quadriceps tendon and other quadriceps muscles
The moving patellar apprehension test is done with patient supine, the clinician translates patella laterally while moving from extended to flexed position, how do we indicate if it’s a positive test ?
A positive test is indicated by symptoms of instability with the test
Examination test to determine patellar tilt for assessment of what ?
Deep patellar retinacular fibers
Test for tightness of deep lateral structures is done by attempting to tilt in a medial direction, inability to obtain a neutral position indicates what ?
Tightness of deep lateral structures
What are common interventions used for treatment of PFPS
- manual therapy
- open vs. closed chain exercises
- quadriceps strengthening
- patellar taping (kinesio-McConnel)
- orthotics
- proximal muscle strengthening
- modalities
when the knee is bent at 30 degrees, just as your foot strikes the ground in running , this region of 30 degrees of knee flexion is called
impingement zone
repetitive sliding can create excess friction especially when the knee is bent at 30 degrees, it is the pinching of irritated structures over the outside of the knee, thereby producing
ITB friction syndrome
joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow, this bone and cartilage break loose causing pain and possibly hindering joint motion, this is called
osteochondritis dissecans
children and adolescents between the ages of _________ who are highly active in sports may be at risk of getting osteochondritis dissecans
10 and 20
when a child is active, the quadriceps muscles pull on the patellar tendon which in turn pull on the tibial tubercle, in some children this repetitive traction on the tubercle leads to inflammation of the growth plate and the tibial tubercle may become very pronounced, this is called
osgood-schlatter disease
causes of ACL injury
- cutting (rotation)
- hyperextension (straight knee landing)
what can be associated with ACL injury
- articular cartilage injuries
- associated meniscal injury
- knee OA
unhappy triad consists of
- ACL
- medial collateral ligament
- medial meniscus
what are tests that we can perform to check the ACL
lachman and anterior drawer tests
normal knees have a 10mm anterior translation and a soft end point, true or false
False / 4mm & solid end point
in the lachman test, we apply a gentle anterior force to the tibia. A translation of more than 4mm (increased translation) and no solid or firm end point (soft end point) indicates an ACL injury. True or false
true
what is an example of ACL reconstruction
graft harvest of patellar tendon / hamstring tendon
Rehabilitation after ACL reconstruction includes
- PT before surgery (ROM & inflammation)
- early WB-ROM to full passive ROM
- early quadriceps and hamstring activity
- swelling and pain
- closed chain to open chain
-LE strengthening and stretching
-perturbation training (neuromuscular and proprioception)
weight bearing protocols in first 2 weeks after ACL reconstruction surgery
- initially brace is locked and crutches are used
- may walk without crutches if no pain or effusion
- may unlock brace once able to perform SLR without lag
- may discontinue use of brace at 6 weeks once adequate quad control is achieved
allograft and hamstring autograft continue PWB with crutches for _______ unless instructed otherwise, immediately post ACL op
6 weeks
we can use retrograde massage and ankle pumps for swelling management in ACL immediate post op phase, true or false
true
criteria for entrance into the return to sport phase include
- min international knee documentation (IKDC) subjective knee score:70
- no post op history or negative pivot shift
- minimum baseline strength
minimum baseline strength for entrance into the return to sport phase after ACL reconstruction surgery
knee extension peak torque / body mass
300 degrees: 40% M / 30% F
180 degrees: 60% M / 50% F
if a PCL injury results in an avulsion fracture, surgery is needed to reattach the ligament, knee function after this surgery is often quite good. True or False
True
stage 1 and 2 of medial collateral ligament injuries require stabilization in varus or valgus position, and for how long is conservative management done ?
valgus position / 2-6 weeks
for lateral collateral ligament injuries, first _____ weeks are restricted weight bearing
4 weeks
what are causes of meniscus tears
- twisting or turning quickly
- lifting something heavy or playing sports
- age
