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OCS Exam > Knee > Flashcards

Knee Flashcards

1
Q

Which meniscus is more mobile?

A

The lateral meniscus

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2
Q

What kind of cartilage makes of the menisci?

A

Fibrocartilage

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3
Q

Which section of the meniscus is the least likely to heal?

A

The white-white or innermost

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4
Q

What history or MOI makes you think meniscus?

A

-Twisting
-Worse with movement, better with rest
-“locking”
-Joint line tenderness
-Effusion within 2 hours
-Sudden onset in those <40 years old, no specific MOI in those >50

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5
Q

Will all meniscal tears have “locking?”

A

No, some can just “shake it out” and keep going

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6
Q

What are the types of meniscal tear?

A

-Longitudinal
-Bucket-Handle (progressed longitudinal)
-Radial (perpindicular to curve)
-Root
-Oblique/flap
-Horizontal

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7
Q

Who has a good meniscal healing prognosis?

A

-Age <35
-Peripheral damage
-Longitudinal tear
-Short tear
-Acute injury with bloody effusion
-Stable knee

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8
Q

What are hallmark meniscal objective findings?

A

-Joint line tenderness
-Effusion
-Postive entrapment test (McMurray’s, Apley’s, Squat)
-Quad Inhibition (atrophy over first 1-2 weeks post injury)

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9
Q

What is joint line tenderness good for regarding meniscal injury?

A

Good Sensitivity (ruling out if negative)

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10
Q

What is the timeline for return to activity with meniscal debridement/meniscectomy?

A

1-2 weeks for ADLs, longer for athletic endeavors

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11
Q

At what length of meniscal tear is a meniscal repair indicated?

A

Longer than 8 mm

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12
Q

What are the indications for a meniscal repair?

A

-Traumatic lesion in the vascular zone
-Intact peripheral circumferential fibers
-Minimal damage to the meniscal body
-Longer than 8 mm

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13
Q

Arthroscopic partial meniscectomy and physical therapy are both..what?

A

likely to result in considerable improvement in functional status and knee pain over a 6-12 month period

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14
Q

Why avoid early hamstring strengthening after meniscal repair?

A

The semimembranosus connects to the medial meniscus

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15
Q

What kind of cartilage does articular cartilage consist of?

A

Hyaline cartilage - to reduce friction between the ends of bones

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16
Q

What type of articular cartilage lesions are symptomatic?

A

Grade III, IV; Grade I and II are typically asymptomatic

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17
Q

What can be said about image findings and articular cartilcage pathophysiology?

A

There is a poor correlation

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18
Q

What are some signs of articular cartilage damage?

A

-Resting genu varus
-Painful crepitus
-Catching, locking, grinding
-Sensitivity to weather changes
-Too little and too much activity is painful
-Quad atrophy
-Deep, dull ache

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19
Q

What are the options for surgical management of knee issues from more palliative to restorative?

A

-Debridement and lavage
-Microfracture
-Autologous Chondrocyte Implantation
-Osteochondral Grafting (OATS)

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20
Q

What is being done with articular catilcage debridement and lavage?

A

Removal of cartilage particles and inflammatory cells for short term pain relief of symptoms

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21
Q

What does the research say regarding debridement and lavage for articular cartilage lesions?

A

-No improvement compared to sham
-Little or no difference in pain or ability to function
-Maybe better than washout

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22
Q

Describe microfracture as a treatment for articular cartilage lesions.

A

Making pick holes through tidemark to encourage blood flow; replaces cartilage with fibrocartilage

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23
Q

What does the research say regarding medium to long-term outcomes with microfracture for articular cartilage lesions?

A

Poor regaring getting back to sport, better with sedentary or low post operative demand individuals. Treatment failure after 5 years is expected

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24
Q

Describe the Autologous Chondrocyte Implantation (ACI) procedure

A

Small biopsy of autologous articular cartilage harvested, enzymatically digested in a lab to release chondrocytes, which are cultured and then implanted at a second surgery with a periosteal flap placed as a patch

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25
Q

When is an osteochondral autograft transplantation system indicated?

A

With full-thickness articular cartilage defects

26
Q

Describe the osteochondral autograft transplantation system procedure

A

Remove plug from NWB surface then press-fit the plugs implanted into the lesion

27
Q

What are the best surgical options for large articular cartilage lesions?

A

Autologous Chondrocyte Implantation or Osteochondral Autograft Transplantation System

28
Q

What is considered a “large” articular cartilage defect?

A

> 4 cm

29
Q

What is a key factor in determining how to intervene with articular cartilage defects?

A

Low or high demand postoperatively

30
Q

When is microfracture not recommended?

A

Lesions >4 cm and for those with high postoperative demands

31
Q

What are principles of articular cartilage rehab?

A

-Understand the surgical procedure
-Control WB Status
-PROM is key
-Slow and progressive rehab
-Rarely return to sports: think ADLs
-Need communication with MDs

32
Q

What are functional subunits (bundles) of ligaments?

A

Ligaments are packaged into bundles, which different bundles are more tense than others at different joint angles; work together to provide stability in specific directions.

33
Q

Ligaments have elastic and viscous properties, what is the difference?

A

Elastic properties deform in proportion to the load and assume the original shame when removed; Viscous properties dampen forces and are time/duratin and rate/speed dependent

34
Q

On what conditions do mechanical properties of ligaments vary?

A

Temperature, injury, disease, aging

35
Q

What changes with ligaments during healing?

A

They initially heal with scar tissue that is predominantly Type III collagen with less tensile strength, more randomly oriented with more hydrogen cross-link bonds.
Scar tissue will contract possibly reducing joint motion

36
Q

Why is mechanical stress needed during healing?

A

Moderate stress induces organization of collagen into more parallel arrangement, resulting in more covalent cross link formation, minimizing scar contraction.

37
Q

What is sufficient stress for mechanical deformation during healing of a ligament?

A

Joint movement

38
Q

What happens to a ligament with immobilization?

A

-Ligament atrophy
-Reduction in intracellular matrix and inferior ligament material production
-Resorption of bony insertion sites
-Reduced tensile strength
-Adaptive shortening of structures
-Changes in uninjured structures
-Starts in just a few weeks from immobilization
-50% of mechanical strength lost aftger 6-9 weeks of immobilization

39
Q

How long does it take for ligament substance to recover after immobilization?

A

Months

40
Q

What MCL injuries involve the meniscus?

A

Grade II and III

41
Q

What is known about the MCL bundles?

A

There are multiple and restrain motion at different angles

42
Q

Is the meniscus attached to the LCL?

A

No, it is separated by the popliteus

43
Q

At what point of knee flexion is the LCL most effective as a restraint?

A

From 0-30 degrees

44
Q

What movement does the ACL restrain?

A

Anterior translation of the tibia on femur or posterior translation of the femur on tibia

45
Q

Which ACL bundle is most taut in flexion?

A

Anterior-medial bundle

46
Q

Which ACL bundle is most taught in extension?

A

The posterior lateral bundle

47
Q

What happens to the ACL bundles as the knee flexes?

A

The bundles twist

48
Q

Which bundle of the PCL is most taught in flexion?

A

Anterior-lateral

49
Q

Which bundle of the PCL is most taught with extension?

A

Posterior-medial bundle

50
Q

What motion does the PCL restrain?

A

Posterior tibial translation or anterior femoral translation;

Secondary: femoral external rotation and tibial internal rotation

51
Q

The ACL assists in sliding the femoral condyles anteriorly when?

A

During knee flexion

52
Q

The PCL assists in sliding the femoral condyles posteriorly when?

A

During knee extension

53
Q

What are signs of collateral ligament injury?

A

-Varus or valgus trauma
-Pos varus or valgus stretss testing
-Swelling, Ecchymosis
-Joint effusoin if meniscal involvement
-TTP at ligament
-Difficulty with pivoting, cutting, etc. (“can run in a straight line but feel like my knee will fall apart if I turn quickly)

54
Q

What are signs and symptoms of ACL injury?

A

-Severe pain with joint effusion
-“popping” “giving way” “buckling”
-Continued effusion, giving way
-Quad inhibition
-Limited ROM
-Flexed knee gait

55
Q

What are ACL mechnisms of injury?

A

-NC: fixed foot with knee in valgus/rotational load
-NC: Hyperextension load (stepping in pothole)
-C: Posteriorly directed blow to anterior femur
-C: Blow to lateral knee with planted foot

56
Q

How common are non-contact vs contact injuries of the ACL?

A

Non-contact 80%
Contact 20%

57
Q

Which ACL test hits more of teh posterior bundle?

A

Lachman’s

58
Q

Which ACL tests more of the anteror bundle?

A

Anterior Drawer Test

59
Q

What are signs and symptoms of PCL injury?

A

-Posterior knee pain
-Effusion, less than ACL
-Flexion beyond 90 increasing pain
-Difficutly descending stairs, squatting, running
-+sag sign
-+posterior drawer
-reduced palpation of tibial plateau step-off

60
Q

What is the mechanism of PCL injury?

A

-Hyperflexion
-Fall on a flexed knee with foot in plantarflexion
-Hyperextension
-Step in a pot hole
-Blow in anterior tibia (dashboard)

OCS Exam (12 decks)

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