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517 Ortho > Knee > Flashcards

Knee Flashcards

1
Q

joints of the knee

A

patellofemoral
tibiofemoral
superior tib fib

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2
Q

degrees of freedom at the knee

A

flex/ext
med/lat rotation

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3
Q

ligaments at the knee stop which movement?

A

ACL - ant translation, med rotation
PCL - post translation, med rotation
MCL - valgus, lat rotation
LCL - varus, lat rotation

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4
Q

smaller knee ligaments

A

coronary attaching meniscus
transverse
meniscofemoral deep to MCL
arcuate
oblique popliteal

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5
Q

medial vs lateral meniscus

A

both improve joint congruence w higher edges
medial condyle deeper so medial meniscus shaped differently

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6
Q

facets of the patella

A

superior, inferior, lateral, medial, odd
each articulates at a different point of knee flex/ext

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7
Q

function of the patella

A

improve torque from quads
bony protection
prevent compression of quad tendon in squat

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8
Q

patella biomechanics

A

superior glide with quad activation NWB to help with force transmission

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9
Q

patella contact in flex/ext

A

0 - none
15-20 - inferior
45 - middle
90 - all facets execpt odd
140 - odd, lateral

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10
Q

patellar loading

A

walking .5 BW
cycling 1.5 BW
upstairs 3.3 BW
downstairs 5 BW
jog 7 BW
squat 7-8 BW
deep squat 20 BW
jump 20 BW

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11
Q

superior tib/fib joint

closed pack, ligaments, muscle attachments

A

closed pack: WB DF
ligaments: ant/post tib fib, IOM
muscles: biceps femoris, peroneals
joint movement in straight line along joint plane

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12
Q

Key diagnostic questions on knee pain

A

rapid/insidious onset
MOI
location
duration
severity
quality
aggravating/alleviating
weight bearing, immediately and currently

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13
Q

Key diagnostic questions on mechanical knee symptoms

A

locking
catching
popping, current or during injury
giving way
pain with stairs
difficulty around corners/rotating

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14
Q

ottawa knee rules

A

age >55 < 18
unable to walk
tender to palpation on: patella or fibular head
unable to flex 90 degrees
98-100% sensitive for detecting when pt needs xray

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15
Q

ACL tear MOI

A

non contact
planted foot
hyperextension + valgus

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16
Q

ACL risk factors

A

female
laxity
metabolic disease
nutrition
microtrauma

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17
Q

ACL restrains:

A

1: anterior translation
2: IR/ER in NWB knee

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18
Q

ACL tear subjective

A

popping/giving out with knee twist/hyperextension and planted foot
immediate pain and dysfunction
instability
inability to walk
immediate swelling

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19
Q

Objective findings in ACL tear

A

large hemarthrosis
pain
+ ant stability tests
involvement of other structures like MCL and medial meniscus

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20
Q

special tests for ACL tear

A

anterior drawer
lachman
pivot shift
Lelli’s

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21
Q

SpIN and SnOUT

A

specificity: Spin, rules in diagnoses, a positive is likely in presence of condition
sensitivity: Snout, rules out diagnoses, a negative is likely if condition is not present

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22
Q

ACL tear prognosis

A

post op 8-12 mo for return to full activity
young pts prefer surgery
increased risk of OA without surgery

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23
Q

ACL reconstruction types

A

autograft: from self, patellar tendon bone tendon bone, hamstring, or quad tendon
allograft: cadaver tissue
real tissue works better bc less brittle

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24
Q

pros/cons of allografts

A

pros: less risk from harvesting from pt, less trauma, less post op pain, faster recovery, no limit on graft size
cons: prolonged inflammatory, can stretch, slower revascularization, 25% fail rate

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25
Q

BTB vs HS graft fail rates

A

both similar failure rate 11%
CL ACL injury 13%

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26
Q

general flow of ACL rehab

A

0-2 weeks: protect, extension ROM, reduce swelling/pain, WB
3-5 weeks: protect, maintain extension, normalize gait
6-8: protect, strengthen, full ROM, proper movement pattern
6-12 months to return to sport

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27
Q

PCL MOI

A

posterior translation of tibia
dashboard injury
large external trauma
fall onto knee w/ PF foot

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28
Q

PCL objective findings

A

joint effusion within 24 hrs
limited ROM due to pain in flexion
pain/instability in WB

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29
Q

PCL special tests

A

posterior drawer
sag sign

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30
Q

PCL surgical protocol

A

1-4 weeks: WBAT crutches, 0-90 ROM, knee extension, reduce effusion, restore leg control
4-10: SLS control, normalizing gait, quad control, no pain w fxal movement
10+: strength, agility, multiplanar movement, control and balance

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31
Q

collateral ligament sprain

A

MCL>LCL
varus or valgus movement
impact on outside of knee while planted can create this

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32
Q

subjective findings collateral ligament sprain

A

swelling/stiff
pain and tenderness over area
able to ambulate
avoid turning corners

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33
Q

objective findings in collateral ligament sprain

A

MCL: tender along entire ligament, at attachments may be avulsion; palpate in flexion
LCL: tender along entire course, palpate in figure four

laxity in extension and 30 flexion, extension being worse injury

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34
Q

MCL injury subjective

A

immediate pain
worse w knee flexion/extension
constant or pain w movement
unstable knee
soft tissue swelling/bruising

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35
Q

MCL grades

A

1: local tenderness; pain, no laxity 30 knee flexion
2: marked tenderness, mild/mod swelling/pain, laxity valgus stress test only at 30 degrees
3: tenderness over MCL, severe laxity w/o end feel in ext and flexion, minimal pain on testing, other involved structures like LCL

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36
Q

MCL special test

A

valgus stress test: extension, 30 degrees flexion
test cluster: history of ext force/rotation trauma, pain/laxity w flexion valgus stress test

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37
Q

MCL sprain grades prognosis/healing timeline

A

1: ~10 days, no laxity
2: 3-4 weeks low end, some laxity at 30 degrees
3: 6-8 weeks, laxity and 0 and 30 degrees
good blood supply for healing!

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38
Q

baker’s cyst

A

collection of synovial fluid in knee
problem when it is aggravated or impairs motion

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39
Q

baker’s cyst intervention

A

RICE
aspiration
often reabsorb on their own in time
doesn’t need treatment unless pt wants for cosmetic or pain interference bc infection risk w invasive treatment

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40
Q

medial gastroc strain MOI

A

acute, forceful push off such as running/jumping, tennis or increased volume running load, acceleration/deceleration fatiguing

41
Q

medial gastroc strain subjective

A

active MOI in DF/stretch/fatigue
hold ankle in PF/neutral and avoid toe off

42
Q

medial gastroc strain objective

A

tenderness/swelling over area
pain w passive DF
unable to perform single leg toe raise
negative thompson
intact peripheral pulses

43
Q

medial gastroc strain grades

timeline, s/s

A

1: 1-3 weeks, sharp pain, no loss of strength or ROM
2: 3-6 weeks, loss of strength, ROM
3: months; pain, swelling, tenderness, bruising

44
Q

medial gastroc strain intervention

A

acute: control pain/inflammation - gentle AROM/PROM then strength like bike, heel raises, leg press
once painfree/full ROM/full strength, resume sport
continue stretching and strengthening for a few months

45
Q

meniscal tear MOI

A

twist, turn, change direction in WB
contact to lat/med knee

46
Q

meniscus tear subjective

A

twisting or older pt with degenerative and minor trauma
popping/swelling/clikcing
jointline pain w twisting/squatting

47
Q

meniscal tear objective

A

med/lat joint line tenderness
effusion
forced flexion/foot ER or IR are painful

48
Q

meniscal special tests

A

McMurray
Apley’s
Steinmann I

49
Q

meniscal tear interventions

A

rehab
menisectomy
meniscus repair
allograft

50
Q

flow of menisectomy post op protocol

A

1-2 weeks: knee brace/crutches; decrease inflam, restore ROM to 90, quad activity, WBAT
2-8: strength/endurance, fxal activity, normal gait, balance/proprioception
8+: maintain ROM, strength/endurance

51
Q

flow of post op meniscal repair

A

0-6: brace 4 weeks post op, no WB at 90+ until 4+ weeks
6-12: discx crutch/brace, full active ROM
12-16: full WB w normal gait pattern
4-6 mo: return to sport

52
Q

osgood schlatter’s

A

osteochondritis inf patella/tibial tuberosity
partial avulsion of tib tuberosity
during growth spurts, trauma to epiphysis
pt in sports run/jump/land

53
Q

osgood schlatter’s objective findings

A

prominent tibial tubercle
mild swelling present
pinpoint tenderness
limited knee flexion, painful end range AROM
painful resisted knee extension
HS/quad/calf shortening

54
Q

osgood schlatter’s prognosis

A

self limited in 6-24 months, reduce activity due avoid bony overgrowth

55
Q

patellar tendonitis

A

overuse, eccentric overload
inferior pole of patella or tibial tubercle

56
Q

subjective patellar tendonitis

A

hx of jumping/kicking sports
ant knee pain
pain after exercise or sitting
pain w sitting, squatting, kneeling, climbing/down stairs, jump, running

57
Q

patellar tendonitis objective

A

tenderness at inferior pole patella, tib tubercle, both
normal AROM
pain w resisted knee extension and OP

58
Q

patellar tendonitis intervention

A

rest from aggravating activity
regain pain free motion, quad/HS length, pain free quad strength
gradual return to activity

59
Q

patellofemoral pain syndrome

A

retropatellar knee pain
from prolonged sitting, WB activity with high load

60
Q

patellofemoral knee pain subjective

A

ant knee pain w stairs, instability
no hx of trauma
no swelling
female>male

61
Q

patellofemoral pain objective

A

valgus, femoral anteversion, abnx tracking
quad weakness
laxity of patellofemoral ligaments
hip weakness
poor eccentric quad control

62
Q

patellofemoral pain special tests

A

Clark patellar grind test
fairbank’s apprehension test

63
Q

patellofemoral pain interventions

A

wall squat
knee stabilization
TKE
calf stretch
clamshells, IT band stretch

64
Q

plica syndrome

A

fold in synovium, normal
can be inflamed/thickened
trauma/overuse

65
Q

plica syndrome subjective

A

insidious
activity related aching
snap/pop

66
Q

plica syndrome objective

A

tenderness over plica
reproduce snap at 60 degrees knee flexion

67
Q

plica syndrome intervention

A

rest
stretch quads/HS/calf
strengthen
patellar bracing
can be surgical

68
Q

prepatellar bursiits

A

prepatellar bursa inflamed/infected
trauma, chronic irritation from excess kneeling

69
Q

prepatellar bursitis subjective

A

knee swelling
knee pain over front of knee

70
Q

prepatellar bursitis objective

A

swelling of inf pole patella
bursal sac tendernss/thickened
normal AROM

71
Q

prepatellar bursitis intervention

A

decrease inflam w ice
activity mod
stretch shortened mm.

72
Q

IT band tendonitis MOI

A

friction between IT band and lateral femoral condyle
runners and cyclists
20-30 knee flexion

73
Q

IT band tendonitis subjective

A

lat knee pain
symptoms after activity, then during

74
Q

IT band tendonitis objective

A

tender lat femoral epicondyle
soft tissue swelling, crepitus
no joint swelling

75
Q

IT band tendonitis special tests

A

Obers
Noble’s

76
Q

IT band tendonitis interventions

A

rest
ice
stretch
cortisone
PRP
long recovery, mainly needs rest

77
Q

patellar dislocation/instability

A

lateral subluxation with young active pts
women>men
high recurrance
indirect trauma
strong quad contraction
along w other knee ligament injuries

78
Q

patellar dislocation subjective

A

pop
immediate pain
knee deformity
hard to bend knee
feeling of instability after relocation

79
Q

patellar dislocation objective

A

laterally shifted patella
patellar apprehension
swelling

80
Q

patellar dislocation intervention

A

brace
regain ROM quickly, strengthen quad, surgery for recurrent instability

81
Q

Knee OA subjective

A

insidious onset
pain/stiffness
buckling/locking/give way
hard to do stairs

82
Q

knee OA MOI

A

joint degeneration decreasing cartilage ability to lubricate, joint surface no longer smooth
avoiding movement leads to stiffness and reduced fluid in joint with less WB

83
Q

knee OA objective

A

angular deformity - vaurs/valgus
effusion
diffuse joint line tenderness
loss of AROM, capsular

84
Q

when is surgery needed for knee OA?

A

not controlled by meds, brace, PT
functional limitations and pain at night

85
Q

knee OA diagnosis

A

50+ y/o
stiffness lasting longer than 30 min
crepitus
bony tenderness
bony enlargement
no palpable warmth

86
Q

knee OA intervention

A

weight loss
exericse/PT: improve ROM, quad strength, low impact exercise
AD
insoles
unloader brace

87
Q

medical knee OA management

A

glucosamine
chondroitin
NSAIDs
COX-2 inhibitors
intraarticular injections of glucocorticoid or hyaluronans

88
Q

unicompartmental knee replacement

A

young or older pt w arthritis in only one knee compartment
ligaments intact
no systemic disease
weight under 200
adv: easier surgery w easier recovery, less complications

89
Q

TKA

A

total knee arthroplasty
tibia, femur, patella
fixed components with cement
large surgical incision

90
Q

adv of minimally invasive knee surgery

A

early mobilization
less pain
cost
shorter hospital time
quicker rehab
less blood loss

91
Q

Patellofemoral Knee Pain CPG Components

A

A: reproduction of pain in squatting/stairs as diagnostic; AKPS outcome measure; hip and knee exercise; foot orthotic to correct pronation; do NOT use dry needling; do NOT only use manual therapy
B: diagnose by retropatellar pain, repro of pain by squat/stairs, exclude other conditions; patellar taping w exercise short term; no knee brace; no biofeedback; no modalities
C: patellar tilt test hypomobility; accupuncture pain relief
F: classification system; BFR; patient education

92
Q

indications for TKR

A

pain interfering with ADLs, sleep
conservative treatment failed
xray confirming cartilage deterioration substantial

93
Q

partial TKR pros

A

unicompartmental arthritis
less invasive
keep most of knee joint
quicker recovery

94
Q

partial TKR cons

A

may wear out quicker
revision more difficult
may have hidden arthritis
90% 10 year survival

95
Q

candidates for partial total knee

A

ideal weight
higher activity
younger age
educate on realistic expectations of revision to TKR in future

96
Q

benefits of custom knee replacements

A

less blood loss
shorter hospital stay
less pain

97
Q

return to sport after TKA

A

6 months
start w walking, biking, swimming, golf, bowling, etc
could go back to certain sports but not most high impact or contact

98
Q

TKA CPG Components

A

strong: motor fx training

moderate: preop exercise program, continuous passive motion, cryotherapy, NMES, strengthening, prognostic factors, post op PT supervision, start within 24 hours, discharge planning

weak: immediate post op knee flexion, group vs indv therapy

theory: preop education, physical activity, post op ROM exercise, prognostic factor of tobacco and pt support, outcome assessment

517 Ortho (8 decks)

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