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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
BTB vs HS graft fail rates
both similar failure rate 11% CL ACL injury 13%
26
general flow of ACL rehab
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
27
PCL MOI
posterior translation of tibia dashboard injury large external trauma fall onto knee w/ PF foot
28
PCL objective findings
joint effusion within 24 hrs limited ROM due to pain in flexion pain/instability in WB
29
PCL special tests
posterior drawer sag sign
30
PCL surgical protocol
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
31
collateral ligament sprain
MCL>LCL varus or valgus movement impact on outside of knee while planted can create this
32
subjective findings collateral ligament sprain
swelling/stiff pain and tenderness over area able to ambulate avoid turning corners
33
objective findings in collateral ligament sprain
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
34
MCL injury subjective
immediate pain worse w knee flexion/extension constant or pain w movement unstable knee soft tissue swelling/bruising
35
MCL grades
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
36
MCL special test
valgus stress test: extension, 30 degrees flexion test cluster: history of ext force/rotation trauma, pain/laxity w flexion valgus stress test
37
MCL sprain grades prognosis/healing timeline
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!
38
baker's cyst
collection of synovial fluid in knee problem when it is aggravated or impairs motion
39
baker's cyst intervention
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
40
medial gastroc strain MOI
acute, forceful push off such as running/jumping, tennis or increased volume running load, acceleration/deceleration fatiguing
41
medial gastroc strain subjective
active MOI in DF/stretch/fatigue hold ankle in PF/neutral and avoid toe off
42
medial gastroc strain objective
tenderness/swelling over area pain w passive DF unable to perform single leg toe raise negative thompson intact peripheral pulses
43
medial gastroc strain grades | timeline, s/s
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
medial gastroc strain intervention
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
meniscal tear MOI
twist, turn, change direction in WB contact to lat/med knee
46
meniscus tear subjective
twisting or older pt with degenerative and minor trauma popping/swelling/clikcing jointline pain w twisting/squatting
47
meniscal tear objective
med/lat joint line tenderness effusion forced flexion/foot ER or IR are painful
48
meniscal special tests
McMurray Apley's Steinmann I
49
meniscal tear interventions
rehab menisectomy meniscus repair allograft
50
flow of menisectomy post op protocol
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
flow of post op meniscal repair
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
osgood schlatter's
osteochondritis inf patella/tibial tuberosity partial avulsion of tib tuberosity during growth spurts, trauma to epiphysis pt in sports run/jump/land
53
osgood schlatter's objective findings
prominent tibial tubercle mild swelling present pinpoint tenderness limited knee flexion, painful end range AROM painful resisted knee extension HS/quad/calf shortening
54
osgood schlatter's prognosis
self limited in 6-24 months, reduce activity due avoid bony overgrowth
55
patellar tendonitis
overuse, eccentric overload inferior pole of patella or tibial tubercle
56
subjective patellar tendonitis
hx of jumping/kicking sports ant knee pain pain after exercise or sitting pain w sitting, squatting, kneeling, climbing/down stairs, jump, running
57
patellar tendonitis objective
tenderness at inferior pole patella, tib tubercle, both normal AROM pain w resisted knee extension and OP
58
patellar tendonitis intervention
rest from aggravating activity regain pain free motion, quad/HS length, pain free quad strength gradual return to activity
59
patellofemoral pain syndrome
retropatellar knee pain from prolonged sitting, WB activity with high load
60
patellofemoral knee pain subjective
ant knee pain w stairs, instability no hx of trauma no swelling female>male
61
patellofemoral pain objective
valgus, femoral anteversion, abnx tracking quad weakness laxity of patellofemoral ligaments hip weakness poor eccentric quad control
62
patellofemoral pain special tests
Clark patellar grind test fairbank's apprehension test
63
patellofemoral pain interventions
wall squat knee stabilization TKE calf stretch clamshells, IT band stretch
64
plica syndrome
fold in synovium, normal can be inflamed/thickened trauma/overuse
65
plica syndrome subjective
insidious activity related aching snap/pop
66
plica syndrome objective
tenderness over plica reproduce snap at 60 degrees knee flexion
67
plica syndrome intervention
rest stretch quads/HS/calf strengthen patellar bracing can be surgical
68
prepatellar bursiits
prepatellar bursa inflamed/infected trauma, chronic irritation from excess kneeling
69
prepatellar bursitis subjective
knee swelling knee pain over front of knee
70
prepatellar bursitis objective
swelling of inf pole patella bursal sac tendernss/thickened normal AROM
71
prepatellar bursitis intervention
decrease inflam w ice activity mod stretch shortened mm.
72
IT band tendonitis MOI
friction between IT band and lateral femoral condyle runners and cyclists 20-30 knee flexion
73
IT band tendonitis subjective
lat knee pain symptoms after activity, then during
74
IT band tendonitis objective
tender lat femoral epicondyle soft tissue swelling, crepitus no joint swelling
75
IT band tendonitis special tests
Obers Noble's
76
IT band tendonitis interventions
rest ice stretch cortisone PRP long recovery, mainly needs rest
77
patellar dislocation/instability
lateral subluxation with young active pts women>men high recurrance indirect trauma strong quad contraction along w other knee ligament injuries
78
patellar dislocation subjective
pop immediate pain knee deformity hard to bend knee feeling of instability after relocation
79
patellar dislocation objective
laterally shifted patella patellar apprehension swelling
80
patellar dislocation intervention
brace regain ROM quickly, strengthen quad, surgery for recurrent instability
81
Knee OA subjective
insidious onset pain/stiffness buckling/locking/give way hard to do stairs
82
knee OA MOI
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
knee OA objective
angular deformity - vaurs/valgus effusion diffuse joint line tenderness loss of AROM, capsular
84
when is surgery needed for knee OA?
not controlled by meds, brace, PT functional limitations and pain at night
85
knee OA diagnosis
50+ y/o stiffness lasting longer than 30 min crepitus bony tenderness bony enlargement no palpable warmth
86
knee OA intervention
weight loss exericse/PT: improve ROM, quad strength, low impact exercise AD insoles unloader brace
87
medical knee OA management
glucosamine chondroitin NSAIDs COX-2 inhibitors intraarticular injections of glucocorticoid or hyaluronans
88
unicompartmental knee replacement
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
TKA
total knee arthroplasty tibia, femur, patella fixed components with cement large surgical incision
90
adv of minimally invasive knee surgery
early mobilization less pain cost shorter hospital time quicker rehab less blood loss
91
Patellofemoral Knee Pain CPG Components
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
indications for TKR
pain interfering with ADLs, sleep conservative treatment failed xray confirming cartilage deterioration substantial
93
partial TKR pros
unicompartmental arthritis less invasive keep most of knee joint quicker recovery
94
partial TKR cons
may wear out quicker revision more difficult may have hidden arthritis 90% 10 year survival
95
candidates for partial total knee
ideal weight higher activity younger age educate on realistic expectations of revision to TKR in future
96
benefits of custom knee replacements
less blood loss shorter hospital stay less pain
97
return to sport after TKA
6 months start w walking, biking, swimming, golf, bowling, etc could go back to certain sports but not most high impact or contact
98
TKA CPG Components
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 (11 decks)

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