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THEREX 2 > Knee > Flashcards

Knee Flashcards

1
Q

The medial mensicus attaches to what ligaments

Lateral meniscus?

A

medial= MCL, ACL, PCL

Lateral = PCL

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2
Q

When the quads activate the mensicus glides ________

A

anteriorly

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3
Q

Which part of the MCL attaches to the medial mensicus?

A

Deeper portion (which is separate from the superficial portion)

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4
Q

In flexion the ___________ bundle of the ACL is tight

A

anteromedial

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5
Q

In extension which bundle of the ACL is tight

A

post-lateral

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6
Q

which portion of the ACL primarily provides restraint to rotational forces

A

postero-lateral

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7
Q

The anteriorlateral bundle of the PCL is tight in __________

the posterio-medial bundle of the PCL is tight in ____________-

A

flexion

extension

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8
Q

What attachs to the medial meniscus?

A

dMCL

Semimembranosus

Quadriceps

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9
Q

What attaches to the lateral mensicus

A

Popliteus

Quadriceps

Arcuate ligament

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10
Q

which mensicus is more mobile

which is C shaped?

A

lateral

medial

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11
Q

which mensicus is more prone to injury

A

medial

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12
Q

how much does the patello-femoral joint normally move

A

7-8 cm

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13
Q

As the knee extends how does the patella move

A

superiorly

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14
Q

Causes of patellar tracing problems

A

Increased Q angle

short IT band (possibly an upslip)

weak hip ABD/ER

foot pronation

lax medial patellar retinaculum

insufficient vmo?

deficits in lateral groove

pelvic dysfunction

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15
Q

what is the open packed position of the knee

A

25

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16
Q

how much flexion is needed to ride a bike

A

110

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17
Q

when is patellar compression greatest in close chain?

What about open chain?

A

CKC- 90

OKC- 30

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18
Q

how much tibial rotation should there be each direction

A

20-30

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19
Q

what muscles externally rotate the tibia when the knee is flexed

what musces medially rotate

A

TFL and biceps femoris

popliteus medially rotates

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20
Q

Knee effusion leads to ________

A

inhibition of the quadriceps

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21
Q

what is the 1# priority in post-op knee patients

A

restoring ext ROM

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22
Q

Weight loss is shown to decrease load on the knee by

A

1:4 ratio

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23
Q

At what point in the knees motion is the quadricep at a mechanical disadvantage

A

last 15 degrees of knee ext

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24
Q

what muscle controls the amount of knee flexion in closed chain activities

A

quad

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25
Q

what muscle resists hyperextension of the knee and supports the posterior capsule

A

gastroc

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26
Q

50+

Knee crepitus

Boney enlargements

Morning stiffness under 30 mins

no palpable warmth

A

Knee OA

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27
Q

What has strong evidence for treating OA?

A

Exercise

NSAIDs

Self management

Education

28
Q

For OA, what evidence level?:

Unloading

Neuro-Rehab

Weight Loss

Corticosteroid inj

A

Moderate

29
Q

For OA, what evidence level:

Lateral wedge insoles

Oral narcotics

Hyaluronic acid

Arthoscropy w/ lavage or debridement

A

NOT recommended

30
Q

Indications of TKA

A

Severe joint pain that compromises function

extensive destruction of artiuclar cartilage/ advanced arthritis

Marked deformity of knee such as genu varum or valgum

gross instabilty or limitation of motion

failure of non-oporative management

31
Q

What movements are associated with valgus collapse of the knee

Foot:

Hip:

VMO inhibiton?

A

Foot : ER

Hip: Adduction and IR

(Hip Abduction and ER weakness)

32
Q

Pain with squatting, getting up from chair, kneeling, prolonged sitting, jumping, walking, running

A

PFPS

33
Q

PFPS acute treatment

A

modalities, rest, gentle ROM, muscle setting exercises in pain free position, isometrics

34
Q

PFPS subacute management

A

look at hip (address contributing mechanical factors)

Education: reduce stairs initially, avoid prolonged sitting

Address flexibility issues

improve muscle strength and endurance of knee extensors and hip extensors, ER, ABD

35
Q

PFPS exercises in close chain: Must exercise caution when…..

A

squatting past 60 degrees

36
Q

PFPS beginning exercises

A

Open chain; Quad sets, isometrics

CLosed chain: mini squats, leg press

37
Q

Pain localized at inferior pole of patella

load related pain that increases with demand on knee extensors

rarely pain at rest

A

patellar tendonopathy

38
Q
A
39
Q

In what order do you progress exercises for patellar tendinopathy

A

Isomeetric

Isotonic

Energy Storage (like jumping)

Return to sport

40
Q

What evidence level: Progressive knee flexion and progressive WB for meniscal and articular cartilage legions

A

Grade B Moderate

41
Q

What’s a major difference between a meniscus and an articular cartilage tear

A

Meniscus- delayed swelling

Articular cartilage- immediate hemarthrosis

42
Q

What is most important for fixing instabilities in the knee joint

A

Functional stability- sensorymotor control

43
Q

What can injure: Medial meniscus, posteromedial capsule, ACL, and MCL

A

Valgus force

44
Q

What structures are injured in the unhappy triad

A

ACL/ MCL/ Medial Mensicus

45
Q

What ligament is injured most common w/ hyperext

A

ACL and sometimes PCL and menisci

46
Q

What ligament is injured with flexion and posterior translation AKA dashboard injury

A

PCL

47
Q

Varus force typically injuries what structures

A

LCL, Posterolateral capsule, PCL

48
Q

Which ligaments often do fine non-operatively

A

PCL and MCL

49
Q

signs and symptoms of ACL injury:

Hx of giving way

loss of end range ___________

6m SL hop test less than ____________________

special tests: ______________

guarding my hamstrings

A

knee ext

less than 80%

Lachman, Anterior drawer, pivot shift

50
Q

What is the MOI that can cause the unhappy triad?

A

Sudden valgus impact with IR or ER of tibia

51
Q

signs and symptoms of unhappy triad:

A

Swelling, hemorrhage, pain, impaired muscle control/inhibition

52
Q

What is the critera necessary to get out of the acute phase of ACL injury

A

Minimal swelling and pain

Full ROM

SLR with NO LAG

Normal gait with no AD or brace

53
Q

What is the most important motion to get at the knee in the acute phase

A

ext

54
Q

What kind of disinhibitory treatment do you do for patients who are less than 3 months post op OR have swelling and pain for ACL/ quad inhibition

A

TENS (treats arthrogenic muscle inhibiton)

55
Q

What kind of disinhibitory treatment do you do for patients with no swelling/pain who are over 3 months post OP for acl injury

A

NMES to treat cortical inhibitions

56
Q

When can you start doing single leg strengthening for ACL

A

around week 6

57
Q

What is the critera for the strengthening phase for post-ACL injury

A

Squat equal on both sides

58
Q

At what degrees of flexion are OKC exercises safe to preform for ACL injuries

when is there the most strain on the ACL?

A

between 90 and 40

between 40 and 0

59
Q

T or F: There are simular strain values to the ACL when comparing open chain knee ext and closed chain squats

A

T

60
Q

When can a patient start running, double leg jumping, and going back to gym after an ACL injury

A

functional phase: 8-16 weeks

61
Q

Return to run criteria

A

95% knee flexion ROM

full knee ext

no effusion

limb symmetry 80% quad:hamstring

LSI >80% eccentric impulse during countermovement jump

pain free aqua jogging and alter-G running

pain free repeated single leg hopping

62
Q

At how many weeks can post ACL injury begin single leg hopping

how many weeks for cutting/changing direction

A

16 weeks

20 weeks

63
Q

Return to sport critera for ACL

A

Normal Neuromuscular control

Quad/HS/Glute index over 90% or isokinetic testing at 60d/s

Hamstring quad ratio over 66%

Hop test 90% comparable to contralateral side. Good landing mechancis

64
Q

What are posterolateral corner repair patients not allowed to do at any point in rehab process

A

Pt is WBAT in brace for 4 weeks, avoid active knee flexion for 4 weeks

NO resisted leg ext machine AT ANY TIME IN REHAB

no high impact cutting/twisitng activities for 3-4 months post-op

65
Q

IT band syndrome factors

Excessive foot ______

Excessive _______ rotation/torsion

Genu ___________

Deep hip rotator/abductor weakness

innominate positioning

A

Pronation

Internal

genu varum

66
Q

Osgood schlatter syndrome happens at the _______

Sinding larsen johansson syndrome happens at the _____________

A

Tibial Tuberosity

Inferior pole of patella

THEREX 2 (12 decks)

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