Knee Flashcards
The medial mensicus attaches to what ligaments
Lateral meniscus?
medial= MCL, ACL, PCL
Lateral = PCL
When the quads activate the mensicus glides ________
anteriorly
Which part of the MCL attaches to the medial mensicus?
Deeper portion (which is separate from the superficial portion)
In flexion the ___________ bundle of the ACL is tight
anteromedial
In extension which bundle of the ACL is tight
post-lateral
which portion of the ACL primarily provides restraint to rotational forces
postero-lateral
The anteriorlateral bundle of the PCL is tight in __________
the posterio-medial bundle of the PCL is tight in ____________-
flexion
extension
What attachs to the medial meniscus?
dMCL
Semimembranosus
Quadriceps
What attaches to the lateral mensicus
Popliteus
Quadriceps
Arcuate ligament
which mensicus is more mobile
which is C shaped?
lateral
medial
which mensicus is more prone to injury
medial
how much does the patello-femoral joint normally move
7-8 cm
As the knee extends how does the patella move
superiorly
Causes of patellar tracing problems
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
what is the open packed position of the knee
25
how much flexion is needed to ride a bike
110
when is patellar compression greatest in close chain?
What about open chain?
CKC- 90
OKC- 30
how much tibial rotation should there be each direction
20-30
what muscles externally rotate the tibia when the knee is flexed
what musces medially rotate
TFL and biceps femoris
popliteus medially rotates
Knee effusion leads to ________
inhibition of the quadriceps
what is the 1# priority in post-op knee patients
restoring ext ROM
Weight loss is shown to decrease load on the knee by
1:4 ratio
At what point in the knees motion is the quadricep at a mechanical disadvantage
last 15 degrees of knee ext
what muscle controls the amount of knee flexion in closed chain activities
quad
what muscle resists hyperextension of the knee and supports the posterior capsule
gastroc
50+
Knee crepitus
Boney enlargements
Morning stiffness under 30 mins
no palpable warmth
Knee OA
What has strong evidence for treating OA?
Exercise
NSAIDs
Self management
Education
For OA, what evidence level?:
Unloading
Neuro-Rehab
Weight Loss
Corticosteroid inj
Moderate
For OA, what evidence level:
Lateral wedge insoles
Oral narcotics
Hyaluronic acid
Arthoscropy w/ lavage or debridement
NOT recommended
Indications of TKA
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
What movements are associated with valgus collapse of the knee
Foot:
Hip:
VMO inhibiton?
Foot : ER
Hip: Adduction and IR
(Hip Abduction and ER weakness)
Pain with squatting, getting up from chair, kneeling, prolonged sitting, jumping, walking, running
PFPS
PFPS acute treatment
modalities, rest, gentle ROM, muscle setting exercises in pain free position, isometrics
PFPS subacute management
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
PFPS exercises in close chain: Must exercise caution when…..
squatting past 60 degrees
PFPS beginning exercises
Open chain; Quad sets, isometrics
CLosed chain: mini squats, leg press
patellar tendonopathy
In what order do you progress exercises for patellar tendinopathy
Isomeetric
Isotonic
Energy Storage (like jumping)
Return to sport
What evidence level: Progressive knee flexion and progressive WB for meniscal and articular cartilage legions
Grade B Moderate
What’s a major difference between a meniscus and an articular cartilage tear
Meniscus- delayed swelling
Articular cartilage- immediate hemarthrosis
What is most important for fixing instabilities in the knee joint
Functional stability- sensorymotor control
What can injure: Medial meniscus, posteromedial capsule, ACL, and MCL
Valgus force
What structures are injured in the unhappy triad
ACL/ MCL/ Medial Mensicus
What ligament is injured most common w/ hyperext
ACL and sometimes PCL and menisci
What ligament is injured with flexion and posterior translation AKA dashboard injury
PCL
Varus force typically injuries what structures
LCL, Posterolateral capsule, PCL
Which ligaments often do fine non-operatively
PCL and MCL
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
knee ext
less than 80%
Lachman, Anterior drawer, pivot shift
What is the MOI that can cause the unhappy triad?
Sudden valgus impact with IR or ER of tibia
signs and symptoms of unhappy triad:
Swelling, hemorrhage, pain, impaired muscle control/inhibition
What is the critera necessary to get out of the acute phase of ACL injury
Minimal swelling and pain
Full ROM
SLR with NO LAG
Normal gait with no AD or brace
What is the most important motion to get at the knee in the acute phase
ext
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
TENS (treats arthrogenic muscle inhibiton)
What kind of disinhibitory treatment do you do for patients with no swelling/pain who are over 3 months post OP for acl injury
NMES to treat cortical inhibitions
When can you start doing single leg strengthening for ACL
around week 6
What is the critera for the strengthening phase for post-ACL injury
Squat equal on both sides
At what degrees of flexion are OKC exercises safe to preform for ACL injuries
when is there the most strain on the ACL?
between 90 and 40
between 40 and 0
T or F: There are simular strain values to the ACL when comparing open chain knee ext and closed chain squats
T
When can a patient start running, double leg jumping, and going back to gym after an ACL injury
functional phase: 8-16 weeks
Return to run criteria
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
At how many weeks can post ACL injury begin single leg hopping
how many weeks for cutting/changing direction
16 weeks
20 weeks
Return to sport critera for ACL
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
What are posterolateral corner repair patients not allowed to do at any point in rehab process
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
IT band syndrome factors
Excessive foot ______
Excessive _______ rotation/torsion
Genu ___________
Deep hip rotator/abductor weakness
innominate positioning
Pronation
Internal
genu varum
Osgood schlatter syndrome happens at the _______
Sinding larsen johansson syndrome happens at the _____________
Tibial Tuberosity
Inferior pole of patella
