knee Flashcards
1
Q
what are the generalized categories for knee injuries
A
- unspecified sprains and strains
- contusions
- meniscal or ligamentous injuries
2
Q
what colleratal ligament is thicker
A
the MCL
3
Q
what is the closed pack position of the knee
A
full extension
4
Q
what is the open packed position of the knee
A
30 degrees flexion
5
Q
ROM of tibial medial rotation
A
30-40
6
Q
ROM of tibial lateral rotation
A
20-30
7
Q
what is the primary restraint of the ACL
A
anterior translation and medial rotation
8
Q
what is the primary restraint of the PCL
A
posterior translation and medial rotation
9
Q
what is the primary restraint for the MCL
A
valgus and lateral rotation
10
Q
what is the primary restraint for the LCL
A
varus and lateral rotation
11
Q
what are the smaller ligaments of the menisci
A
- meniscotibial ligament (coronary) deep MCL
- transverse ligament
- meniscofermoral (deep MCL)
- acruate ligament
- obliques popliteal ligament
12
Q
what are the 5 facets of the patella
A
superior, inferior, medial, lateral and odd
13
Q
what are the purposes of the patellofemoral joint
A
1) increase the lererage or torque of the quads by increasing the axis of rotation
2) provide a boney protection when the knee is flexed
3) prevent damaging compressive forces on the quad tendon with resisted knee flexion
14
Q
petella glides
A
open packed: superior glide with knee extension
closed packed: inferior glide with knee extension relative to the femur
15
Q
what facet is in contact at 0 degrees knee ROM
A
none
16
Q
what facet is in contact at 15-20 degrees knee ROM
A
inferior
17
Q
what facet is in contact at 45 degrees knee ROM
A
middle
18
Q
what facet is in contact at 90 degrees knee ROM
A
all except the odd
19
Q
what facet is in contact at 140 /full flexion knee ROM
A
odd and lateral
20
Q
patellor loading (least impactful to most impactful)
A
(depends on the amount of knee flexion and eccentric loading of the quads)
walking, cycling, up stairs, down stairs, jogging, squatting, deep squatting, jumping
21
Q
what is the closed packed postion of the superior tib fib joint
A
wt bearing DF
22
Q
what are the degrees of motion of the superior tib fib joint
A
2 (anterior-lateral and posterior medial)
23
Q
what are the ligaments associated with superior tib-fib joint
A
anterior and posterior tib-fib and interosseous membrane
24
Q
what are the muscles that attach to the superior fibular head
A
biceps femoris and fib long and brev
25
what are mechanical knee symptoms
- locking or catching
- popping
- giving way
- pain with stairs
- difficult turning corners
26
what are the 5 ottawa knee rules
1) age greater then 55 or less then 18
2) unable to walk
3) tenderness to palpation of the patella
4) tenderness to palpation on the fibular head
5) unable to flex 90 degrees
27
what is the MOI of a ACL tear
usually non contact hyperextension and valgus
28
what is the subjective of ACL tear
- risk of injury is increased in women
- twisting or hyperextension hx
- sensation of their knee "popping" or "giving out" as the tibia subluxes anteriorly
- pain and immediate dysfunction
- instability
- immediate swelling
29
objective findings for the ACL
- large hemarthorsis
- pain
- potential involvement of near by structures
- positive special test (anterior drawer, lachmanns and pivot shift, lellis)
30
ACL graph choices
auto or allo graft
31
what are the pros of an allograph
- lack of harvest morbidity
- lass trauma a quicker surgery
- decreased post op pain
- easier and early rehab
- lack of limit to the size of the graft
32
what are the cons of an allograph
- slower rate of biologic incorporation and prolonged inflammatory response
- they stretch
- delayed revascularization and recellularization
- higher fail rate
33
does autograph choice affect failure rate
no they are both about 11%
34
what are the most importance factors in ACL recovery
aceiving full knee extension and good quad activation
35
when can you start jogging post op ACL repair
4-5 mo
36
what is RTS timeline post op ACL repair
7-12 mo
37
what are the 3 things that increase knee injury risk post op ACL
1) fear of re-injury
2) suboptimal knee function prior to RTS
3) returning to sport before 9 moths post repair
38
what percentage of pt return to some sport post op ACL
81%
39
what percentage of pts post ACL return to competitive sports
55% (65% return to pre injury level of activity)
40
what is the strongest and largest ligament in the knee
the PCL
41
MOI of a PCL injury
- external trauma
- direct blow to the anterior tibia or a fall onto the knee with the foot in a planter flexed position
42
Subjective of a PCL injury
- effusion within the first 24 hours
- limited ROM
- pain an instability in wt bearing
43
objective of the PCL injury
- effusion, decreased ROM, tenderness
- positive posterior drawer test and positive sagg sign
44
RTS timeline for PCL
9-12 mo
45
1 week post op PCL
brace locked to 0 degrees of extension
46
phase 1 post op PCL
1-4 weeks
WBAT, RICE, avoid sagg
47
phase 2 post op PCL
4-10 weeks
week 6: start AROM and strengthening
week 8: start stationary bike and SLS
48
phase 3 post op PCL
10+ weeks
closed chain strengthening, light plyos, running
49
what are the subjective findings for MCL sprain
- localized swelling or tenderness
- medial tenderness (tenderness proximal or distal to MCL might indicate an avulsion injury
- pain with flex and ex
- feel unstable
50
MOI of the MCL sprain
hit on the outside of knee while foot is planted
51
objective MCL sprain
grade 1: local tenderness on medial femoral condyle or medial tibial plateau. pain but no laxity with the valgus stress tests
grade 2: marked tenderness, mild to mod swelling and pain. laxity and pain at 30 degrees in stress test
grade 3: tenderness over MCL, extreme laxity at both 0 and 30 degrees with no pain, lateral meniscus might be involved
52
prognosis of grade 1 MCL/ LCL
10 days
53
px of grade 2 MCL/ LCL
3-4 weeks
54
px of grade 3 MCL/ LCL
6-8 weeks
55
MCL treatment
start bike early, quad sets, SLR, hip sex, hamstrings, and LE stretches
56
LCL MOI
varus impact with foot planted
57
LCL subjective
- localized swelling or tenderness
- lateral tenderness
- pain with flex and ex
- feel unstable
58
LCL objective
swelling, brusing, limited ROM due to pain, positive or painful varus stress test
59
what is a bakers (popliteal cyst)
abnormal collection of synovial fluid in the fatty layer of the popliteal fossa
60
subjective of a bakers/ popliteal cyst
- complaints of tightness/swelling behind the knee or pain down the back of the leg (for a larger cyst)
- insidious onset
- sometimes asymptomatic
61
objective of a bakers cyst
- pt prone and leg extended with a noticable mass visible in the popliteal fossa
62
tx for baskers cyst
non-invasive: RICE and NSAIDS
invasive: aspiration
63
MOI of a medial gastroc strain
acute, forceful push off with the foot joint in DF position. can be due to increased running loads, acceleration and decceleration as well as fatiguing conditions
64
subjective of medial gastroc strain
- complaints of pulling or tearing sensation in the calf
- may hold the ankle in PF to avoid placing tension on the injured muscle
65
objective meidal gastroc strain
- tenderness and swelling
- pain with PROM DF
- pain the AROM PF
- negative thompson test
- peripheral pulses are in tact
66
grade 1 medial gastroc strain RTS
a sharp pain that is felt at the time of injury or pain with activity; little to no loss of strength and ROM less then 10% decreased . RTS 1-3 weeks
67
grade 2 medial gastroc strain RTS
clear loss of strength and ROM with marked pain, swelling and bruising. Muscle fiber disruption between 10 and 50%. RTS: 3-6 weeks
68
grade 3 medial gastroc strain RTS
pain, swelling, tender, and bruised. RTS can take months
69
when can sport specific activities be resumed with medial gastroc strain
painfree full symmetrical ROM and full strength
70
MOI of meniscal tear
turning, twisting, or change in direction when wt bearing
71
subjective of a meniscal tear
popping swelling or clicking
pain along the joint line with twisting or squatting activites
72
what is the percentage of load transmittion in knee extension on the meniscus
50%
73
what is the percentage of load transmittion in knee 90 degrees of flexion on the meniscus
85%
74
how much does the presume increase with a rescission of 15-34%
350%
75
what are the objective findings of a meniscal tear
- tenderness of the medial or lateral joint line
- some effusion
- pain reproduced with forced flexion and circumduction
- postive mcmurrys, apleys, steinmann 1 sign, thesselies
76
what are the 4 surgical approaches for meniscal tear
- rehab
- menisctomy
- meniscus repair
- allograph transplantation
77
meniscetomy post op phase 1
1 day - 2 weeks: RICE and start neuro reedu on quads
78
meniscetomy post op phase 2
2-8 weeks: ROM and strengthening
79
meniscetomy post op phase 3
8+ weeks: plyos and RTS
80
athroscopic meniscus repair phase 1
0-6 weeks: ROM
81
athroscopic meniscus repair phase 2
6-12 weeks strengthening
82
athroscopic meniscus repair phase 3
12-16 weeks: begin jogging and running, SL strength, plyos
83
athroscopic meniscus repair phase 4
4-6 mo: RTS
84
what is osgood schlatters
osteochronditis of the inferior patella, osteochondritits of the tibial tuberosity or tibial tubercle traction apophysitis. form of periostitis that manifests as a partial avulsion of the tibial tuberosity
85
MOI of osgood schlatters
occurs during growth spurts
86
subjective of osgood schlatters
- gradually increasing pain and swelling below the involved knee
- involvement in sporting activities that involve running, jumping, and landing
87
objective of osgood schlatters
- prominance over the tibial turbercle
- mild swelling
- pinpoint tenderness over the tibial tuberosity
- limited knee flexion PROM
- painful AROM at all ranges
- Pain with resisted knee extension
- shorted HS, quads, or calfs
88
px of osgood schlatters
self-limiteing and spintaneously remitting over a period of 6- 24 mo
89
MOI of patellor tendonitis (jumpers knee)
- overuse condition that is associated with eccentric overloading during deceleration activites (jumping and downhill running)
- occurs over the inferior pole of the patella
90
subjective of patellor tendonitis
- hx of jumping or kicking sprots
- anterior knee pain
- pain at the end of exercise or following sitting
- pain with knee flexion
91
objective of patellor tendonitis
- localized tenderness at the inferior pole of the patella at the tibial tubercle or both
- AROM normal
- Pain with PROM knee flexion
- Pain with resisted knee extension
92
tx for patellar tendonitis
1) rest from aggravating activities
2) regain AROM
3) gradual resumption of aggravated s/s
93
what is patellofemoral pain syndrome
common disorder that is dx on the presence of anterior or retropatellar knee pain accociated with prolonged sitting or with wt bearing activites
94
subjective of patellofemoral pain syndrome
- anterior knee pain with stairs or hills
- instability of the patella
- no hx of trauma
- more common in female pts
95
patellofemoral pain syndrome objective
- valgus alignement
- femoral anteversion
- abnormal tracking
- weak quads
- generalized laxity of patellofemoral ligaments
- hip weakness
- poor eccentric quad control in wt bearing
- positive clarkes sign
- positive fairbanks for patellar instability
96
what is plica syndrome
fold in the synovium that becomes inflamed and thickened from trauma or overuse
97
what is the subjective of plica syndrome
- insidous onset of knee pain that my be related to a fall or injury
- activity related aching in the anterior or anteromedial aspects of the knee
- snapping or popping
98
objective of plica syndrome
- tenderness most commonly medial
- may produce snapping or popping at 60 degrees of knee flexion or PROM ex
99
MOI of prepatellar bursitis
bursa that is inflamed or infected as a result of trauma to the anterior knee or chronic irritations from activities such as kneeling
100
prepatellar bursitis subjective
complaints of knee swelling and knee pain just over the front of the knee
101
prepatellar bursitis objective
swelling directly over the inferior portion of the patella
- bursal sac (acute) or bursal sac thickening (chronic)
- normal AROM of knee
102
MOI ITB tendonitis
friction between the lateral femoral condyle and the ITB common in runners and cyclists
103
ITB tensonitis subjective
- lateral knee pain
- progressively worsening
104
ITB tendonitis objective
- tender at lateral femoral epicondyle
- soft tissue swelling and crepitus
- positive obers and nobles
105
patellor dislocation and instability
sublux of the patella laterally caused by an indirect trauma with a strong quad contraction while leg is in valgus
106
patellor dislocation and instability subjective
- feel a pop an immediate pain
- deformity
- painful knee flexion
- may spontaneously relocating living feelings of instability
107
patellor dislocation and instability objective
- laterally shifted patella
- patellar apprehension
- swelling
108
OA of the knee subjective
- insidious onset of pain/stuffness
- pain with wt bearing
- complaints of buckling, locking, or giving way
- difficulty with stairs
109
OA of the knee objective
- angular deformity (varus or valgus)
- effusion
- diffuse tenderness
- loss of AROM in capsular pattern
110
factor for the clincial dx of knee OA
1) age over 50
2) stiffness longer then 30 mins
3) crepitus
4) boney tenderness
5) boney enlargement
6) no warmth to palpation
greater then 3 highly sensitive
