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Ortho LE and UE > knee > Flashcards

knee Flashcards

1
Q

what are the generalized categories for knee injuries

A
  • unspecified sprains and strains
  • contusions
  • meniscal or ligamentous injuries
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2
Q

what colleratal ligament is thicker

A

the MCL

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3
Q

what is the closed pack position of the knee

A

full extension

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4
Q

what is the open packed position of the knee

A

30 degrees flexion

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5
Q

ROM of tibial medial rotation

A

30-40

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6
Q

ROM of tibial lateral rotation

A

20-30

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7
Q

what is the primary restraint of the ACL

A

anterior translation and medial rotation

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8
Q

what is the primary restraint of the PCL

A

posterior translation and medial rotation

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9
Q

what is the primary restraint for the MCL

A

valgus and lateral rotation

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10
Q

what is the primary restraint for the LCL

A

varus and lateral rotation

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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
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12
Q

what are the 5 facets of the patella

A

superior, inferior, medial, lateral and odd

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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

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14
Q

petella glides

A

open packed: superior glide with knee extension
closed packed: inferior glide with knee extension relative to the femur

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15
Q

what facet is in contact at 0 degrees knee ROM

A

none

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16
Q

what facet is in contact at 15-20 degrees knee ROM

A

inferior

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17
Q

what facet is in contact at 45 degrees knee ROM

A

middle

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18
Q

what facet is in contact at 90 degrees knee ROM

A

all except the odd

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19
Q

what facet is in contact at 140 /full flexion knee ROM

A

odd and lateral

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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

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21
Q

what is the closed packed postion of the superior tib fib joint

A

wt bearing DF

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22
Q

what are the degrees of motion of the superior tib fib joint

A

2 (anterior-lateral and posterior medial)

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23
Q

what are the ligaments associated with superior tib-fib joint

A

anterior and posterior tib-fib and interosseous membrane

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24
Q

what are the muscles that attach to the superior fibular head

A

biceps femoris and fib long and brev

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25
Q

what are mechanical knee symptoms

A
  • locking or catching
  • popping
  • giving way
  • pain with stairs
  • difficult turning corners
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26
Q

what are the 5 ottawa knee rules

A

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

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27
Q

what is the MOI of a ACL tear

A

usually non contact hyperextension and valgus

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28
Q

what is the subjective of ACL tear

A
  • 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
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29
Q

objective findings for the ACL

A
  • large hemarthorsis
  • pain
  • potential involvement of near by structures
  • positive special test (anterior drawer, lachmanns and pivot shift, lellis)
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30
Q

ACL graph choices

A

auto or allo graft

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31
Q

what are the pros of an allograph

A
  • 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
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32
Q

what are the cons of an allograph

A
  • slower rate of biologic incorporation and prolonged inflammatory response
  • they stretch
  • delayed revascularization and recellularization
  • higher fail rate
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33
Q

does autograph choice affect failure rate

A

no they are both about 11%

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34
Q

what are the most importance factors in ACL recovery

A

aceiving full knee extension and good quad activation

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35
Q

when can you start jogging post op ACL repair

A

4-5 mo

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36
Q

what is RTS timeline post op ACL repair

A

7-12 mo

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37
Q

what are the 3 things that increase knee injury risk post op ACL

A

1) fear of re-injury
2) suboptimal knee function prior to RTS
3) returning to sport before 9 moths post repair

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38
Q

what percentage of pt return to some sport post op ACL

A

81%

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39
Q

what percentage of pts post ACL return to competitive sports

A

55% (65% return to pre injury level of activity)

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40
Q

what is the strongest and largest ligament in the knee

A

the PCL

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41
Q

MOI of a PCL injury

A
  • external trauma
  • direct blow to the anterior tibia or a fall onto the knee with the foot in a planter flexed position
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42
Q

Subjective of a PCL injury

A
  • effusion within the first 24 hours
  • limited ROM
  • pain an instability in wt bearing
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43
Q

objective of the PCL injury

A
  • effusion, decreased ROM, tenderness
  • positive posterior drawer test and positive sagg sign
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44
Q

RTS timeline for PCL

A

9-12 mo

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45
Q

1 week post op PCL

A

brace locked to 0 degrees of extension

46
Q

phase 1 post op PCL

A

1-4 weeks
WBAT, RICE, avoid sagg

47
Q

phase 2 post op PCL

A

4-10 weeks
week 6: start AROM and strengthening
week 8: start stationary bike and SLS

48
Q

phase 3 post op PCL

A

10+ weeks
closed chain strengthening, light plyos, running

49
Q

what are the subjective findings for MCL sprain

A
  • 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
Q

MOI of the MCL sprain

A

hit on the outside of knee while foot is planted

51
Q

objective MCL sprain

A

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
Q

prognosis of grade 1 MCL/ LCL

A

10 days

53
Q

px of grade 2 MCL/ LCL

A

3-4 weeks

54
Q

px of grade 3 MCL/ LCL

A

6-8 weeks

55
Q

MCL treatment

A

start bike early, quad sets, SLR, hip sex, hamstrings, and LE stretches

56
Q

LCL MOI

A

varus impact with foot planted

57
Q

LCL subjective

A
  • localized swelling or tenderness
  • lateral tenderness
  • pain with flex and ex
  • feel unstable
58
Q

LCL objective

A

swelling, brusing, limited ROM due to pain, positive or painful varus stress test

59
Q

what is a bakers (popliteal cyst)

A

abnormal collection of synovial fluid in the fatty layer of the popliteal fossa

60
Q

subjective of a bakers/ popliteal cyst

A
  • complaints of tightness/swelling behind the knee or pain down the back of the leg (for a larger cyst)
  • insidious onset
  • sometimes asymptomatic
61
Q

objective of a bakers cyst

A
  • pt prone and leg extended with a noticable mass visible in the popliteal fossa
62
Q

tx for baskers cyst

A

non-invasive: RICE and NSAIDS
invasive: aspiration

63
Q

MOI of a medial gastroc strain

A

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
Q

subjective of medial gastroc strain

A
  • complaints of pulling or tearing sensation in the calf
  • may hold the ankle in PF to avoid placing tension on the injured muscle
65
Q

objective meidal gastroc strain

A
  • tenderness and swelling
  • pain with PROM DF
  • pain the AROM PF
  • negative thompson test
  • peripheral pulses are in tact
66
Q

grade 1 medial gastroc strain RTS

A

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
Q

grade 2 medial gastroc strain RTS

A

clear loss of strength and ROM with marked pain, swelling and bruising. Muscle fiber disruption between 10 and 50%. RTS: 3-6 weeks

68
Q

grade 3 medial gastroc strain RTS

A

pain, swelling, tender, and bruised. RTS can take months

69
Q

when can sport specific activities be resumed with medial gastroc strain

A

painfree full symmetrical ROM and full strength

70
Q

MOI of meniscal tear

A

turning, twisting, or change in direction when wt bearing

71
Q

subjective of a meniscal tear

A

popping swelling or clicking
pain along the joint line with twisting or squatting activites

72
Q

what is the percentage of load transmittion in knee extension on the meniscus

A

50%

73
Q

what is the percentage of load transmittion in knee 90 degrees of flexion on the meniscus

A

85%

74
Q

how much does the presume increase with a rescission of 15-34%

A

350%

75
Q

what are the objective findings of a meniscal tear

A
  • 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
Q

what are the 4 surgical approaches for meniscal tear

A
  • rehab
  • menisctomy
  • meniscus repair
  • allograph transplantation
77
Q

meniscetomy post op phase 1

A

1 day - 2 weeks: RICE and start neuro reedu on quads

78
Q

meniscetomy post op phase 2

A

2-8 weeks: ROM and strengthening

79
Q

meniscetomy post op phase 3

A

8+ weeks: plyos and RTS

80
Q

athroscopic meniscus repair phase 1

A

0-6 weeks: ROM

81
Q

athroscopic meniscus repair phase 2

A

6-12 weeks strengthening

82
Q

athroscopic meniscus repair phase 3

A

12-16 weeks: begin jogging and running, SL strength, plyos

83
Q

athroscopic meniscus repair phase 4

A

4-6 mo: RTS

84
Q

what is osgood schlatters

A

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
Q

MOI of osgood schlatters

A

occurs during growth spurts

86
Q

subjective of osgood schlatters

A
  • gradually increasing pain and swelling below the involved knee
  • involvement in sporting activities that involve running, jumping, and landing
87
Q

objective of osgood schlatters

A
  • 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
Q

px of osgood schlatters

A

self-limiteing and spintaneously remitting over a period of 6- 24 mo

89
Q

MOI of patellor tendonitis (jumpers knee)

A
  • overuse condition that is associated with eccentric overloading during deceleration activites (jumping and downhill running)
  • occurs over the inferior pole of the patella
90
Q

subjective of patellor tendonitis

A
  • hx of jumping or kicking sprots
  • anterior knee pain
  • pain at the end of exercise or following sitting
  • pain with knee flexion
91
Q

objective of patellor tendonitis

A
  • 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
Q

tx for patellar tendonitis

A

1) rest from aggravating activities
2) regain AROM
3) gradual resumption of aggravated s/s

93
Q

what is patellofemoral pain syndrome

A

common disorder that is dx on the presence of anterior or retropatellar knee pain accociated with prolonged sitting or with wt bearing activites

94
Q

subjective of patellofemoral pain syndrome

A
  • anterior knee pain with stairs or hills
  • instability of the patella
  • no hx of trauma
  • more common in female pts
95
Q

patellofemoral pain syndrome objective

A
  • 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
Q

what is plica syndrome

A

fold in the synovium that becomes inflamed and thickened from trauma or overuse

97
Q

what is the subjective of plica syndrome

A
  • 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
Q

objective of plica syndrome

A
  • tenderness most commonly medial
  • may produce snapping or popping at 60 degrees of knee flexion or PROM ex
99
Q

MOI of prepatellar bursitis

A

bursa that is inflamed or infected as a result of trauma to the anterior knee or chronic irritations from activities such as kneeling

100
Q

prepatellar bursitis subjective

A

complaints of knee swelling and knee pain just over the front of the knee

101
Q

prepatellar bursitis objective

A

swelling directly over the inferior portion of the patella
- bursal sac (acute) or bursal sac thickening (chronic)
- normal AROM of knee

102
Q

MOI ITB tendonitis

A

friction between the lateral femoral condyle and the ITB common in runners and cyclists

103
Q

ITB tensonitis subjective

A
  • lateral knee pain
  • progressively worsening
104
Q

ITB tendonitis objective

A
  • tender at lateral femoral epicondyle
  • soft tissue swelling and crepitus
  • positive obers and nobles
105
Q

patellor dislocation and instability

A

sublux of the patella laterally caused by an indirect trauma with a strong quad contraction while leg is in valgus

106
Q

patellor dislocation and instability subjective

A
  • feel a pop an immediate pain
  • deformity
  • painful knee flexion
  • may spontaneously relocating living feelings of instability
107
Q

patellor dislocation and instability objective

A
  • laterally shifted patella
  • patellar apprehension
  • swelling
108
Q

OA of the knee subjective

A
  • insidious onset of pain/stuffness
  • pain with wt bearing
  • complaints of buckling, locking, or giving way
  • difficulty with stairs
109
Q

OA of the knee objective

A
  • angular deformity (varus or valgus)
  • effusion
  • diffuse tenderness
  • loss of AROM in capsular pattern
110
Q

factor for the clincial dx of knee OA

A

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

Ortho LE and UE (7 decks)

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