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Knee Flashcards

1
Q

Ottawa Knee Rules, send to XR for any of the following:

A

Age > 55
Isolated tenderness of patella (no other knee bone tenderness)
Tenderness of the head of the fibula
Inability to flex knee >90
Inability to WB both immediately and in the ED regardless of limping

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2
Q

What is compartment syndrome?

A

Osseofascialcompartment pressure rises to a level that decreases perfusion. Acute usually due to trauma, key symptoms is pain out of proportion to clinical situation, usually first symptom. 6 P’s!

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3
Q

What are the 6 P’s of compartment syndrome?

A

Pain, Palpable tenderness, Paresthesia, Paresis, Pallor, Pulselessness

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4
Q

Osteochondritis dissecans

A

WHO: children and adolescents

Segment of bone cracks and loosens away resulting in loosening of cartilage as well. Disruption of blood supply possibly from repetitive jumping/loading

Treatment:
Relative Rest Mostly,
SX possibly

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5
Q

ACL tear

A

usually from sudden pivoting, audible pop, instability, and effusion within 1 or 2 hours.

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6
Q

PCL tear

A

usually from blunt trauma to anterior tibia, sudden hyperflexion or extension injury, pain with kneeling

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7
Q

Medial plica syndrome

A

Acute or chronic medial knee pain, overuse, onset of new activities, may report mechanical symptoms such as popping or clicking

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8
Q

menisical tear

A

Male, age >40
can be due to cutting or twisting injury while bearing weight, effusion within 24 to 48 hours, locking or giving away

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9
Q

Patellar subluxation or dissocation

A

anterior pain in children and adolescents, history of subluxation

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10
Q

What is a common cause of anterior knee pain?

A

Patellar subluxation or dislocation, tibial apophysitis (Osgood-Schlatter), jumper’s knee, and patellofemoral pain syndrome.

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11
Q

What are common causes of medial knee pain?

A

Medial collateral ligament sprain, medial meniscal tear, pes anserine bursitis, medial plica syndrome

Each of these conditions can lead to pain on the inner side of the knee.

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12
Q

What is a common injury associated with posterior knee pain?

A

Popliteal cyst (Baker’s cyst), Posterior cruciate ligament injury

This condition involves swelling behind the knee.

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13
Q

What is a common cause of lateral knee pain?

A

Lateral collateral ligament sprain, lateral meniscal tear, iliotibial band tendonitis

These conditions affect the outer side of the knee.

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14
Q

What is the Zohler Sign?

A

Grasp the patella and apply a caudal glide then ask the patient to contract the quad. POS: retro-patellar pain

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15
Q

How is the Clarke test performed?

A

Add a mild compression to the patella and ask the patient to contract the quad. POS = retro-patellar pain

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16
Q

What is the scoring criteria for the lateral step down test?

A

7 Point Scale
0-1 = Good
2+ = moderate

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17
Q

What is the Anteromedial Bundle of the ACL responsible for?

A

Tension at full extension

The Anteromedial Bundle maintains tension when the knee is fully extended.

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18
Q

When does the ACL reach maximum tension?

A

45-60 degrees of flexion

This range indicates the optimal flexion angle for ACL tension.

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19
Q

What is the role of the Posterolateral Bundle of the ACL?

A

Tension at full extension

Similar to the Anteromedial Bundle, it also maintains tension when the knee is fully extended.

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20
Q

What happens to the ACL under <30 degrees of flexion?

A

Tension to anterior translation

This indicates the ACL’s role in preventing forward movement of the tibia.

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21
Q

What occurs at 60-90 degrees of flexion concerning the ACL?

A

Laxity and tibial rotation

The ACL becomes less taut, allowing for rotation of the tibia.

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22
Q

What are the bundles of the PCL?

A

Anterolateral and Posteromedial bundles

These bundles work together to stabilize the knee.

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23
Q

How does the tensile strength of the PCL compare to the ACL?

A

50% thicker and 2x tensile strength

This indicates that the PCL is more robust than the ACL.

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24
Q

At what degree of flexion is the PCL most resistant to posterior force?

A

90 degrees of flexion

This position provides maximum stability against posterior forces.

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25
What happens to the PCL's resistance as the knee is more extended?
Less resistance to posterior force ## Footnote The effectiveness of the PCL decreases as the knee approaches full extension.
26
What movement does the PCL restrain?
Internal rotation of the tibia on the femur ## Footnote This is essential for maintaining knee stability.
27
What is a key characteristic of Patella Tendon reconstruction?
Extension Lag ## Footnote Extension lag refers to the inability to fully extend the knee after surgery.
28
What is a notable effect on quadriceps strength after Patella Tendon reconstruction?
Quad strength deficits longer ## Footnote This indicates that patients may experience prolonged weakness in the quadriceps muscle.
29
What is a significant outcome associated with HS Graph reconstruction?
Increased anterior knee laxity ## Footnote Anterior knee laxity refers to the increased looseness or instability in the anterior part of the knee joint.
30
Diagnosis of Knee OA – Altman Criteria
Knee pain and 3 of 6 or more: Age >50-years Stiffness <30 minutes Crepitus Bony tenderness Bony enlargement No palpable warmth
31
Treatment for Knee OA - CPR
5 Variables (1) hip or groin pain or paresthesia, (2) anterior thigh pain, (3) passive knee flexion less than 122 degrees, (4) passive hip medial (internal) rotation less than 17 degrees, and (5) pain with hip distraction If 1/5 present +LR= 5.1 If 2/5 present +LR= 12.9
32
What is pes anserine bursitis?
inflammation of the bursa beneath SGT tendons that attach to pes anserine
33
who usually gets pes anserine bursistis?
middle age, women, overweight, early stage knee OA and diabetes, patients participating in activities involving excessive lateral movement
34
How does pes anserine bursitis present?
inflammation, spontaneous, swelling, pain with palpation. Hurts during stairs and STS
35
What special tests would you do for pes anserine bursitis?
HS length palpation
36
who usually gets Patellar tendonosis/tendinopathy?
12-19 y/o and 50-59 y/o Not signficant towards one sex Athletes (jumping)
37
How does patellar tendonosis/tendinopathy present?
Gradual or quick onset not associated with injury, Increased pain swelling with participation in repetitive aggravating factors. Localized knee pain, signs of inflammation, irritation with repetitive loading of the knee, valgus of knee, patellar tracking
38
What special tests would you do for patellar tendonosis/tendinopathy?
Zohler's sign Clarke Test Lateral step down test
39
What is Tibial apophysitis (Osgood-Schlatter lesion)?
inflammation/irritation below the knee, specifically around the tibial tubercle
40
Who usually gets Tibial apophysitis (Osgood-Schlatter lesion)?
11 y/o- 14y/o (early teens) male athlete w/ freq jumping, running, or squatting
41
How does Tibial apophysitis (Osgood-Schlatter lesion) present?
pain on tibial tuberosity/patellar tendon, pain with activities with excessive use of quad (jumping, running, squatting, stair climbing, etc.
42
Who usually gets IT band tendonitis
15-50 years old women > men "athletes involved in repetitive activities (running) or a sudden increase in activity"
43
How does IT band tendonitis present?
sharp pain on lateral aspect of knee and/or hip especially during heel strike and running, pain in lateral aspect of knee when extending knee while applying pressure on lateral femoral condyle (noble test). possible palpable cyst
44
What special tests would you do for IT band tendonitis?
Noble's Compression Test Ober Test Renne Test
45
What is a Popliteal cyst (Baker's cyst)?
fluid filled bursa that develops behind the knee (intrarticular inflammatory
46
Who usually gets a Bakers cyst?
more common in adults but can occur in children OA, RA, gout, ACLor meniscal tears
47
How does a Baker's Cyst present?
vague posterior popliteal region, Any activities with knee flexion that can cause pressure on cyst will cause pain, Palpable mass, sharp pain in the knee and calf, swelling or erythema of the calf, sensation that feels like water running down the calf
48
What special tests do you want to do for a Baker's Cyst?
Foucher's sign Ultrasound Imaging
49
What is Medial plica syndrome?
Derangement of one of the 4 shelf-like membranes (plicae) that separate the synovium of the patella and the Tib-Fem joint. They are elastic, allowing knee joint movement, but with repetitive movememnt or trauma they can become irritated. Plicae form in early development to separate the knee into 3 compartments (Suprapatellar, medial & lateral tibiofemoral). Sometimes the mesenchymal tissue forming them are not reabsorbed, leaving observable inward folds in the knee.
50
Who usually gets Medial plica syndrome?
children and adolesents, medial most common! May be common in active youth who engage in repetitive sports (cycling, running, rowing, etc).
51
How does Medial Plica syndrome present?
Vague, non-specific anterior/medial knee pain. Tender on palpation, pain when the PF joint is loaded (knee flexion). Examples: sit to stand, squatting and stair use, usually have clicking and popping
52
What special tests would you want to do for Medial Plica Syndrome?
Stutter Test Hughston Test Mital-Hayden Test (Mediopatellar Plica Test)
53
What is the Patella ballottement test(AKA) Patella tap test?
Test for knee effusion Clinician pushes the fluid to the knee Tap (thumb or fingers) on the patella pushing it posteriorly POS = floating patella that taps the femoral condyle
54
Posterior Sag (Godfrey) Sign
For PCl, Step 1 – observe the position Step 2 – ask for isometric HS contraction
55
Describe the pivot shift test
begin in extension, grasp the heel and add IR of the tibia. With the proximal hand apply a valgus stress (lateral fibula region). Then using both hands move the pts knee into flexion looking for a clunk or feeling of instability (POS). If clunk or instability = positive for ACL tear.
56
Describe the dial test
for Posterolateral Corner Injury, Dial Test Part 1. Grasp B feet, flex 45-60 degrees and rotate both legs externally (Tibia ER). If one side is excessively more than the other suspect posterlateral corner injury. Dial Test Part 2. Grasp B feet, flex 90 degrees and rotate both legs externally (Tibia ER). If one side is excessively more than the other suspect posterlateral corner AND PCL injury.
57
Describe the Thessaly Test
For meniscus tear, Test the uninvolved side 1st Begin at 5 degrees knee flexion, Rotate 3x IR & ER Repeat at 20 degree knee flexion The test is positive if there is a sense of locking, catching, or pain at either the medial or lateral joint line.
58
Describe the Apley test
For meniscus tear, Prone & Flex knee to 90 Distraction and Compression with rotation (Both IR and ER) Possibly useful for meniscus tear with compression
59
Describe the Renne Test
For ITB Friction, Apply pressure along the lateral femoral condyle Patient stands on involved side and flexes and extends knee POS for pain or crepitus around 30 degrees knee flexion
60
What is the open and closed packed position of the tibiofemoral joint?
Open Packed: 25 Flexion Closed Packed: Ext + Tibial ER
61
Describe inferior and superior glide patellar mobs
Inferior Glide for Flexion Superior Glide for Extension
62
What direction would improve from doing an anterior tibial glide?
Extension
63
What bundle of the ACL does the lachman's test assess?
anteromedial bundle
64
What bundles of the ACL does the anterior drawer test assess?
anteromedial and posterolateral bundles
65
What specific thing are you testing for in a pivot shift test for ACL?
rotatory instability of the knee
66
At what degrees is there peak loading forces on the ACL?
low degrees of flexion: 0-30 degrees
67
At what point in gait is loading the highest on the ACL?
Midstance
68
What is ligamentization in terms of ACL rehab?
Process by which the ACL graft transitions into are more mature "ligament" -Not as strong as the original ACL  -Will visually appear like an ACL but structurally different in terms of collagen make up Process can take up to 1-2 years following surgery

Advanced Orthopedics (8 decks)

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