Knee 2 Flashcards
which meniscus is more c shaped?
medial
describe the relative relationship of the semitendinosus and semimembranosus at the knee
semimembranosus is deep to the semitendinosis
describe the physical exam for medial plica?
the tibia is rotated internally, then the knee is passively extended and flexed between 30 and 100 degrees while the examiner palpates the medial patellofemoral joint, feeling for pop, click, or tenderness
when can you consider surgery for a grade 3 MCL tear?
if there are other associated injuries
what does the prone external rotation test (Dial test) test for ? 2 structures
posterolateral corner (30 degrees) and PCL if asymmetry is noted at both 30 and 90 degrees
describe the posterolateral drawer test
90 degrees knee flexion with external rotation of the tibia, push on the tibia posteriorly, positive test is excessive posterior rotation of the lateral tibial condyle
describe the reverse pivot shift test
90 degrees knee flexion, externally rotate the tibia. extend the knee to feel a clunk as the tibia reduces
what does the reverse pivot shift test evaluate for?
lateral ligament laxity/ injury
what is the arcuate sign on knee imaging and what does it indicate?
avulsion of the proximal fibula with the posterolateral ligament complex and indicates posterolateral instability
what is the lateral capsular sign on knee imaging and what does it indicate?
avulsion of the midportion of the lateral capsular ligament with small fragement of proximal lateral tibia, associated with high incidence of ACL tear and indicates anterolateral instability
injury to the middle third of the lateral capsular ligament of the knee shown by the lateral capsular sign on radiograph is usually associated with what injury?
ACL injury
what are the three cornerstones of management for LCL grade I and II sprains?
crutches, RICE and rehab
what are the two major bundles of the ACL?
anteromedial and posterolateral
on MR imaging, a patient has kissing subchondral bruising of the middle third of the lateral femoral condyle and posterior third of the lateral tibial plateau. This pattern is present in over half of cases involving what major ligament injury?
ACL tear
ACL reconstruction is typically delayed how long after initial injury to allow or decrease in swelling and increase in ROM?
3 weeks
t/f a partial ACL tear can be treated with PRICES, functional rehab and protective bracing
true
what are the two bundles of the PCL?
posteromedial and anterolateral
t/f a positive abduction or adduction stress test in 0 degrees can indicate PCL pathology
true
which meniscus is most prone to tears? why?
medial - less mobile compared to lateral
what is the arterial supply of the ACL and PCL?
middle geniculate artery
the double PCL sign on MRI is indicative of what?
bucket handle meniscal tear
what are three three main types of autograft options for ACL reconstruction?
patellar tendon, hamstring tendon (semiT / gracilis) and quad tendon
a patient who is s/p ACL reconstruction now presents with painful anterior knee mass, loss of extension, and a click at terminal extension. what is the most likely diagnosis?
cyclops lesion - localized anterior knee arthrofibrosis
what does the evidence say for functional bracing after ACL reconstruction
evidence does not support use of functional bracing
what are the classifications for lachman testing?
1 : 1-5mm translation
2: 6-10 mm translation
3. > 10mm translation
a - firm end point
b - no firm end point
what is the general treatment for grade 1 or 2 PCL injury
conservative , non operative, protected weightbearing
what is the treatment for PCL injury if combined with other ligamentous injuries?
operative treatment
what is the typical return to sport time for a grade 1 MCL injury?
7 days
what type of knee brace do you use for grade II / III MCL injury?
hinged knee brace
what is the usual treatment for grade I LCL injury?
non operative treatment with limited mobilization, progressive ROM, functional rehab
what is the typical return to sport time for grade I LCL injury?
6-8 weeks
what is the first step in assessment for a player with suspected multiligamentous knee injury?
neurovascular assessment
ITB avulsion from Gerdy’s tubercle, biceps femoris avulsion from femoral head and popliteus avulsion are seen in what general type of knee injury?
posterolateral corner injury
what is the typical return to sport time for grade II MCL injury?
2-4 weeks
what are the three hallmarks of non operative treatment for grade II MCL injury?
hinged knee brace, weightbearing as tolerated and range of motion exercises
after meniscus repair, what is the typical RTP time?
6-8 months
why are lateral meniscus tears less common?
lateral meniscus is more mobile
what is the most vascular zone of the meniscus?
peripheral
meniscectomy increases the risk of future development of what?
arthritic changes of the knee
generally, immobilization of the knee is contraindicated after patella dislocation. when can you consider immobilization?
first time dislocation, only for symptom management
what are the three cornerstones of management for a recurrent patella dislocation?
crutches, functional rehab and patella bracing
t/f there may be swelling, snapping or popping around the patella in PFPS
true
a patient has recurrent painful catching episodes over the medial patellofemoral joint. what is the most likely diagnosis?
painful synovial plica
what rotation will you place the tibia in to palpate plica?
internal rotation
t/f imaging is not helpful for painful synovial plica
true
you should evaluate for muscular tightness in what three areas in a patient with Osgood Schlatter?
hamstring, quad, and heel cord
treatment for pes anserine bursitis should involve rehab focusing on stretching of what muscle group?
hamstrings
in addition to hamstring stretching, what else can you do to treat deep infrapatellar bursitis?
CSI posterior to patellar tendon
why is immobilization usually inappropriate for the treatment of tendinitis involving tendons surrounding the knee joint?
causes adverse effects on collagen tissue and muscle atrophy
on XR examination of the lateral view of the knee, you see fat (lower density) on top of blood in the knee joint. what is this diagnosis and what does this most likely indicate?
lipohemarthrosis - indicates fracture until proven otherwise
an ACL on MRI typically appears what color?
dark/black
a segond fracture consists of avulsion of what ligament?
anterolateral ligament avulsion
what is the anatomic landmark called that you should look for on lateral view of the knee MRI to evaluate the integrity of the ACL?
blumensaat’s line
what is considered a normal lateral center edge angle on hip AP view?
25-39 degrees
