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Musculoskeletal Pathophysiology > Knee > Flashcards

Knee Flashcards

1
Q

RA often presents with _____ deformity.

A

valgus

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2
Q

What is surgical tx for knee RA?

A

synovectomy

arthroplasty

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3
Q

Which is more common at the knee, RA or OA?

A

OA

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4
Q

Role of ACL?

A

prevent anterior translation of tibia on femur

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5
Q

Role of PCL?

A

prevent posterior translation of tibia on femur

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6
Q

OA often presents with _____ deformity.

A

varus

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7
Q

What ages have higher incidence of OA?

A

> 50 ya

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8
Q

OA at the knee results in loss of _____ joint space. Leads to:

A

medial

severe genu varus

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9
Q

Pharma and Nutri management of OA?

A 
NSAIDS
OTC analgesics
acetominophen
chondrointin sulfate
glucosamine sulfate
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10
Q

Surgical management of knee OA?

A
  1. arthroplasty (most common)
  2. osteotomy (corrects deformity)
  3. Osteochondral autograft
  4. autologous chondrocyte implantation
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11
Q

Hyalgan, synvisc, orthovisc, euflexxa are examples of:

A

visco-supplementaion injections

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12
Q

What is unconstrained knee arthroplasty?

A

spares PCL

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13
Q

What is constrained knee arthroplasty? When is it used?

A

removes PCL and has mechanical link for stability

used when there is poor ligamentous support or as a revision for a failed TKR

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14
Q

When would unicondylar replacement be selected?

A

when most of joint destruction is limited to one side (usually medial)

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15
Q

When is osteochondral autograft used?

A

used with small lesions 1-1.5 cm

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16
Q

TKR post-op concerns?

A 
infection
DVT
wound healing
terminal extension
functional motion for stairs
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17
Q

Describe what happens with high tibial osteotomy for medial compartment OA:

A

remove lateral wedge
realign jt surface
NWB for 6 weeks

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18
Q

Describe what happens with an osteochondral autograft:

A

small piece of bone articular cartilage is moved from NWB area onto WB area (NWB for 6 weeks)

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19
Q

When is high tibial osteotomy used?

A

used mostly with younger patients

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20
Q

Tibial plateau fx are more prevalent on the ____ side.

A

Lateral (80%)

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21
Q

Tibial plateau fx often involve which ligament?

A

MCL (needs to be controlled with motion brace set at 45 degrees)

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22
Q

Lateral tibial plateau fx is secondary to:

A

valgus force with compression and knee in flexion

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23
Q

What is a common mechanism of injury for patella fx?

A

direct blow or traction from a quad injury

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24
Q

Patella alta ratio:

A

> 1:1

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25
Q

Patella balta ratio:

A

< 1:1

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26
Q

Osteochonditiris dessicans is usually a result of:

A

osteochondral fx

usually lateral aspect of medial femoral condyle

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27
Q

What are degenerative changes related to patellar dsyfxn?

A

softening and erosion of patellar articular cartilage

significant pain and crepitus under patella with motion

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28
Q

How is patellar degeneration treated?

A

arthrospopic debridement OR replacement of undersurface of patella

29
Q

Lateral tracking dysfxn signs and symptoms?

A

anterior knee pain worse with sitting, stairs, cycling
crepitus
more common in women
may be related to Q angle, pronated feet

30
Q

Which gender more commonly experiences patellar subluxation?

31
Q

Patella more often dislocates/subluxes in which direction?

A

dislocates/subluxes laterally

32
Q

What is the clinical sign for patellar sublux?

A

apprehension test

33
Q

What is the Tx for patellar sublux?

A

closed reduction, braced in extension for 2-3 wks

34
Q

When does patellar sublux most often?

A

planted foot and ER of femur with strong quad contraction

35
Q

Osgood Schlatter disease is described as:

A

traction apophysitis of patellar tendon at tibial tubercle

36
Q

Osgood Schlatter disease usually occurs in

A

adolescents

37
Q

Osgood Schlatter disease signs and treatment?

A

pain with activity
may see lump on anterior tibia
treat by restricting vigorous activity until healed

38
Q

Name the injury:

Anterior knee pain and edema that is worse with resistance to knee extension is.

A

Patellar tendinitis

39
Q

Name the injury:

Often secondary to forceful quad contraction when knee is in flexed position with potential for myositis ossificans.

A

quad rupture

40
Q

Name the injury:

Tendon irritation over lateral femoral condyle.

A

ITB friction syndrome

41
Q

Medial: Lateral meniscal injury incidence?

42
Q

Medial meniscus injury associated with:

A

MCL and ACL injury

43
Q

Lateral meniscus injury associated with:

A

cyst - must be fully removed

44
Q

Meniscal injury clinical test

45
Q

Meniscal signs?

A 
pain
edema/effusion
locking
clicking
restricted motion
46
Q

Management of meniscal injuries:

A
  1. menisectomy (partial arthroscopic excision of fragment)

2. repair (if tear is in “red zone” where there is enough vascularity for healing)

47
Q

What is synovial plica?

A

folds of remnants of embryonic synovial tissue in the knee

48
Q

Signs and symptoms of plica?

A

pain with prolonged knee flexion, sitting

clicking/locking

49
Q

How is plica treated?

A

arthroscopic removal

50
Q

Name the components of the unhappy triad:

A

Medial collateral ligament
medial meniscus
Anterior cruciate ligament
(requires surgery to promote stability)

51
Q

Which has greater incidence of injury, MCL or LCL?

52
Q

MCL and LCL injury Sxs:

A

pain

giving way/frank instability

53
Q

Clinical tests for MCL/LCL:

A

valgus and varus stress tests

54
Q

1st degree collateral injury Tx:

A

RICE

support 1-2 wks

55
Q

2nd degree collateral injury Tx:

A

RICE
immobilize 2-3 wks
assistive device for WB

56
Q

3rd degree collateral injury Tx:

A

Full tear
Requires reconstruction (may be arthroscopic)
Controlled motion bracing
Assistive device

57
Q

ACL mechanism of injury:

A

valgus/ER force with foot planted OR excessive IR

58
Q

PCL mechanism of injury:

A

anteromedial blow to flexed knee or fall onto knee

59
Q

Cruciate ligament tests?

A

lachman

drawer signs

60
Q

What are Sxs of cruciate ligament injury?

A

pain
effusion
single plane OR rotary instability

61
Q

Describe surgical reconstruction for ACL:

A
  1. mid 1/3 patellar tendon (bone-tendon bone graft)
  2. hamstring graft
  3. augmentation with allograft (less common)
62
Q

Name some rehab issues for ACL reconstruction:

A
  1. minimize immobility effects w/out overloading soft tissues
  2. graft is strongest right after operation, then gets avascular and necrotic
  3. revascularization of the graft at 8-10 wks
  4. up to 1 year to remodel and become dense mature ligament
63
Q

Rehab principles for ACL reconstruction:

A
  1. early: closed chain exercises better
  2. limit open chain knee extension
  3. achieve early full AROM
64
Q

Pre-patellar bursitis, AKA?

A

“housmaid’s knee”

65
Q

Infra-patella bursitis, AKA?

A

“clergyman’s knee”

66
Q

What are the 4 common busae of the knee?

A
  1. pre-patellar
  2. infra-patellar
  3. pes anserine (just distal to medial joint)
  4. popliteal
67
Q

GIVING WAY is a symptom that may be associated with which injuries?

A

ligament injury
meniscal injury
patellar dislocation
quad inhibition

68
Q

LOCKING is a symptom that may be associated with which injuries?

A

meniscal injury
synovial plica
osteochondritis dessicans

Musculoskeletal Pathophysiology (14 decks)

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