Knee 3 (test 3) Flashcards
prevalence of meniscus injury
2nd most common knee injury
medial is injured more than lateral
posterior horn > anterior horn
risk factors for meniscus injury
acute injury = all WBing sports
degenerative injury
-older age
-male > female
-work related kneeling/squatting/stair climbing
a greater time elapsed from any knee injury
describe the meniscus
nearly circular wedge shaped fibrocartilage disks on tibial plateau
attached to tibia via horizontal coronary ligaments
function of meniscus
stability > shock absorption
deepen joint surface for stability
outer 1/3 is 80% type 1 collagen
inner 1/3 is 60% type II and 40% type I
describe the medial meniscus
more O shaped
torn more frequently
attachment to MCL
describe the lateral meniscus
more C shaped
greater mobility without ligamentous attachment
symptoms of meniscal injury
joint pain; could refer to shin
limited and painful motion
limits with WBing + possible catching/locking
onset of meniscus
if acute = trauma; probably weight bearing sport
chronic = gradual/unkown; usually with older people and w/o prior injury
signs of meniscal tear
swelling
asymmetrical/antalgic gait
limited/painful ROM (depends on where tear is)
weak and painful resisted testing
pain with compression
special tests for meniscus
meniscal CPR
McMurrays
Eges
Thessaly’s (lateral only)
findings indicated by Apleys test
distraction = ligament
compression = high specificity for meniscus
what would MMT and palpation show if meniscus is involved
possible joint line tenderness with palpation
inhibited quads with MMT
effectiveness of an MRI
in a study with 44 asymptomatic 20-68 year olds 98% had a meniscal abnormality and 61% had abnormalities in 3/4 meniscal regions
**some people can have majority of meniscus changed and still have no symptoms…
PT Rx for meniscus
POLICED = WEAK support
assistive device to prevent limp
JM
MET
purposes of JM for meniscus
pain modulation via descending pathways
meniscal integrity
purposes of MET for meniscus + effectiveness compared to sx
meniscal integrity and stabilization
NMES has moderate support for strength
equally as effective as sx in regards to pain with degenerative tears
less anxiety/depression vs sx
what is a partial meniscectomy + the associated post op aspects
removal of tear
post op:
-no immobilization
-earlier WBing
-return to play within 2-6 weeks
what is a meniscal repair + associated post op aspects
sutured
post op:
-primarily with tears in outer 1/3
-immobilization and/or limited ROM initially
-toe touch WBing for 4-6 weeks
-return to play in ~ 12 weeks (dense healing)
effectiveness/support of sx for degenerative tears
sx no better at 2, 6, or 12 months vs sham (placebo) sx without ARJC
strong recommendation against sx for nearly all degenerative tears even in the presence of age related joint changes
what is a bakers cyst
excessive swelling in popliteal space often due to articular changes (i.e. ARJC)
fluid filled cyst due to persistent inflammation and subsequent weakening of capsule
a herniation of fluid through posterior capsule
signs and symptoms of a bakers cyst
asymptomatic until there is significant effusion
mimics degenerative meniscus tear
ROM limited and painful with flexion and extension
resisted/MMT into flexion is painful
palpable popliteal protrusion just medial to medial gastroc head
PT Rx for bakers cyst
like degenerative meniscal tear/ARJC
precautions with forceful activities
big picture = reduce swelling to get better stability/ROM/etc
**stretch of capsule cant be addressed conservatively
prognosis for bakers cyst
difficult to manage in active individuals
complication: rupture may occur and mimic a gastroc tear
MD Rx for bakers cyst
aspiration and/or surgical repair
incidence/prevalence of ARJC at the knee
most commonly of the medial femoral condyle and patellar articular surface
seen with 60-80% of knee scopes
greater prevalence in elite level sports
similar prevalence in non-elite athletic and non-athletic populations
risk factors for ARJC
older age
previous joint injury
increased BMI
occupational activities
weak quads
symptoms of ARJC
gradual/unknown onset
pain relief with non-WBing
stiffness <30 min after prolonged position
limited/painful motion
severity of ARJC symptoms is associated with what (and what is it NOT associated with)
bone edema with subarticular bone attrition
synovitis
NOT associated with:
-osteophytes or reduction in joint space
signs of ARJC
observation of asymmetrical/antalgic gait with possible genu varum
ROM = limited with firm end feels; especially pain with ext CPP
capsular pattern of restriction flx > ext
consistent block
stress tests and acessory motion findings for ARJC
distraction = relief
compression = pain
AM = hypomobile
special tests for ARJC
possible + meniscal tests
impaired walking distance and gait velocity with 6 minute walk tests and timed up and go
MMT/palpation findings for ARJC
inhibited quads and hip abductors
palpation = joint line tenderness
in the study with 44 asymptomatic 20-60 year olds what % had cartilage lesions or osteophytes/spurring
17% had cartilage lesions
27% has osteophytes/spurring
effectiveness of STM for ARJC
massage improved pain and function but less than JMs
better than usual care when individualized with JM
**additive is best
modalities effectiveness of ARJC
continuous passive motion = weak/inconclusive
Estim, acupuncture, and electromagnetic devices may help
US = short term pain relief
dry needling effectiveness for ARJC
unclear
orthotics/bracing effectiveness for ARJC
lateral heel wedges are common but NOT recommended
unloader knee brace could be helpful
effectiveness of joint mobilizations for ARJCs
greater immediate pain and functional benefits vs massage (at knee and ankle)
immediate change in ext ROM when combined with STM and MET
short term pain and functional benefits
long term and greater pain relief with equal or greater gains when added to exercise
MET effectiveness for ARJC
strong supportive evidence
increase in anti inflammatory markers and chondroprotective properties
NMES = moderate support for strength
long term benefits with pain and function
what muscles should be targeted with ARJC
quads
hip exercises; especially anti gravity mm
MET for ARJC
aerobic to help pain and disability
aquatic to help disability
Tai Chi = not clinically important
coordination/balance activities help pain and function
other PT Rx components aside from MET and MT
weight management
pt edu and self management
timing of MET + effectiveness
12 PT sessions over a year are better than 12 sessions over 9 weeks
