Knee Flashcards

Question

Q – angle definition and norms

Answer 1

Represents Structural relationship between quadriceps muscle in the patella (ASIS to patellar midpoint) Men 10 to 15° women 15 to 20° Angles greater than 20° considered abnormal

Answer 2

1: age greater than 55 2: isolated tenderness of the patella 3: tenderness at the fibular head 4: inability to flex knee to 90° 5: inability to bear weight both immediately and in the emergency room ( four steps limping is okay)

Answer 3

-Avoid terminal < 30° knee extension during non-weight-bearing exercise (due to decreased contact) -->SLR has decreased patellar force than with quad activation with increased knee flexion BUT decreased patellar stability so if unstable train at greater degrees knee flexion -Avoid 90° flexion or greater in weight-bearing activity (Due to decreased contact force and increased quad activation)

Answer 4

- -Immediate swelling indicates internal trauma and hemiarthrosis - -Delayed onset of hours or days indicate synovial fluid response, often to joint surface strain (patellar dislocation, MCL injury)

Answer 5

Grade 1+ equals 3 mm to 5 mm Grade 2+ equals 5 mm to 10 mm Grade 3+ equals greater than 10 mm

Answer 6

SCFE – overweight or very tall and thin prepubescent male 7-18 yo; reproduce knee pain with FABER; loss of hip IR and excessive ER LCPD 5 to 18-year-old; associated with (+) knee exam of swelling, gradual onset pain and locking

Answer 7

Performed at zero and 20 to 30° knee flexion Valgus stress test at full extension determines possible or probable involvement of MCL along with secondary restraints – Grade 2+ PCL may be involved ACL usually involve – Grade 3+ ACL probably involved Varus stress test at full extension determines possible involvement of LCL ACL and PCL Varus sensitivity .25 Valgus sensitivity .86-.96 Specificity unknown

Answer 8

1. Anterior drawer – tests anteromedial bundle – ACL rupture if excursion is greater than 6 mm with soft or and feel – Increased excursion with tibial IR may indicate compromise of lateral capsule/PCL – increased excursion with external rotation May indicate MCL, posterior capsule, or posterior oblique ligament involvement -Sensitivity 76%/ specificity 86% 2. Lachman test-posterolateral (larger) bundle: gold standard – Sensitivity 96% specificity 100% Pivot shift: guarding often an issue - sensitivity 24% specificity 98%

Answer 9

Posterior drawer – – If increased laxity with tibial ER indicates possible posterior lateral corner injury – Sensitivity 89% specificity 92% Posterior sag sign – performed at 45° hip flexion 90° knee flexion – Sensitivity to 78% specificity 100% --Activate Quads in this position: reduction is 97.6% sensitive and 100% specific for PCL rupture

Answer 10

Unlikely to be confirmed with clinical examination unless patient experiences an acute locking episode McMurray test – attempt to elicit locking or clicking complaints – Sensitivity 58.5% and 16% – Specificity 93.4% and 98% Aptly test –pain with distraction indicates ligamentous injury, pain with compression indicates meniscal injury – Medial meniscus 81% – Lateral meniscus 90% Joint line tenderness low sensitivity and specificity Combination of all three tests sensitivity 78.8% specificity 79.3%

Answer 11

Unlikely to be confirmed with clinical examination unless patient experiences an acute locking episode McMurray test – attempt to elicit locking or clicking complaints (IR tibia for lateral men, ER for medial men) – Sensitivity 58.5% and 16% (LOW) – Specificity 93.4% and 98% Aptly test –pain with distraction indicates ligamentous injury, pain with compression indicates meniscal injury – Medial meniscus 81% – Lateral meniscus 90% Joint line tenderness low sensitivity and specificity Combination of all three tests sensitivity 78.8% specificity 79.3%

Answer 12

one: history of catching or locking two: joint line tenderness three: pain with forced hyperextension Four: pain with maximal passive flexion Five: pain or an audible click with McMurray 5/5= 92.3% +PV Specificity: 99% 4/5 specificity 96%

Answer 13

Plantarflexion is ideal to decrease the gastrocnemius moment arm

Answer 14

1. pain with MMT through quadriceps ROM 2. Step down test – says visual analog scale and range of motion 3. But tell him ability – normal between 25 and 50% of the teller with, greater movement suggest laxity (Sage sign)**WHAT?!** 4. Apprehension test – excessive movement and patient expression of concern 5. Patellar tilt test – flexion to 20° attempts to flip lateral edge of the patella upward, if unable to do so indicates type lateral retinaculum

Answer 15

Used in cases of recalcitrant knee extension limitations

Answer 16

20 to 30° flexion

Answer 17

Effect greater changes and neural activation and increase muscle hypertrophy Improve volitional concentric contraction Decrease symptoms of tendinitis

Answer 18

Three repetitions, two times per day, seven days per week for 12 weeks More beneficial than concentric exercises Use of a decline board if there is discomfort Should refrain from sport activity during rehabilitation Bilateral eccentric training may be as effective as unilateral training

Answer 19

Apply in one direction and assess. if greater than 50% symptom reduction is not achieved in tape in alternate direction

Answer 20

criteria: patient must meet ALL criteria to be considered Isolated ACL tear, full pain-free range of motion, NO joint effusion, MVIC quadriceps 70% of uninvolved LE, single leg hopping on involved leg with out pain * administered within two months of injury *If 5/5 met, then trial 10 tx PT; patients must then meet all criteria to be D/C'd w/o referral back to surgeon Screen: 1. Episodes of getting way since initial injury: <1 2. Hop test:greater than 80% timed 3. KOS ADL: greater than 80% 4. Global rating score: greater than 60% If positive administer perturbation activities

Answer 21

Treatment of pain relief for unicompartmental degenerative joint disease in tibiofemoral joint Minimal to no pain relief and an obese patient patients No evidence to support the sloughing reversal of degenerative process with the use of these unloading braces

Answer 22

No conclusive evidence demonstrates effectiveness of bracing in preventing injuries Decrease in rx of braces s/p reconstruction, no evidence. Use of brace 1 to 2 years post operatively correlated with significant decrease in quadriceps strength compared to bracing for three months. Increased function where your brace in patients with 80% quadriceps strength Unclear whether brace wearing is cause or effect to quadriceps strength

Answer 23

Surgical technique were bone his resected from intercondylar notch using a motorized a abrader which allows for increased base in joint ACL repair

Answer 24

Full knee extension and resolution of inflammatory process minimize the risk of limited postsurgical knee range of motion

Answer 25

Quadriceps strength and full knee extension Inability to achieve these is strongly correlated with decreased postoperative function Hamstring strength appears to recover without focused intervention even when this muscle group is used the source of the graft

Answer 26

Wayberry (WB) exercises were not sufficient to restore quadriceps strength. ACL strain appears to be the highest 30° with knee extension PROM 0-120 deg = no strain on ACL Graft strongest day of implant, decreases in strength consistently (healing doesn't become a factor until 4-6 wks s/p; graft weakest 12 weeks post op

Answer 27

Meniscal repair: no WB flexion past 45 deg 0-4 weeks post op Chondral damage – weight-bearing cannot be restricted long enough to allow full healing of articular surfaces without compromising ACL health, restrict WB 0-4 weeks, may benefit from bracing afterward memisectomy: no changes needed MCL injury – ACL reconstruction provide stable environment for healing even great three MCL sprain, therefore MCL is typically not surgical repaired, place LE in IR to decrease stress on MCL PCL – rehabilitation is focused on PCL guidelines because of risk of PCL graft failure risk

Answer 28

Failure to progress, complains of instability, decreased function, increased pain/ swelling, disproportionate pain to injury

Answer 29

That is often less rigid after construction revision then typically soon Revision surgeries are often staged Where activities and exercise must be slow down protect already compromised graft PWB 2 weeks, still gait trainig to encourage full knee extension; defer FWB in uncontrolled environment until 4 weeks s/p

Answer 30

Initially managed conservatively allowing growth plates to close Decision to return to sport is often based on risk-benefit analysis If surgery is indicated there are surgical options that are designed to avoid damage to epiphyseal plate

Answer 31

Females are 4-8 times more likely to tear ACL than males Injuries are out the noncontact as result of a cutting rotary motion reasons are inward collapse of knee, muscular weakness, straight knee when landing, excessive quadriceps activation eccentric activity, joint laxity, narrow femmoral notch and hormonal influences Exercise regimens implemented to help prevent ACL injuries have shown a decease risk for ACL injuries by 88-74%

Answer 32

We're coming because often has partial tears in injuries to the PCL higher rate of feeling when compared to ACL quadricep strength and return to function Early medial compartment to generation can be associated with media meniscus and/or PLC involvement decreased meniscal force and increased TF force due to altered arthrokinematics increased PF force (esp with OKC exercises)

Answer 33

Often indicated with continent and injuries of meniscus capsule or other ligaments Single bundle Achilles tendon all allograft High percentage of patients with continued laxity after surgery. some evidence suggests decrease laxity with double bundle procedure Double bundle patellar tendon and semi tendinosis allograft Rehabilitation initially slow progression especially inflection Graft is most tension between 70-90° of flexion Limited resistance of knee flexion (hamstrings) for four months Minimal P Cialis year from 60° to 0 nonweightbearing knee extension Bottom Line: SLOW knee flexion and ROM gains - knee flexion to 60 at 2 weeks - knee flexion to 110 at weeks 3-5 - full knee ROM at 16 weeks - Tension at graft greatest at 70-90 degrees flexion so train knee extension at 60-0deg flexion (greater deg found to have posterior shear force with OKC knee extension) - NO resisted knee flexion until 8 weeks (due to post shear of hamstrings)

Answer 34

Injured ligaments should be protected from stress during initial 6-8 weeks of healing Internal rotation of the tibia will decrease MCL stress extra rotation of tibia decrease LCL stress Normalizing quadriceps strength in facilitating dynamic stabilization are the focus Grade 3 strain space repair can be braced or immobilize and 30° flexion during wb first 2-6 weeks MCL often treated conservatively; surgery vs conservative tx = results --NOTE: MCL injury in children, suspect epiphyseal injury vs MCL due to fairly of bone vs ligament LCL: mixed nonop results

Answer 35

Degeneration of articular cartilage, inflammation of the synovium, and changes in the underlying subchondral bone to the point where patients are typically debilitated by pain and resultant loss in function

Answer 36

Nonoperative treatment: –if injury is localized to the peripheral third – Primary focus controlling swelling worse during passive range of motion and minimizing quadrate step strength losses with nonweightbearing activity – Patient education to avoid squatting pivoting cutting and running to minimize stress Decision to remove/repair based on meniscus tear location (peripheral 1/3 repair esp in younger patients) -Meniscectomy – recovery time to six weeks -Repair – WB slowly progressed for 8 weeks, if stable fixation and good vascularization then gait with knee locked in extension allowed WBAT for 4-6 weeks; week 1-4: no WB flexion past 45 deg 4-8 wks: no WB flexion past 90 recovery time 6 to 9 months Sport activities: 4 months after longitudinal repair, 6-9 months after radial and central 1-3 repair Meniscal transplant: –recovery time 6 to 9 months – age under 40, high activity level, minimal osteoarthritis, not a candidate for TKA -Limit WB 3-6 weeks s/p; FWB achieved 6-9 weeks s/p

Answer 37

Reported to be the strongest single predictor of functional limitations in patients with knee arthritis Preoperative quadriceps strength is predictive of functional ability one year after TKA

Answer 38

Found to lubricate join and decrease swelling and inflammation by inhibiting induction inactivity of degenerative enzymes in proinflammatory signals

Answer 39

Current recommendation for a glucosamine sulfate and chondroitin can be used but discontinued after six months of no benefit has occurred

Answer 40

Medial compartment – high tibial osteotomy it Lateral compartment– Femoral osteotomy When performed in patients less than 60 years old may delay need for TKA up to 10 years but failure rate as high as 25% after osteotomy treat like Fx: no FWB for 4 weeks; no ankle cuff/resistance distal to osteotomy site; full ROM immediately okay NMES (full extension but no external fixator as with ACL)

Answer 41

Quicker rehabilitation Maintenance of normal joint kinematics due to cruciate ligament sparing Better proprioception Bone preservation Improve functional abilities compared to TKA Survivorship rate ranging from 94 to 97% over 10 years

Answer 42

``` Maximum of 10° Varus or 5° valgus Flexion contracture less than 10° Intact ACL Absence of the telephone moral symptoms BMI below 32 age <60 ```

Answer 43

Correlated with higher risk of falls and a slide toward morbidity

Answer 44

60% acute decline Decreased functional abilities with tug test and stairclimbing test Can be due to activation failure or muscle atrophy early electrical stimulation

Answer 45

Increases 1% per year from about 10% at 10 years to about 20% at 20 years

Answer 46

Decrease quadriceps flexibility, hypermobile patella, altered VMO response time, and diminished quadriceps explosive strength

Answer 47

Synovectomy, lateral retinaculum release, realignment procedures both proximal and distal to proximal

Answer 48

Patellar taping and knee flexion angle of 70 to 90° to decrease risk of patellar subluxation avoid terminal knee extension

Answer 49

Sounds like pop or snap resulting in pain it tibial tubercle. patients recover quickly

Answer 50

Children ages 10 to 15 years Present bilaterally 25% of the time Incidents as high as 20% and athletes 5% of nonathletes Treatment: rest ice and stretching strengthening of quadriceps hamstrings and Iliotibial band NSAIDs and time Self-limiting condition should be allowed to continue all activity to toleration

Answer 51

Generally is asymptomatic, inadvertent find on xray Become symptomatic as a result of the trauma to patella, creating instability Requires surgical intervention

Answer 52

Ages 10 to 12 years Inferior pole of the talent Treatment similar to OSD

Answer 53

Presentation similar to SLJ however location of pain is deep within tendon fibers Tell her fitness most often it just opened all of the Tele

Answer 54

Grade 0– normal Cartlidge without notable deficits | Grade 4 – severe abnormal full thickness osteochondral injury

Answer 55

Medial femoral condyle and the patellar articular surface

Answer 56

Arthroscopic lavage and debridement, microfracture, autologous chondrocyte implantation (ACI), osteochondral transplantation (OATS)

Answer 57

Methodological quality of articular cartilage repair studies is generally low. Overall good to excellent improvement with no clear best Surgical technique

Answer 58

Age greater than 30 years | ACL index injury greater than five years ago

Answer 59

– Twisting injury – Tearing sensation a time of injury – Delayed effusion 6 to 24 hours post injury – History of catching your locking – Pain with forced hyperextension – Pain with maximum flexion – Pain or audible click with McMurray's maneuver – Joint line tenderness – Discomfort or sense of walking or catching in the over either the medial or lateral joint line during the Thessaly test at 5 or 29 degrees flex

Answer 60

– Acute trauma with hemathrosis 0–2 hours – Insidious onset aggravated by repetitive impact – Intermittent pain and swelling – History of catching or locking – Drain line tenderness

Answer 61

Clinical examination is frequently inconclusive due to non-specific nature of symptoms MRI sensitivity 83.2%, specificity 94.3% for chondral lesions

Answer 62

Examination by will train clinician may be as accurate as MRI in regards to diagnosing of meniscus injury

Answer 63

Single hop test – mean distance: 208.08 cm, MDC: 8.09% Triple hop test – mean distance: 67 670 cm, MDC: 10% Crossover hop test – mean distance: 640 cm, MDC: 12.25% 6 m hop test – mean time: 1.85 seconds, MDC 12.96%

Answer 64

Six minute walk test: 6.31 m Tag: 2.49 seconds Stare measure: 5.49 seconds

Answer 65

Zero – no wave with downward stroke Trace – small wave of fluid on the medial side 1+: large bulge of fluid on the medial side 2+: fusion completely fills medial knee sulcus and returns to be outside without downward stroke 3+: inability to move the fusion out of the medial aspect of the knee

Answer 66

Sensitivity: medial – 83% lateral – 68% Specificity: medial – 76% lateral – 97%

Answer 67

McMurray – Sensitivity 55%: medial meniscus – 50% lateral meniscus – 21% - Specificity 77%: medial meniscus-77% lateral meniscus – 94% Thessaly test 5° knee flexion – Sensitivity: medial 41%-66%, lateral 16%-81% – Specificity media meniscus 68% to 86%, lateral 89-91% Thessaly test 20° knee flexion – Sensitivity: medial 59%-89%, lateral 67%-92% – Specificity media meniscus 83% to 97%, lateral 95-96%

Answer 68

Findings: – History of mechanical catching or locking reported by patient – Joint line tenderness – Pain with forced knee hyperextension – Pain with maximum passive knee flexion – Pain or audible click with McMurray maneuver 5 positive findings – specificity: 99.0% sensitivity: 11.2% 1 positive finding - sensitivity: 76.6%, specificity: 43.1%

Answer 69

85% of patients to use CPM had satisfactory outcome in lesion grade, where as 15% of those who did not have satisfactory outcome

Answer 70

This includes a meal weight-bearing as tolerated really mobile vision with emphasis on prevention of fusion and return to sports one range of motion was achieved along with demonstration of 75% strength Index and completion of functional running program 90% of accelerated group had successful repair versus 88% of standard group

Answer 71

C: clinicians me utilize early progressive need mobilization following the menus am and articular cartilage surgery

Answer 72

D: there are conflicting opinions regarding the best use of progressive weight-bearing patients with meniscal repairs or chondral lesions

Answer 73

Meniscus – C: clinicians me lies early progressive return to activity following Nieman it's cool repair surgery Articular Cartlidge – E: conditions may need to delay return to activity depending on the type of articular cartilage surgery.

Answer 74

D: there are conflicting opinions regarding the best use of clinic-based programs for patients following meniscectomy to increase quadriceps strength and functional performance

Answer 75

B: clinician should consider strength training and functional exercise to increase quadriceps and hamstring strength, quadriceps endurance and functional performance following menisectomy

Answer 76

B: neuromuscular electrical stimulation can be used with patients following meniscal or chondral injuries to increase quadriceps muscle strength

Answer 77

One year: 40% Five year: 60% 10 years: 80%

Answer 78

PCL with a Seattle | PLC with ACL or PCL

Answer 79

No that was laxity: 20% That was laxity at 30° of knee flexion: 53% Fagus laxity at 0° knee flexion: 78%

Answer 80

Acceleration and deceleration motions with excessive quadriceps contraction and reduced hamstring cocontraction at or near full knee extension

Answer 81

Dashboard injury: 38.5% On flexed knee with foot plantar flexed: 24.6% Sudden violent hyperextension: 11.9%

Answer 82

Lateral head of the gastroc, popliteus tendon, popliteofibular ligament, LCL, arcuate ligament-fbellofibular ligament Primary resistant to varus and external rotation forces secondary resistant to posterior translation of tibia and femur

Answer 83

One third of individuals will compensate and successfully returned unrestricted activity without surgery One third of individuals will return to recreational activities with the bracing and lower extremity strengthening program and activity modification One third of individuals will not be able to return to sport due to instability and will require surgical intervention

Answer 84

No correlation between laxity in functional or subjective outcomes Majority of subjects treated nonoperatively can expect to return to activity at the same or similar level No significant differences are noted in range of motion following a PCL injury

Answer 85

Long-term outcomes for a sleigh grade 3 sprain our poor Eli | Grade one into sprain long-term outcomes are good

Answer 86

Good results documented for grade one and 2 injuries using nonoperative treatment Conservative management of more severe PLC injury is Lisa poor functional outcomes Surgical interventions of the PLC injuries are more successful than chronic

Answer 87

Environmental: increase shoe surface interaction for higher traction may increase risk of ACL injury Anatomical: increase BMI, narrow femoral notch and increased joint laxity Hormonal: early and late follicular phases of menstrual cycle increased risk of injury Neuromuscular: combined loading patterns detrimental to ACL injury such as Varus or valgus extension moments especially during slight knee flexion. Strong quadriceps activation during eccentric contractions maybe a main factore in injury to ACL

Answer 88

Sensitivity: 44.1% Specificity: 44.4% Potential copers and potential noncopers can be equally consider candidates for non-operative ACL management

Answer 89

– MOI consisting of deceleration and acceleration motions with noncontact Valgus load at a near full knee extension – Hearing or feeling of the pop at the time of injury – Swelling within 0 to 2 hours phone injury – History of giving way – Last event range knee extension – Positive Lachlan test with nondiscrete end feel increased anterior tibial translation – positive pivot shift test – 6 m singling hop test result that is less than 80% of the uninvolved Limb – Maximum voluntary isometric quadriceps strength Index that is less than 80% using burst superimposition technique

Answer 90

Posterior directed force on proximal tibia, fall on flex me with foot plantar flexed, or sudden violent hyperextension of need joint – Abrasions or Ecchymosis on anterior aspect of proximal tibia – Localize posterior knee pain with kneeling or decelerating – Positive posterior drawer test at 90° with non-discreet and feel or increment creased posterior tibial translation – Positive posterior sag test – Positive modified stroke test or Goldstein – Lots of new extension during gate observation or range motion testing

Answer 91

– Trauma by force applied to lateral aspect of the lower extremity – Rotational trauma – Pain with valgus stress performed at 30° knee flexion – Increased separation between femur and tibia with valgus stress – Normal knee range of motion – Palpatory provocation of MCL reproduces familiar pain – Positive modified stroke or both sign

Answer 92

– Excessive there is drama – Localize effusion over LCL – Palpatory provocation of LCL reproduces pain – Pain with Varus stress at zero and 30° or increased laxity – Positive stroke or bulge sign

Answer 93

Sensitivity: 85% Specificity: 94% Normal = -1 to 2 mm Nearly normal = 325 mm Abnormal = 6 to 10 mm severely abnormal = greater than 10 mm

Answer 94

Sensitivity: 24% Specificity: 98%

Answer 95

Sensitivity 90% | Specificity 99%

Answer 96

Sensitivity 79% specificity 100%

Answer 97

Pain: Sensitivity 78% specificity 67% Laxity: sensitivity 91% specificity 49%

Answer 98

No quality studies have been performed

Answer 99

C: quotations can consider using continuous passive motion in the immediate postoperative period to decrease postoperative pain

Answer 100

C: early weight-bearing can be used for patients following ACL reconstruction without incurring detrimental effects on stability or function Little evidence exists for MCL, PCL, multiple ligament injuries and weight-bearing. However current surgical protocols recommend limited weight-bearing in PCL, multiple ligaments and MCL reconstructions. But mcl injured can have WB immediately.

Answer 101

C: the use of functional need bracing appears to be more beneficial than not using a brace and patients with ACL deficiency. Not great professional Scears with ACL deficiency have 6.4 times greater risk of stating subsequently injury

Answer 102

B: the use of immediate postoperative need racing appears to be no more beneficial than not using a brace following ACL reconstruction

Answer 103

D: conflicting evidence exists for the use of function on the bracing inpatients following ACL reconstruction It appears higher-level patients (skiers) decreased risk for subsequent injury.

Answer 104

Expert opinion Non-op: bracing typically not recommended Op: hinge brace locked in full knee extension for 2 to 4 weeks

Answer 105

Expert opinion Non-op: Bracing for grade 2 and three raptures for 4 to 6 weeks Op: Following surgery long hinged brace allowing 30° to 90° new motion for first three weeks

Answer 106

Expert opinion Knee brace locked in for extension four weeks after surgery

Answer 107

B: immediate mobilization is supported with the goal of decreasing pain increasing range of motion in limiting adverse changes to soft tissue structure

Answer 108

C: clinician should consider use of credit therapy to reduce. Postoperative knee pain. No reduction in postoperative drainage or improvement in early new range of motion demonstrated

Answer 109

B: clinician should consider the use of exercise as part of the in clinic program, supplemented by prescribed home-based program supervised by a physical therapist

Answer 110

B: clinician should consider the use of neuromuscular education is a supplementary program to strength training in patients with me stability and movement coronation impairments Nonoperative ACL care with perturbation activity improve successful outcomes by 4.88 times versus standard rehab

Answer 111

B: rehabilitation that emphasizes early restoration of knee extension and early weight-bearing activity appears to be safe for patients with ACL reconstruction. No evidence exists to determine the efficacy your safety of early return to sports

Answer 112

B: clinician should consider use of eccentric exercises are gone there inpatients following ACL reconstruction to increase muscle strength and functional performance. Clinician should consider the use of eccentric squat program in patients with PCL injury to increase muscle strength and functional performance

Answer 113

measured at malleoli; 12-18 degrees normal

Answer 114

Females have narrower femoral groove, smaller crucial ligament CSA, greater Q-angle

Answer 115

- If ACL inTact, medial meniscus doesn't have significant role on AP stability - If ACL deficient, posterior horn of medial meniscus functions as secondary restraint to AP translation by wedging b/t femur and tibia

Answer 116

Extracapsular; restrains tibial ER - -55% varus restrain in extension (5 deg flexion) - -69% varus restrain in flexion (25 deg flexion)

Answer 117

Medial PF ligament and lateral PF ligament | **Note: MPFL can tear with patellar dislocation, causing patellar instability

Answer 118

Lysis of MCL + PCL

Answer 119

- hyperextension injury (land with straight knee from jumping) - Can be injured with medial (winds around PCL) or lateral (winds around lateral condyle) tibial rotation injuries

Answer 120

- Knee hyperflexion injury or knee fixed and stuck against object (EX: fall onto knees; dashboard MVA injury) - PCL MOST taut in knee flexion, resulting in injuries with knee flexion vs extension with ACL

Answer 121

pulls meniscus posteriorly and IRs tibia on femur during knee flexion

Answer 122

- Knee extension: increased valgus and tibial ER (screw home) - Knee flexion: increased varus * *Note: posterior shear at 85-105 knee flexion: rationale for training after PCL injury at less knee flexion and for training after ACL injury at high degree knee flexion

Answer 123

Closed Chain: 1. Flexion: posterior roll, anterior glide of f.condyles 2. Extension: anterior roll, posterior glide of f.condyles Open Chain 1. flexion: posterior roll and glide of tibia on femur 2. extension: anterior roll and glide of tibia on femur

Answer 124

Femoral anteversion, external tibial torsion, genu valgum, subtalar hyperpronation

Answer 125

Cluster 4 hop tests (Noyes et al): all hop tests have low sensitivity (~50%) 1. times and untimed single hop for distance highly specific (95%) 2. normal is 80-85% uninvolved

Answer 126

1. Walking Uphill: - -Concentric: gastroc/hamstrings 2. Walking Downhill: - -Eccentric: quads **uphill and retro treadmill walking produce less PF joint restrictive forces than forward walking

Answer 127

1. No soreness: progress 1 variable/1 step 2. Soreness dissipates with warm up: stay at same level 3. Soreness remains with warmup: day off or decrease 1 level)

Answer 128

1. Ligament or articular cartilage: s/p 2 months -2 years 2. Bone: 5 weeks-->3 months 3. Tendon: -itis: 3-7 weeks; laceration: 5 wks -6 months 4. Mucle Strains: --Gr I: 14 days --Gr 2: 4 days-3 months --Gr 3: 3 weeks to 3-6 months 5. Ligament Sprains: (take 2x as long as muscles to heal, likely due to vascularity) Gr 1: 3 days Gr 2: 3 wks-3-6 months Gr 3:3 weeks -6-12 months

Answer 129

1. BPTB: decreased healing time due to bone-bone interface BUT increased incidence anterior knee pain, extensor mechanism dysfunction, patellar fracture 2. Hamstring: increased healing time due to soft tissue and bone interface (ex: 12 weeks vs 6-8 weeks) risk hamstring strain but no decreased hamstring strength 3. Allograft: much slower healing than autograft; >failure chance and risk of disease transmission; not optimal for younger patients

Answer 130

PCL Sparing: maintains proprioception of ligament, decreased risk of subluxation/dislocation due to ligament intact; improved knee flexion and potentially increased quad activation PCL substituting: Greater ease of surgery and deformity correction, decreased wear rate if PCL sacrificed, DON'T mobilize TF joint due to risk of subluxing/dislocating knee

Answer 131

MOI: Direct blow (fall) or indirect (jumping) Tx: aspiration with long cast/brace 3-6 weeks; return to WBAT and gradual progress ROM (esp flexion) and strength after cast removal; Cycling and CKC exercises 6 weeks s/p, return to full ROM/strength 12 weeks If nondisplaced: early WBAT, AAROM and isometric quads 4-6 weeks severly comminuted: PWB 6 weeks, gradual AAROM in 3-6 weeks ORIF: ROm at 1-2 weeks s/p

Answer 132

80% of patients >40 MOI is forced knee flexion with max quad activation Tx: surgical with KI in full extension for 6 weeks; 6 months time for rehab

Answer 133

Only fracture of knee with initial NWB * *PT secrets 4 variations of tx: 1. PROM and strength w/o WB until 6-12 weeks 2. NWB cast (long leg foot groin cast w/ 5 deg flexion) 3-6 wks then 2-4 wks NWB rehab then progress WB 9-16 wks 3. traction with passive exercise 6 weeks; NWB 12 weeks 4. cast with NWB and progressive WB 12 weeks ROM expectations after plating: 1-122 deg FWB ~12.6 weeks s/o