knee

Question 1

when is L/S manip appropriate for PFJ pain?

Answer 1

diff in hip IR >14 deg, ankle DF with knee flexed >16 deg, navicular drop >3 mm, no stiffness with sitting 20 min, squatting is most painful activity

Question 2

clinical findings that would support use of orthotics for PFP syndrome

Answer 2

2 deg or more forefoot varus, 78 deg or less great toe ext

Question 3

clinical findings to support use of patellar taping for PFP

Answer 3

tibial angulation >5 deg, (+) patellar tilt test

Question 4

tests useful for meniscal dx

Answer 4

mcmurray, joint line tenderness, thessaly

Question 5

tests for ruling in/ruling out ACL tears

Answer 5

ruling in: ant drawer and pivot shift

ruling out: lachman

Question 6

best test for patellar instability

Answer 6

moving patellar apprehension test

Question 7

ottowa knee rules

Answer 7

> 55 yo, tenderness at head of fibula or patella, inability to flex knee to 90 deg, inability to WB immediately and upon ER arrival

Question 8

area of ACL impingement

Answer 8

intercondlyar fossa

Question 9

what rotation of the tibia is needed for full extension?

Answer 9

lateral

Question 10

describe grade I-IV joint mobs

Answer 10

I: small amp, pain relief
II: large amp, pain relief
III: large amp, capsule stretch
IV: small amp, capsule stretch

Question 11

be cautious with what after PCL reconstruction?

Answer 11

flexion; the graft is tensioned between 70 and 90 - no ham curls for 4 months post-op

Question 12

a degenerative process is characterized by….

Answer 12

fibroblasts, vascular hyperplasia and disorganized collagen

Question 13

what is the quad index and why is it cool?

Answer 13

quad index is strength of involved quad/strength of uninvolved quad - if less than 85%, was indicative of decreased function. Was better at predicting hop test performance than other factors, including: graft type, presence of meniscus injury, knee pain and knee sx

Question 14

which meniscus is C-shaped and which one is O-shaped?

Answer 14

O shaped: lateral

C shaped: medial

Question 15

which ligs hold the menisci in place?

Answer 15

coronary ligaments

Question 16

what is contained in the arcuate complex?

Answer 16

LCL (or FCL), arcuate lig, popliteus tendon and biceps femoris tendon

Question 17

which menisci has a better chance of healing after injury?

Answer 17

medial (rich blood supply)

Question 18

what type of shear force is created during squat/leg press?

Answer 18

posterior shear (greatest between 83-105 deg); no anterior shear

Question 19

when is anterior shear developed during okc quad exercise?

Answer 19

40 deg til 10 deg ext

Question 20

what are the criteria for pertubation testing after ACL tear?

Answer 20

< or = to 1 episode of giving way, >or= to 80% timed on hop tests, >or= to 80% on KOS - ADL score, >or= to 60% on global rating score

Question 21

what precautions need to be followed if patellar tendon graft is used for ACL repair? hamstring graft?

Answer 21

patellar: possible irritation during PRE’s, consider alteration of knee flexion angle during NMES (45-60 deg)
hamstring: no ham strengthening until 8-12 wks post-op

Question 22

what precautions need to be followed if partial menisectomy is done with an ACL? meniscal repair?

Answer 22

menisectomy: no specific modifications

meniscal repair: no WB flexion beyond 45 deg for 4 wks

Question 23

what precautions need to be followed if MCL injury occurred along with ACL-R

Answer 23

restrict motion to sagittal plane until 4-6 wks for MCL healing, perform PREs with tibia in IR during early postop period