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PTRS 745 Exam 2 > Knee > Flashcards

Knee Flashcards

1
Q

Content: Biomechanics of Knee Extension (3)

A
  1. Tibia glides anterior
  2. Patella glides superior and lateral
  3. Fibular head anterior
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2
Q

Content: Biomechanics of Knee Flexion (3)

A
  1. Tibia glides posterior
  2. Patella glides inferior and medial
  3. Fibular head glides posterior
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3
Q

Q: What is the CPR for the knee?

A

flexion > extension (10:1)

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4
Q

Q: What is the close packed position of the knee?

A

Full extension

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5
Q

Q: What is the resting position of the knee?

A

30 degrees of flexion

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6
Q

Content: Consideration for MT

  1. 30-40 degrees of extension
  2. 15-30 degrees of extension
  3. 5-15 degrees of extension
  4. 0-5 degrees of extension
A
  1. Pure glide
  2. Incorporate rotation component
  3. Emphasize rotation
  4. Engage muscles/lateral hamstrings
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7
Q

Content: Portion of Patellar Contact During

  1. 0 degrees of extension
  2. 20 degrees of flexion
  3. 30-60 degrees of flexion
  4. 60-90 degrees of flexion
  5. 135 degrees of flexion
A
  1. No contact
  2. Inferior pole
  3. Mid patella
  4. Superior patella
  5. Medial and Lateral edges
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8
Q

Q: Where is tibiofemoral loading highest? Patellofemoral loading?

A

TF = stair climbing > walking/sit to stand/squat

PF = deep squats (lowest during walking)

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9
Q

Q: What part of the patient profile can have a large effect on the knee?

A

BMI and body type

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10
Q

Content: Routine BOS/Q’s for Aggravating Factors [used on those unwilling to talk about their problem] (8 - general idea)

A
  1. Kneel
  2. Sit for long time
  3. Sit to stand
  4. Squat
  5. Twisting
  6. Walk
  7. Running/jumping/sports related moves
  8. Stairs
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11
Q

Content: Common Descriptions - Locking (3)

A
  1. Stuck in an angle, can’t flex/extend
  2. Tibiofemoral (loose body/meniscus or difficulty with extension)
  3. Patellofemoral (loose body/meniscus or difficulty with extension)
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12
Q

Content: Common Description - Catching

A

Momentarily locking

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13
Q

Content: Common Description - Giving Way/Buckling (4)

A
  1. Pain or weakness?
  2. Tibiofemoral (ligament/mensical injury)
  3. Patellofemoral (tracking problem)
  4. Classic with ACL/meniscus problems
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14
Q

Content: Common Description - Crepitus/Clicking/Grinding (3)

A
  1. Joint surface changes
  2. Establish type and location
  3. Can be with or without pain
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15
Q

Content: Arthroscopic Grading System (Grade 0-4)

A

Grade 0 = normal cartilage

Grade 1 = softening and swelling

Grade 2 = Partial thickness defect, fissures < 1.5 cm diameter

Grade 3 = Fissures down to subchondral bone, > 1.5 cm diameter

Grade 4 = Exposed subchondral bone

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16
Q

Content: Debridgement/Chondroplasty (4)

A
  1. Removes loose flaps of cartilage
  2. Eliminates mechanical symptoms
  3. No restriction on rehab
  4. Short-term benefits in 50-70% people
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17
Q

Content: Reconstruction Options (for Femoral Condyle Injury) (3)

A
  1. Fixation of cartilage fragments
  2. Osteochondral autograft or mosaicplasty
  3. Microfracture
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18
Q

Term: Drilling of subchondral bone

A

Fixation of cartilage fragments

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19
Q

Term: Replace a defect cartilage in WB area with normal cartilage and bone plugs

A

Osteochondral autograft or Mosaicplasty

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20
Q

Content: Microfracture (4)

A
  1. Osteochondral drilling for bone marrow stimulation
  2. Protected weight bearing
  3. Continuous passive motion (CPM)
  4. Best results for acute and small cartilage lesion (2x2 cm)
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21
Q

Content: Carticel Transplant (for Femoral Condyle Injury( (5)

A
  1. Cell therapy to form hyaline-like cartilage
  2. 2-stage procedure (1–Arthroscopic to identify location and size of defect, 2–Cell transplant)
  3. Continuous PROM with CPM
  4. Prolonged protection and delayed weight bearing
  5. Long rehab (Protective, Slow return to function)
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22
Q

Q: ACL: ________________ fibers taut in flexion and _____________ taut in extension

A

Anteriomedial, Posteriolateral

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23
Q

Q: PCL: ________________ fibers taut in flexion and _____________ taut in extension

A

Anteriolateral, posteriomedial

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24
Q

Q: What is the purpose of the ACL?

A

Prevents anterior translation of the tibia in NWB and guides tibial rotation

25
Q

Content: Gender differences for ACL injury (5)

A
  1. Increase incidence of ACL injury in females (8-10:1)
  2. Architecture/physiology: small intercondylar notch and female hormones (i.e. attachment less stable)
  3. Landing and cutting: increased valgus posture
  4. Motor control (Reflexive activity of hamstrings is delayed in females; control of hams prevents anterior translation of femur)
  5. Overall conditioning
26
Q

Content: Open vs Close Chain Exercises for ACL

A

Close Chain = minimize shear, WB increases strain on ACL

  • More functional
  • Axial loading/co-contraction of quads/hams increase compression forces on the knee and decreases anterior translation/increases stablity

Open Chain = Not initially, increase resistance increases strain on ACL

  • can cause too much stress on the new graft
27
Q

Q: When is the most tensile force on the ACL during open chain knee extension?

A

Last 25 degrees

28
Q

Content: consideration for ACL rehab (5)

A
  1. Limit open chain extension (90-30 degrees)
  2. Work on hamstring curls to reduce ACL strain
  3. Delay open chain extension for 8-12 wks
  4. Gain muscle conrol before starting open chain
  5. Perfom close chain in restricted range (20-60 degrees)
29
Q

Content: Surgical Intervention for PCL Injury

A
  1. Precautions related to posterior tibial translation and HS strengthening
  2. Knee flexion > 30 degrees increases tension in PCL with open-chain
  3. Knee flexion > 60 degrees increases tension in PCL with closed-chain
  4. OKC and CKC exercises for knee flexion should be limited to 40 of flex
30
Q

Q: What is the function of the MCL?

A

Restrains valgus and ER of the tibia

31
Q

Q: What is the function of the LCL?

A

Restrains varus and IR(ER) of tibia

32
Q

Content: Open vs Close Chain Exercise in PF Syndrome

A

Open: Load increases from 30-0 degrees, perform extension from 90-45

  • 30-0: Quad working more, inferior pole in contact, not a lot of patellar contact
  • 90-45: limiting motion increases amount of patellar contact, do LAQ over SAQ

Close: Load increases from 60-90 degrees, perfrom extension from 0-45

  • Deeper squat increases load on PF joint
33
Q

Content: Screw home mechanism (3)

A
  1. Happens during last 15 degrees of knee extension
  2. NWB = tibia ER with extension
  3. WB = femur IR with extension
34
Q

Content: NWB Screw Home Mechanism (4)

A
  1. Tibia moving
  2. from 30-15 degrees = glide and rotation
  3. from 15-5 degrees = rotation > glide
  4. from 5-0 = pure rotation
35
Q

Content: WB Screw Home Mechanism (5)

A
  1. Femur moving
  2. from 45-30 both condyles glide/roll equal distance
  3. from 30-15 rotation - medial moves farther posterior than lateral condyle
  4. from 15-5 increase in rotation at lateral knee
  5. from 5-0 mobility of menisci, all rotation
36
Q

Content: From 15-5 degrees during WB Screw Home Mechanism (3)

A
  1. Distance between lateral meniscus and tibial plateau increases
  2. Increased mobility
  3. More of a spin movement
37
Q

Q: When is it important to understand patellar contact during knee motion?

A

When prescribing exercises for patellofemoral syndrome

38
Q

T/F: Knee joint loading is proprotional to body weight.

A

True

39
Q

Defn: epiphysitis

A

Growth plate inflammation, attachment of tendon to bone

40
Q

T/F: In those with chronic pain delay the patient history as long as you can.

A

True, their history will be long, get the information you really need first

41
Q

Q: What is crepitus usually associated with?

A

Arthritic changes in the joint

42
Q

Content: Common Descriptions - Popping

A
  1. Matters if it hurts
  2. Popping with injury = ligament involvement
  3. Popping with ADLs = arthritic changes or cavitation in synovial fluid (no big deal)
43
Q

T/F: Femoral condyle injuries do not increase the risk of OA later in life.

A

False, do increase risk for OA

44
Q

Q: What is the difference with type 1-2 and type 3-4 on the arthroscopic grading system?

A

1-2 = less severe

3-4 = more problematic

in regards to recovery

45
Q

Q: What is the function of the meniscus? (2)

A
  1. Shock absorption
  2. Stability under load (secondary to ACL deficiency)
46
Q

Q: Describe the vascularization of the menisci

A

outer 1/3 = vascularized

inner 2/3 = not vascularized

47
Q

Q: Why should an ACL deficient knee not be under high load?

A

Will wear out menisci

48
Q

Q: Which meniscus is more likely to be injured and why?

A

Medial, more tightly bound to tibial plateau

49
Q

Q: What is the most common type of meniscal tear?

A

Longitudinal or bucket tear

50
Q

Q: Describe the ACL and PCL distal and proximal attachment.

A

ACL distal = medial tibia

ACL proximal = Lateral condyle

PCL distal = lateral tibia

PCL proximal = medial condyle

51
Q

Content: Functions of the ACL (4)

A
  1. Limits anterior translation of tibia in NWB
  2. Allows ER of tibia
  3. Restricts IR of tibia
  4. Prevent anteriorlateral instability of the knee
52
Q

Content: Paterall tendon bone ACL graft (3)

A
  1. Most common
  2. Better initial outcomes
  3. Better connection with bone on bone
53
Q

T/F: All grafts stretch out over time

A

True, graft/injured side always has more slace

54
Q

Q: Which ACL graft has better long term outcomes?

A

Hamstring tendon graft

55
Q

Q: Why is WB important early/throughout ACL rehab

A

To increase tensile strength of the tendon/graft

56
Q

Q: What preventative measures can be taking for ACL injury? (4)

A
  1. Landing/cutting techniques
  2. Hamstring strength
  3. Eccentric Loading
  4. Quad to Hamstring ratio
57
Q

T/F: The ACL has 50% more tensile strength than the PCL.

A

False, flip it

58
Q

T/F: One study suggests that it may not be the patella that is tracking laterally but rather the femur that is ER from 0-30 of knee flexion that gives the appearance of patella movement.

A

False, IR

59
Q

T/F: Squats should be an exercise for focusing on quads over glutes.

A

False: flip it

PTRS 745 Exam 2 (12 decks)

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