KNEE Flashcards
what is the unhappy triad
ACL, MCL, medial meniscus
foot planted, rotational force with hyperext, think
ACL
ACL injury, max swelling occurs within ___
12 hours
typically, with ACL injury, will the pt be able to walk without assist
no
return to sport with ACL is usually
6-9 mos
where is autograft for ACL usually taken from
gracilis, semitendenosis, or patellar tendon
issue with allographs
higher failure rate
restriction associated with meniscus repair
very limited flexion for sev weeks
with ACL rehab, what is a must
get full ext in 2 weeks
with ACL, you want to get full ROM for all within ___ - ___wks
3-4
what ex do you avoid with ACL rehab
do not do any open chain short or long arc quads
what is one issue to look at week 4 with ACL rehab
the tissue is more compromised at ths time bc the tensile strength changes, increasing change for re-injury
why might you question graph type with rehab ex choices for ACL
ex: dont do hamstring/heel slides if hamstring tendon was uses
pts are usually braced for how long after ACL repair
1 full week
about mid to late rehab for ACL, avoid open chain and closed chain (what degrees)
60-90 closed
30-0 open
tibiofemoral joint usually causes px with increase in stairs bc of the concentric forces, but px going down stairs is due to
compression and eecentric
bow legged
genu varus
knocked knees
genu valgus (associated with RA)
with genu recurvatum, what needs stretched/strengthed
everything post needs strengthened, everything ant needs stretched
ant knee px (especially with squatting or stairs) think
patello femoral
beneficial ex for patellarfemoral interventions
strengthen hip ER and quads, ITB stretches
patellar tendonitis is aka
jumpers knee
explain jumpers knee
associated with eccentric over loads and deceleration
px with active contraction or passive stretch
valgus knee with pronation
persistant pain that follows the medial and lateral joint line with swelling at sometimes catching may be
art cart issue
chondromalacia patella is aka
patellofemoral OA
where is px with patellofemoral OA
retropatellar (worse with sitting and stairs)
what is “True” chondromalacia patella
softening of the cart on the post patella
what age usually has true chondromalacia patella
12-35 women
patella baja restricts what motions (low riding)
restricts extension
high patella (alta) may lead to what issue
subluxation or dislocation
what motion pinches the fat pads causing px
hyper ext
normal q angle
10-15
how to meausre q angle
asis to center of patella
center of patella to tibial tuberosity
q angle measures the tendency of what
tendency of patella to track laterally
the higher the q angle, the higher the chance that the patella will track
laterally
meniscus moves with what structures
femoral condyles
during IR, which part of the meniscus is primarily compressed
lateral
during the last 15 degrees of extension, the tibia does what
ER
greatest PF contact is at __ degrees of flexion
60 of knee flexion
best range for OKC ex for pts with PF probs
below 60 degrees flexion
best range for CKC ex for pts with PF probs
0-30
which of the ligg heal well dt good bld supply
MCL
LCL resists ___ and ___
varus force and ER
85% of medial rotation force is resisted by ACL at what angles
30 and 90 degrees of
during IR, what ligg are getting most stress
ACL/PCL
during ER, what ligg are getting most stress
MCL/LCL
what makes up the arcuate complex
arcuate lig LCL popliteus lateral gastroc biceps femoris
why is healing an issue with the meniscus
lack of bld supply (poor)
what part of meniscus is injured more often and why
medial, it is less mobile than lateral
knee going out or buckling and compression hurts, think
meniscus
what 2 structures attach to the medial meniscus
MCL, semimebranosis
what 2 structures attach to the lateral meniscus
popliteus and PCL
glut med strain is often felt at the
GT
If ITB is tight, the femur often _____ rotates and the patella goes ____
IR of femur pushing the patella laterally
movement dx with ITB friction syndrome
TF rotation syndrome (IR)
capsular pattern for knee
Flexion greater than ext
closed packed knee
full ext
open packed knee
25 degrees of flexion
when knee flexes, the tibia glides
post
3 functions of the patella
provides articulation
protects femur
improves moment arm
hoffas syndrome is aka
infrapatellar fat pad syndrome
for hoffas syndrome, where is the px usually
ant knee
bakers cyst, the px is usually
post
what motion is usually very pxful with bakers cyst
flexion
hoffa’s syndrome, what motion causes px
ext
apophysitis at the inf pole of the patella
sinding larson johansons syndrome
apophysitis at the tibial tuberosity
oschgoods
superficial fibular nerve innervates (motor to )
fibularis longus and brevis
sensation for fibular N is at
dorsum of foot and ant lower leg
meniscus may not always have an MOI, but pts often report a feeling of
giving way or locking during gait and stairs
if PCL is injured, is it typical for it to swell
not usually
Ottowa knee rules are highly sensitive to
fx
list the Ottowa knee rules
over 55 pinpoint patellar tenderness fib head tenderness cant flex to 90 cant WB
common MOI for PCL tear is
MVA where knee gets driven into dash
unstable meniscus tear where the knee often locks
bucket handle
type of meniscal tear that can lead to DJD
horizontal
if meniscus is repaired, they are usually braced and limited to 90 degrees of flexion for ___ wks
3
normal knee flexion
0-145
you want to achieve full ROM for meniscus rehab within
4 wks
common with athletes, appears as large soft mass behind knee, achy px
bakers cyst
ITB friction syndrome, how might you rule out hamstring strain instead
with ITB friction syndrome, the px usually is localized at lateral femoral condyle, resisted contraction doesn’t reproduce px
need to find out from christina about spin snout numbers
ok
where is palpation of knee OA commonly pxful
medial knee
reoccuring swelling, may or may not have an MOI, sharp x with buckling or giving out
meniscus
2 special tests for meniscus
mcmurrays and apleys
how valid are mcmurrays and apley
both have low sensitivity and specificity
which lig injury MOI is usually non contact
ACL
quad dominance over hamstrings, which can increase q angle, sets up an increase of injury for which lig
ACL
deep achy pain, especially if walking/running down hill
patellafemoral issue
ant drawer and lachmens and pivot shift are for
ACL test
increased q angle IR pronated foot tight IT band (IR femur) all of these set a pt up for which type of disorder
patellofemoral
how can ITB cause an issue with the medial side of the knee
subpatellar area bc if ITB is really tight, it can pull on the patella
prepatellar bursitis is often caused by
repetitive hitting of the knee or kneeling and hitting floor
conditions related to tibiofemoral rotational syndrome
• Meniscal injury • MCL/LCL sprain • Patellofemoral joint dysfunction • ITB friction syndrome • Hamstring strain/tendinopathy LMMHIP
conditions related to knee hypomobility
- OA/DJD
- Patellofemoral joint dysfunction
- Knee contracture
conditions related to knee ext syndrome
• Jumper’s knee • Osgood-Schlatter disease • Patellofemoral joint dysfunction • Patellar tendonitis • Quadriceps strain POP Q
conditions related to knee hyperext syndrome
• Patellofemoral joint dysfunction • Fat pad syndrome • Baker’s cyst • Anterior knee pain F B P A
conditions related to patellar lateral glide syndrome
• Patellofemoral joint dysfunction • Anterior knee pain • Patellar dislocation • Plica syndrome PAD
this syndrome is described by excessive strength of the quads (dominance) so something is being pulled
knee ext syndrome
In this movement dysfunction, knee pain is associated with impaired knee extensor mechanism. Dominance of the hamstrings (for extension) and poor functional performance of the glut max and quadriceps muscles result in this condition which places excessive stresses on the knee
hyper ext of the knee syndrome
all knee movement dx have what as a possible pathology
patello femoral dysfunction
with tibiofemoral rotational dysfunction, the tibia rotates ___ while the femur rotates ___
tibia goes lateral while femur can go either way
patellar tendonitis is aka
jumpers knee
px with activity that requires repetitive knee ext would make you think what mvmt dx
knee ext syndrome
patellar lateral glide syndrome pathologies
P P A D
plica, pf dysfunction, ant px, dislocation
in this movement dysfunction, knee pain results from impaired patellar relationship with the trochlear groove.
patellar lateral glide syndrome
list all of the mvmt sx dx
tibiofemoral rotation syndrome - L M M H I P hypomobility -djd, OA, PFD Knee ext syndrome - P O P Q Knee hyper ext syndrome - F B P A Lateral patellar glide - P P A D
plica is what mvmt dx
lateral patellar glide
this mvmt dx is Often seen in ballet dancers, soccer players, skaters, and swimmers
tibiofemoral rotation syndrome
explain tibiofemoral px vs patella femoral px (stairs)
Tibial femoral joint usually increases pain going upstairs (b/c concentric pull muscles)
patellofemoral problems usually worse going downstairs (b/c compression and eccentric pull)
what are some interventions for PatelloFemoral px
Strengthen hip lateral rotators Quadriceps strengthening ITB stretching (also retinaculum mobilization) Patellar bracing/ taping Foot orthosis
with a tendonitis, there is usually px with active contraction and ____
passive stretch
Autologous osteochondral mosiacplasty grafting –taking bone parts out of a cadaver and implanting it or
Autologous chondrocyte implantation may be a tx for
art cart defect
Often times, there is ___ noted with knee OA
swelling (also, remember that the medial compartment of knee degenerates faster than lateral)
ACL/PCL innervated by
tibial N
with ITB friction syndrome, resisted muscle tests are usually
neg
recurrent swelling with sharp px, may report locking or catching think
meniscus
explain how do do assessment distraction for tib femoral joint
their leg is off table, you stabalize their lower leg btwn your legs and pull down
remember for knee, the assessment includes distraction, ant glide, post glide, patella glide and tilts
yes
to increase knee ext, you glide tibia
ant
to increase knee flexion, you glide tibia
post
list all ways to increase knee flexion with mobs
- post drawer type mob
- ant glide of femur prone (pillow under thigh as you hold thigh, push femur down- slight knee flexion)
- seated posterior glide of tibia (add some distraction as you push post, towel under knee)
- Unicondylar, they are seated and you push on medial condyle like you are internally rotating them as you push post)
List all ways to increase knee ext with mobs
- ant drawer type mob
- post femoral glide (they are supine -use towel under knee (your mobbing hand is above the patella) and you push the femur post
- ant glide (short seated) towel under knee and add distraction
- Unicondylar glide (for lateral unicondylar they need to be supine bc knee needs to be in ext -push on lateral condyle as you push post)
flexion main concepts (mobs)
flexion : post glide of tibia or ant glide of femur
extension main concepts (mobs)
ant glide of tibia or post glide of femur
patellar glides, superior is for
ext (superior is the only one for ext, all others are for flexion)
patellar glides, superior is for
ext (superior is the only one for ext, all others are for flexion)
explain the convex/concave of tibia femur
The femur is convex on the concave tibia
resting position of knee
25 degrees flexion
knee distraction should not exceed a grade
II
ant fibular head glide helps with knee
ext
ant fibular head glide can be done
prone, sidelying, all 4s
tib/femoral angle (what degrees are valgum/varum)
Genu valgum: “knock knees”; angle less than 165°
Genu varum: “bow legs”; angle approaches or exceeds 180°
tib/femoral angle (what degrees are valgum/varum)
Genu valgum: “knock knees”; angle less than 165°
Genu varum: “bow legs”; angle approaches or exceeds 180°
ottawa knee rules
o In an acute injury, if one of 5 variable identified are present, radiographs are required.
Age >/= 55 years
Isolated patellar tenderness without other bone tenderness
Tenderness of the fibular head
Inability to flex knee to 90 degrees
Inability to bear weight immediately after injury and in the ED
how to grossly check tibial torsion
they are seated, you use your fingers around the malleoli (like you draw a line btwn) keep in mind the angle of the malleoli when placing your fingers
how can you objectively determine patella baja/alta
measure the length of the patella, then compare that to the length of the tibial tub to bottom of patella
2 special tests for knee edema
ballotable (top and bottom of knee joint and push togeher)
milking -move it around to 1 spot
pes anserine is located
medial and distal to tib tub
how to check a pts screw home mech
With patient sitting with knee flexed to 90, palpate the tibial tubercle and a point on the patella so the two points form a vertical line. Patient actively extends the knee. You should observe the tibia laterally rotating on the femur.
how to check a pts screw home mech
o With patient sitting with knee flexed to 90, palpate the tibial tubercle and a point on the patella so the two points form a vertical line. Patient actively extends the knee. You should observe the tibia laterally rotating on the femur.
if ant drawer is pos, what do you do next
slocums
like ant drawer but turn foot in and test then turn foot out and test
explain pivot shift
supine hip flexed, knee mostly ext your hand makes a C over calf as your thumb is behind fibular head you IR knee slightly flex knee and add valgus force clunk = pos
main features of valgus/varus testing
make sure and start in opposing position
do at 5 and 30 degrees both
main features of valgus/varus testing
make sure and start in opposing position
do at 5 and 30 degrees both
explain mcmurrays
meniscus
2 components
pt is supine
you ER tibia
their hip is flexed and knee flexed as you hold foot
and apply valgus force (from lat knee line) as you take the knee into ext
then IR knee and do varus force
explain thessaleys test
they stand, bend knee, hold your hands and twist trunk
explain thessaleys test
they stand, bend knee, hold your hands and twist trunk
pivot shift, starts in knee
ext
mcmurrays starts in knee
flexion
explain patella apprehension test
start with full ext, you move their patella lat as you flex knee and ext it back
then repeat with medial patellar glide
Clarke’s sign
mean patella one
What is the BEST range to do open-kinetic chain knee exercises if patient has patellofemoral joint problems or a recent ACL injury?
Avoid 0-30 degrees of extension
Want to do 40-90 degrees of flexion
What is the BEST range to do closed-kinetic chain knee exercises if patient has patellofemoral joint problems?
0-30 degrees of knee flexion
