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KNEE Flashcards

1
Q

what is the unhappy triad

A

ACL, MCL, medial meniscus

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2
Q

foot planted, rotational force with hyperext, think

A

ACL

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3
Q

ACL injury, max swelling occurs within ___

A

12 hours

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4
Q

typically, with ACL injury, will the pt be able to walk without assist

A

no

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5
Q

return to sport with ACL is usually

A

6-9 mos

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6
Q

where is autograft for ACL usually taken from

A

gracilis, semitendenosis, or patellar tendon

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7
Q

issue with allographs

A

higher failure rate

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8
Q

restriction associated with meniscus repair

A

very limited flexion for sev weeks

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9
Q

with ACL rehab, what is a must

A

get full ext in 2 weeks

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10
Q

with ACL, you want to get full ROM for all within ___ - ___wks

A

3-4

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11
Q

what ex do you avoid with ACL rehab

A

do not do any open chain short or long arc quads

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12
Q

what is one issue to look at week 4 with ACL rehab

A

the tissue is more compromised at ths time bc the tensile strength changes, increasing change for re-injury

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13
Q

why might you question graph type with rehab ex choices for ACL

A

ex: dont do hamstring/heel slides if hamstring tendon was uses

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14
Q

pts are usually braced for how long after ACL repair

A

1 full week

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15
Q

about mid to late rehab for ACL, avoid open chain and closed chain (what degrees)

A

60-90 closed

30-0 open

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16
Q

tibiofemoral joint usually causes px with increase in stairs bc of the concentric forces, but px going down stairs is due to

A

compression and eecentric

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17
Q

bow legged

A

genu varus

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18
Q

knocked knees

A

genu valgus (associated with RA)

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19
Q

with genu recurvatum, what needs stretched/strengthed

A

everything post needs strengthened, everything ant needs stretched

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20
Q

ant knee px (especially with squatting or stairs) think

A

patello femoral

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21
Q

beneficial ex for patellarfemoral interventions

A

strengthen hip ER and quads, ITB stretches

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22
Q

patellar tendonitis is aka

A

jumpers knee

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23
Q

explain jumpers knee

A

associated with eccentric over loads and deceleration
px with active contraction or passive stretch
valgus knee with pronation

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24
Q

persistant pain that follows the medial and lateral joint line with swelling at sometimes catching may be

A

art cart issue

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25
Q

chondromalacia patella is aka

A

patellofemoral OA

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26
Q

where is px with patellofemoral OA

A

retropatellar (worse with sitting and stairs)

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27
Q

what is “True” chondromalacia patella

A

softening of the cart on the post patella

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28
Q

what age usually has true chondromalacia patella

A

12-35 women

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29
Q

patella baja restricts what motions (low riding)

A

restricts extension

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30
Q

high patella (alta) may lead to what issue

A

subluxation or dislocation

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31
Q

what motion pinches the fat pads causing px

A

hyper ext

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32
Q

normal q angle

A

10-15

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33
Q

how to meausre q angle

A

asis to center of patella

center of patella to tibial tuberosity

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34
Q

q angle measures the tendency of what

A

tendency of patella to track laterally

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35
Q

the higher the q angle, the higher the chance that the patella will track

A

laterally

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36
Q

meniscus moves with what structures

A

femoral condyles

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37
Q

during IR, which part of the meniscus is primarily compressed

A

lateral

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38
Q

during the last 15 degrees of extension, the tibia does what

A

ER

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39
Q

greatest PF contact is at __ degrees of flexion

A

60 of knee flexion

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40
Q

best range for OKC ex for pts with PF probs

A

below 60 degrees flexion

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41
Q

best range for CKC ex for pts with PF probs

A

0-30

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42
Q

which of the ligg heal well dt good bld supply

A

MCL

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43
Q

LCL resists ___ and ___

A

varus force and ER

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44
Q

85% of medial rotation force is resisted by ACL at what angles

A

30 and 90 degrees of

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45
Q

during IR, what ligg are getting most stress

A

ACL/PCL

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46
Q

during ER, what ligg are getting most stress

A

MCL/LCL

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47
Q

what makes up the arcuate complex

A 
arcuate lig
LCL
popliteus
lateral gastroc
biceps femoris
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48
Q

why is healing an issue with the meniscus

A

lack of bld supply (poor)

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49
Q

what part of meniscus is injured more often and why

A

medial, it is less mobile than lateral

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50
Q

knee going out or buckling and compression hurts, think

A

meniscus

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51
Q

what 2 structures attach to the medial meniscus

A

MCL, semimebranosis

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52
Q

what 2 structures attach to the lateral meniscus

A

popliteus and PCL

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53
Q

glut med strain is often felt at the

A

GT

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54
Q

If ITB is tight, the femur often _____ rotates and the patella goes ____

A

IR of femur pushing the patella laterally

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55
Q

movement dx with ITB friction syndrome

A

TF rotation syndrome (IR)

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56
Q

capsular pattern for knee

A

Flexion greater than ext

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57
Q

closed packed knee

A

full ext

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58
Q

open packed knee

A

25 degrees of flexion

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59
Q

when knee flexes, the tibia glides

A

post

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60
Q

3 functions of the patella

A

provides articulation
protects femur
improves moment arm

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61
Q

hoffas syndrome is aka

A

infrapatellar fat pad syndrome

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62
Q

for hoffas syndrome, where is the px usually

A

ant knee

63
Q

bakers cyst, the px is usually

A

post

64
Q

what motion is usually very pxful with bakers cyst

A

flexion

65
Q

hoffa’s syndrome, what motion causes px

A

ext

66
Q

apophysitis at the inf pole of the patella

A

sinding larson johansons syndrome

67
Q

apophysitis at the tibial tuberosity

A

oschgoods

68
Q

superficial fibular nerve innervates (motor to )

A

fibularis longus and brevis

69
Q

sensation for fibular N is at

A

dorsum of foot and ant lower leg

70
Q

meniscus may not always have an MOI, but pts often report a feeling of

A

giving way or locking during gait and stairs

71
Q

if PCL is injured, is it typical for it to swell

A

not usually

72
Q

Ottowa knee rules are highly sensitive to

A

fx

73
Q

list the Ottowa knee rules

A 
over 55
pinpoint patellar tenderness
fib head tenderness
cant flex to 90
cant WB
74
Q

common MOI for PCL tear is

A

MVA where knee gets driven into dash

75
Q

unstable meniscus tear where the knee often locks

A

bucket handle

76
Q

type of meniscal tear that can lead to DJD

A

horizontal

77
Q

if meniscus is repaired, they are usually braced and limited to 90 degrees of flexion for ___ wks

A

3

78
Q

normal knee flexion

A

0-145

79
Q

you want to achieve full ROM for meniscus rehab within

A

4 wks

80
Q

common with athletes, appears as large soft mass behind knee, achy px

A

bakers cyst

81
Q

ITB friction syndrome, how might you rule out hamstring strain instead

A

with ITB friction syndrome, the px usually is localized at lateral femoral condyle, resisted contraction doesn’t reproduce px

82
Q

need to find out from christina about spin snout numbers

A

ok

83
Q

where is palpation of knee OA commonly pxful

A

medial knee

84
Q

reoccuring swelling, may or may not have an MOI, sharp x with buckling or giving out

A

meniscus

85
Q

2 special tests for meniscus

A

mcmurrays and apleys

86
Q

how valid are mcmurrays and apley

A

both have low sensitivity and specificity

87
Q

which lig injury MOI is usually non contact

A

ACL

88
Q

quad dominance over hamstrings, which can increase q angle, sets up an increase of injury for which lig

A

ACL

89
Q

deep achy pain, especially if walking/running down hill

A

patellafemoral issue

90
Q

ant drawer and lachmens and pivot shift are for

A

ACL test

91
Q 
increased q angle
IR
pronated foot
tight IT band (IR femur)
all of these set a pt up for which type of disorder
A

patellofemoral

92
Q

how can ITB cause an issue with the medial side of the knee

A

subpatellar area bc if ITB is really tight, it can pull on the patella

93
Q

prepatellar bursitis is often caused by

A

repetitive hitting of the knee or kneeling and hitting floor

94
Q

conditions related to tibiofemoral rotational syndrome

A 
•	Meniscal injury
•	MCL/LCL sprain
•	Patellofemoral joint dysfunction
•	ITB friction syndrome
•	Hamstring strain/tendinopathy
LMMHIP
95
Q

conditions related to knee hypomobility

A
  • OA/DJD
  • Patellofemoral joint dysfunction
  • Knee contracture
96
Q

conditions related to knee ext syndrome

A 
•	Jumper’s knee
•	Osgood-Schlatter disease
•	Patellofemoral joint dysfunction
•	Patellar tendonitis
•	Quadriceps strain
POP Q
97
Q

conditions related to knee hyperext syndrome

A 
•	Patellofemoral joint dysfunction
•	Fat pad syndrome
•	Baker’s cyst
•	Anterior knee pain
F B P A
98
Q

conditions related to patellar lateral glide syndrome

A 
•	Patellofemoral joint dysfunction
•	Anterior knee pain
•	Patellar dislocation
•	Plica syndrome
PAD
99
Q

this syndrome is described by excessive strength of the quads (dominance) so something is being pulled

A

knee ext syndrome

100
Q

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

A

hyper ext of the knee syndrome

101
Q

all knee movement dx have what as a possible pathology

A

patello femoral dysfunction

102
Q

with tibiofemoral rotational dysfunction, the tibia rotates ___ while the femur rotates ___

A

tibia goes lateral while femur can go either way

103
Q

patellar tendonitis is aka

A

jumpers knee

104
Q

px with activity that requires repetitive knee ext would make you think what mvmt dx

A

knee ext syndrome

105
Q

patellar lateral glide syndrome pathologies

A

P P A D

plica, pf dysfunction, ant px, dislocation

106
Q

in this movement dysfunction, knee pain results from impaired patellar relationship with the trochlear groove.

A

patellar lateral glide syndrome

107
Q

list all of the mvmt sx dx

A 
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
108
Q

plica is what mvmt dx

A

lateral patellar glide

109
Q

this mvmt dx is Often seen in ballet dancers, soccer players, skaters, and swimmers

A

tibiofemoral rotation syndrome

110
Q

explain tibiofemoral px vs patella femoral px (stairs)

A

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)

111
Q

what are some interventions for PatelloFemoral px

A 
Strengthen hip lateral rotators
Quadriceps strengthening
ITB stretching (also retinaculum mobilization)
Patellar bracing/ taping
Foot orthosis
112
Q

with a tendonitis, there is usually px with active contraction and ____

A

passive stretch

113
Q

Autologous osteochondral mosiacplasty grafting –taking bone parts out of a cadaver and implanting it or
Autologous chondrocyte implantation may be a tx for

A

art cart defect

114
Q

Often times, there is ___ noted with knee OA

A

swelling (also, remember that the medial compartment of knee degenerates faster than lateral)

115
Q

ACL/PCL innervated by

A

tibial N

116
Q

with ITB friction syndrome, resisted muscle tests are usually

A

neg

117
Q

recurrent swelling with sharp px, may report locking or catching think

A

meniscus

118
Q

explain how do do assessment distraction for tib femoral joint

A

their leg is off table, you stabalize their lower leg btwn your legs and pull down

119
Q

remember for knee, the assessment includes distraction, ant glide, post glide, patella glide and tilts

A

yes

120
Q

to increase knee ext, you glide tibia

A

ant

121
Q

to increase knee flexion, you glide tibia

A

post

122
Q

list all ways to increase knee flexion with mobs

A
  1. post drawer type mob
  2. ant glide of femur prone (pillow under thigh as you hold thigh, push femur down- slight knee flexion)
  3. seated posterior glide of tibia (add some distraction as you push post, towel under knee)
  4. Unicondylar, they are seated and you push on medial condyle like you are internally rotating them as you push post)
123
Q

List all ways to increase knee ext with mobs

A
  1. ant drawer type mob
  2. post femoral glide (they are supine -use towel under knee (your mobbing hand is above the patella) and you push the femur post
  3. ant glide (short seated) towel under knee and add distraction
  4. 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)
124
Q

flexion main concepts (mobs)

A

flexion : post glide of tibia or ant glide of femur

125
Q

extension main concepts (mobs)

A

ant glide of tibia or post glide of femur

126
Q

patellar glides, superior is for

A

ext (superior is the only one for ext, all others are for flexion)

127
Q

patellar glides, superior is for

A

ext (superior is the only one for ext, all others are for flexion)

128
Q

explain the convex/concave of tibia femur

A

The femur is convex on the concave tibia

129
Q

resting position of knee

A

25 degrees flexion

130
Q

knee distraction should not exceed a grade

A

II

131
Q

ant fibular head glide helps with knee

A

ext

132
Q

ant fibular head glide can be done

A

prone, sidelying, all 4s

133
Q

tib/femoral angle (what degrees are valgum/varum)

A

 Genu valgum: “knock knees”; angle less than 165°

 Genu varum: “bow legs”; angle approaches or exceeds 180°

134
Q

tib/femoral angle (what degrees are valgum/varum)

A

 Genu valgum: “knock knees”; angle less than 165°

 Genu varum: “bow legs”; angle approaches or exceeds 180°

135
Q

ottawa knee rules

A

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

136
Q

how to grossly check tibial torsion

A

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

137
Q

how can you objectively determine patella baja/alta

A

measure the length of the patella, then compare that to the length of the tibial tub to bottom of patella

138
Q

2 special tests for knee edema

A

ballotable (top and bottom of knee joint and push togeher)

milking -move it around to 1 spot

139
Q

pes anserine is located

A

medial and distal to tib tub

140
Q

how to check a pts screw home mech

A

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.

141
Q

how to check a pts screw home mech

A

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.

142
Q

if ant drawer is pos, what do you do next

A

slocums

like ant drawer but turn foot in and test then turn foot out and test

143
Q

explain pivot shift

A 
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
144
Q

main features of valgus/varus testing

A

make sure and start in opposing position

do at 5 and 30 degrees both

145
Q

main features of valgus/varus testing

A

make sure and start in opposing position

do at 5 and 30 degrees both

146
Q

explain mcmurrays

A

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

147
Q

explain thessaleys test

A

they stand, bend knee, hold your hands and twist trunk

148
Q

explain thessaleys test

A

they stand, bend knee, hold your hands and twist trunk

149
Q

pivot shift, starts in knee

A

ext

150
Q

mcmurrays starts in knee

A

flexion

151
Q

explain patella apprehension test

A

start with full ext, you move their patella lat as you flex knee and ext it back
then repeat with medial patellar glide

152
Q

Clarke’s sign

A

mean patella one

153
Q

What is the BEST range to do open-kinetic chain knee exercises if patient has patellofemoral joint problems or a recent ACL injury?

A

Avoid 0-30 degrees of extension

Want to do 40-90 degrees of flexion

154
Q

What is the BEST range to do closed-kinetic chain knee exercises if patient has patellofemoral joint problems?

A

0-30 degrees of knee flexion

MSK (10 decks)

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