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MSK II > Knee > Flashcards

Knee Flashcards

1
Q

Locking with meniscus

A

Knee gets locked in flexion and cannot be extended

In bucket handle meniscal tear

Does not get fixed until surgeon performs

Why non-elective? Subchondral break down

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2
Q

Injury?

A

Ligament or meniscal tears

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3
Q

Non-contact?

A

One ligament (usually ACL)

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4
Q

Pop?

A

ACL

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5
Q

Swelling?

A

Within hours - ACL

Overnight - meniscus

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6
Q

Locking?

A

Meniscus

Bucket handle meniscus tear

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7
Q

Joint line tenderness?

A

Meniscus or arthritis

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8
Q

Stairs?

A

Patellofemoral

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9
Q

Squatting?

A

Meniscus

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10
Q

Pain landing from a jump?

A

Tendinopathy

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11
Q

Delayed swelling

A

Intra-synovial or extracapsular

Menisci, collateral ligaments, quad/patellar tendon, patella subluxation

EXCEPTION: MCL
Attaches to medial joint capsule, so you might have immediate swelling, might not

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12
Q

Giving way straight plane walking

A

Patellar instability

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13
Q

Giving way cutting movements

A

ACL
PCL
Capsule

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14
Q

Giving way descending stairs

A

Quadriceps inhibition

Quads eccentric control problem

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15
Q

Stroke Test Grade 0

A

No fluid-wave while performing a downward stroke

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16
Q

Stroke Test Trace

A

If the downward stroke produces a small bulge on the medial aspect of the knee

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17
Q

Stroke Test Grade 1+

A

Larger bulge on medial side of the knee

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18
Q

Stroke Test Grade 2+

A

If the medial fluid returns to its position without performing a downward sweep

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19
Q

Stroke Test Grade 3+

A

The excess of fluid makes it impossible to stroke the medial fluid away

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20
Q

Hemiarthrosis

A

Collection of blood in joint

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21
Q

Fractures

A

Hx of recent trauma, osteoporosis

Unwillingness to bear weight

Hemiarthrosis

Point tenderness to bony structures

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22
Q

Peripheral Arterial Disease

A 
Age > 55 years
Type II DM
Smoking
Sedentary lifestyle
Intermittent claudication
Unilateral cool extremity
Decreased pulses
Increased capillary refill
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23
Q

DVT

A

Recent surgery, pregnancy, trauma, immob

Calf pain

Edema

Tenderness

Homan’s sign? 50/50 accuracy

Wells criteria

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24
Q

Compartment Syndrome

A 
Trauma
Rigorous unaccustomed activity
Severe leg pain with passive stretching
Paresthesias
Decreased pulses
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25
Q

Ottawa Knee Rules

A

You DON’T need an xray if…

Age 2-55
No fibular head TTP
No isolated patellar TTP
Able to flex 90 degrees
Able to WB for 4 steps after injury AND in ED
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26
Q

Pittsburgh Knee Rules

A

No fall or blunt knee trauma
Age 12-50
Able to walk 4 WB steps in the ED

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27
Q

Tibial and fibular fx

A

MOI… MVA, sports

Tx…

Stable = closed reduction and cast or walking cast or functional brace

Unstable = ORIF of Illizarov

Complications…

Ankle stiffness
Arterial/nerve injury
Malunion
Nonunion
Compartment syndrome
Infection
CRPS
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28
Q

Tibial plateau fx

A

MOI… Valgus or varus force and axial loading

Tx…

Undisplaced = hemiarthrosis aspiration, CPM, PWB after 8 weeks

Comminuted = slightly depressed c traction

Displaced = ORIF

Complications…

Frequently leads to knee OA
PWB for at least 2 mos

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29
Q

Patella fx

A

MOI… Direct blow or the result of a strong quad contraction

Tx…

Undisplaced = aspiration, plastic cylinder in ext. for 3-4 weeks

Comminuted = patellectomy or cast

Displaced = ORIF

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30
Q

Knee OA Symptoms

A

Pain with WB

Morning stiffness

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31
Q

Knee OA Systemic Risk Factors

A 
Age and sex
Genetics
Decreased estrogen levels
Increased bone mineral density
Obesity
Acute injury
Repetitive injury
Joint deformity
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32
Q

CRITERIA FOR CLASSIFICATION OF KNEE OA

A 
Age > 50
Knee crepitus
Palpable bony enlargement
Bony TTP
Morning stiffness that improves in  3 variables present
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33
Q

Knee OA tx

A

Manual therapy + exercise

Gait training for lack of TKE

Hip mobilizations

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34
Q

Indications for TKA

A

Can no longer stand the pain

Radiographic severity NOT an indicator

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35
Q

Contraindications for TKA

A 
Major psychiatric disorder
Poor soft tissue coverage
Infection
PVD
Poor motivation
Alcohol and drug use
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36
Q

Goal of any TKA

A

Restore the mechanical axis of the TFJ through bony cuts, soft tissue mobilization, and ideal component implantation with proper patellar tracking

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37
Q

3 Steps TKA

A

Skin incision
Arthrotomy
Mobilization of the extensor mechanism

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38
Q

Medial Parapatellar TKA advantages

A

Gold standard
Protects neurovascular structures
Clear visualization of the joint

39
Q

Medial parapatellar TKA disadvantages

A

Extensive incision through the quadriceps tendon

PCL may or may not be spared

s/p 1 year have 40-50% deficit in quad strength

40
Q

Common TKA surgical elements

A

PCL may or may not be removed

Femoral component is metal

Tibial component is metal

Spacer on top of tibia is plastic

***In a year, everyone is pretty much in the same place REGARDLESS of the surgical intervention

41
Q

PCL sparing or sacrificing

A

Very controversial

Based on surgeon’s comfort level currently

42
Q

TKA Complications

A 
DVT
Stiff knee
Infection
Peripheral nerve injuries
Aseptic loosening
Extensor Mechanism Rupture
43
Q

DVT s/p TKA

A

Greatest 1st week after surgery
First sign can be PE

Symptoms...
Pain
Swelling
Redness of the leg
Dilation of the surface veins

15% higher risk DVT for every decade after 50

44
Q

Sx/sy PE

A

Chest pain
Respiratory symptoms w/wo hemoptysis
Tachycardia (> 100)

10% cases fatal within first hour

45
Q

Stiff knee

A

Flexion contracture equal to or > 10 degrees

Total arc of motion

46
Q

Stiff knee tx

A 
Intensive PT
Splinting
Injections
Close manipulation (MUA)
Arthroscopic debridement (ONLY AFTER MUA FAILS)
Revision surgery (COMPONENTS FAIL)
47
Q

Most important predictors of post-op stiff knee?

A

Pre-op ROM

48
Q

Conservative vs Manipulation for Stiff Knee

A

Manipulation works best within 3 mos sx

Late manipulation can be more risky with complications as quad and patella tendon rupture, femur fracture, and hematoma formation

More successful for flexion gains than extension gains

49
Q

Stairs

A

85 degrees knee flexion

50
Q

Rising from a chair

A

95 degrees knee flexion

51
Q

Kneeling and squatting

A

125-135 degrees knee flexion

52
Q

Osgood Schlatter’s

A

Overuse injury of the knee

Symptoms BELOW knee cap…
Pain
Swelling
Tenderness

Constant/overuse pulling of patella tendon

Low of dx if growth plates are closed

Don’t need to take off from sport

53
Q

Discoid lateral meniscus

A

More common during puberty in girls

Lateral meniscus is much thicker than normally expected

Clinical exam - Click, ext block

Tx - reshaping or excision if symptomatic

54
Q

Meniscal prevalence

A

Medial > Lateral

55
Q

Meniscal injuries sx/sy

A 
Joint line TTP
Knee locking
Daily pain
Effusion
Decreased flexion ROM
56
Q

Thessaly test

A

Meniscal tear

Standing + rotation

+ pain and/or clicking

57
Q

Meniscal tears

A

MOI… Loading and rotation

Lateral more common with ACL tears as the lateral tibial plateau subluxes anteriorly

58
Q

Red red zone

A

Good blood supply

Repair

59
Q

Red white zone

A

Controversial

Some surgeons may opp to try and repair

60
Q

White white zone

A

No blood supply

Menisectomy or conservative tx

61
Q

Apley test

A

Meniscal tear

Patient prone

+ reproduction of pain or clicking with compression and rotation

62
Q

McMurray test

A

Meniscal tear

Flex knee to end-range with one hand

IR/ER into ext and back into flexion

+ pain and/or clicking

63
Q

Diagnostic accuracy for meniscal tear special tests

A

Lateral meniscus high LR

64
Q

Combination of meniscal testing

A

Hx of mechanical catching or locking reported by pt

Joint line tenderness

Pain with forced knee HYPERext

Pain with max passive knee flexion

Pain or audible click with McMurray maneuver

65
Q

Conservative treatment for meniscal repairs

A

Modalities for inflammation

Flexibility

Quad strengthening

Hamstring strengthening

  • **Semimembranosus attaches to medial meniscus
  • **Be aware of after meniscal repair

Orthotics

66
Q

Menisectomy

A

WB immediately
They don’t need a brace
1st or 2nd day lose crutches
No swelling with increase in activity level

67
Q

Meniscal repair

A 
PROTECT FOR 1 MONTH
Passive extension
TTWB
No flexion > 90 for 4 weeks
No CKC exercises > 90 for 4 weeks

Hamstrings - for 1 month, especially if it’s a medial meniscal repair

68
Q

Meniscal transplantation

A

C/I - advanced arthrosis

No arthritis in either compartment

No genu varum or valgum

You must have failed menisectomy at least once

69
Q

ACL

A

Women > men

Noncontact most common

Pts with these injuries have greater risk of developing OA

70
Q

ACL MOI

A

HYPERext, valgus, ant tib translation, rotation

71
Q

Sx/sy ACL

A 
Inability to continue play
Immediate joint effusion
Commonly feel/hear pop
Instability
Limited ROM
Quad atrophy
72
Q

Lachman test

A

ACL

Gold standard

Don’t let femur move

+ laxity or no end feel

73
Q

Anterior drawer

A

ACL

Don’t use this

Too much flexion and the hamstring will contribute to a false negative

+ no end feel or excessive motion

74
Q

Pivot shift

A

ACL

Surgeons do this UNDER ANESTHESIA

Physically impossible to get a good pivot shift test while someone is awake

+ tibia will sublux in ant/lat position

75
Q

Non-operative management ACL

A 
Improve stability
Return to activities
Minimize complications
Restore ROM
Restore strength
Normalize gait
76
Q

ACL extension

A

Work on immediate passive extension, then flexion will generally return as swelling subsides

77
Q

OC knee extension

A

Yes with full blown ACL tear

NO with partial tear bc there’s more tensile force in OC movement

78
Q

Autographs

A

Comes from you

BPTB
Hamstrings
Quads
ITB

79
Q

Allographs

A

BPTB
TA/TP
Achilles tendon

80
Q

Bone to bone healing

A

Trumps all tissue healing

81
Q

Non-modifiable factors return to sport

A

Graft
Age
Sex
Sport level

82
Q

Modifiable factors return to sport

A

Increased motivation confidence
Optimism
Low fear

83
Q

Avulsion fx of anterior tibial spine

A

Intra-articular fx, hemiarthrosis

Anatomical reduction

ORIF or reduction by extending the knee

84
Q

Valgus stress test

A

MCL

+ reproduction of pain and/or laxity

85
Q

MCL tears

A

Pain increases with partial tears

Complications…
Instability
Pellegrini-Stieda lesion
Adhesions

86
Q

LCL tears

A

Better outcomes in pts c valgus alignment

Surgical repair in first two weeks (III)

Conservative tx (I and II)

Complications…
Traction injury peroneal nn
Instability

87
Q

Varus stress test

A

LCL

+ reproduction of pain and/or laxity

88
Q

PCL tears

A

MOI…

Blow to ant tibia (dashboard injury) or hyperflexion

Dx…

History, posterior drawer, “sag” sign, dial test

Commonly other ligaments are also torn

Surgical repair is difficult

89
Q

Posterior drawer test

A

PCL

+ increase posterior tibial translation

90
Q

Posterior sag sign

A

PCL

Pt supine

+ increased posterior tibial translation

91
Q

Dial test

A

PCL

Examines ER of tibia

+ PCL tear increased ER at 90 degrees knee flexion

+ PLRI increased tibial ER at 30 degrees flexion

92
Q

Patella tracking

A

SUPERIOR in EXTENSION

93
Q

ITB Friction Syndrome

A

Risk factors…
> 20 miles a week
Training on canted surfaces
Training on inclined or declined surfaces

Second most common injury in runners

Occurs at 20-30 degrees knee flexion

94
Q

Bursa

A

Suprapatellar
Pre patellar
Infrapatellar
Pes anserine

MSK II (2 decks)

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