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PT OCS Exam > Knee > Flashcards

Knee Flashcards

1
Q

Ottawa XR Rules (1 of 5) to rule out fracture, if all negative then XR not required.

A 
Age >= 55
TTP patella only;
TTP fibular head;
AROM less than 90
Unable to WB
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2
Q

Common ACL MOI(s)? ACL special tests?

A

Tibia IR on an ER femur (CKC)
Femur ER on an IR tibia (CKC)
Tibia anteriorly translates on femur (Hyperextension)
Valgus/IR load with increased quad, dec. H/S

1) Lachman’s (rule in/out), 2) Pivot-shift

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3
Q

Common PCL MOI(s)? PCL Special Tests?

A

Dashboard or blunt trauma to tibia
Fall on Flexed knee
Violent hyperextension

1)Post. Drawer (rule in/out), 2)Post. Sag (next best)

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4
Q

Common MCL MOI(s)? MCL Special Tests?

A

Valgus force (Lateral blow with foot fixed)

Valgus test at 30 degrees (pain and/or laxity)

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5
Q

Common Post. Lat. corner MOI(s)? Special Tests?

A

Hyperextension + ER/Varus
Complete Dislocation
Flexed/ER knee with A/P trauma

Posterolateral drawer
Dial test (Prone ER at 30 and 90 degrees of flexion) *if + at 30 PLC involved, if + at both consider PCL
Reverse pivot-shift
Recurvatum + ER

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6
Q

Common LCL MOI(s)? LCL Special tests?

A

Varus stress (medial blow to the knee)

Varus stress test at 30 degrees (pain and/or laxity)

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7
Q

Common Meniscus MOI(s)? Special tests?

A

Deep flexion injury (too much compression)
Hyperextension
Rotation on planted leg

Meniscal Pathology Composite Score (3+/5)
Thessaly Test (SL standing while pivoting IR/ER)
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8
Q

What is the Meniscal Pathology Composite Score (3+/5)?

A 
Combines 5 tests
H/O Locking/catching
TTP at joint line
pain with hyperextension
pain with end range PROM flexion
pain/click with McMurray

*Consider ACL involvement if 3/5 positive

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9
Q

Limb Symmetry Index for functional tests

A

Ideally better than 85% (Best of 2 trials with 2 practice attempts)

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10
Q

Ligament response to injury

A 
ACL/PCL intracapsular (immediate swelling with injury)
Menisci extracapsular (delayed swelling)

*Grade 3 MCL rupture can swell immediately due to capsular attachment

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11
Q

Soreness Rules for progression

A

No Soreness - modify 1 variable
Soreness diminished by warm-up - same level
Soreness remains after warm-up - decrease to prior level or consider taking the day off if still not resolved

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12
Q

Grading knee effusion

A

Trace (small wave on medial side with down stroke)
1+ (large bulge on medial side with down stroke)
2+ (effusion spontaneously returns to medial side after upstroke)
3+ (so much effusion it can’t be moved out of medial knee)

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13
Q

Surgical Precautions for knee

A

ACL with PTB consider likely patellar tendinitis
ACL with H/S graft (no resisted H/S 8-12 weeks)

Meniscal repair (No WB flexion beyond 45 degrees, 1 month)

Mircrofracture (NWB 2-4 weeks)

MCL (avoid valgus stress 4-6 weeks)

Post. Lat. corner avoid hyperextension, ER and varus stress 6-8 weeks, No resisted H/S 12 weeeks

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14
Q

Running progression

A

requires 80% strength of uninvolved, trace or less effusion

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15
Q

Candidates for UKA

A

Intact ACL

near normal weight (BMI

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16
Q

Posterior Oblique Ligament

A

Posteromedial stabilizer which works with semimembranosus to resist valgus force near full extension

17
Q

Arcuate ligament complex

A

Posterolateral stabilizer of the knee (resists ER/hyperextension)

18
Q

Posterolateral corner is made up of:

A

Arcuate ligament, LCL, popliteal tendon, lateral gastroc

19
Q

Knee outcome measures and MCID

A

KOOS (WOMAC+) 100 is the best possible score, MDC ranges based on section

20
Q

LEFS

A

MCID and MDC are both 9

21
Q

KOS

A

MCID 7 and MDC 8.87

22
Q

PF joint during flexion/extension

A 
Inferior facet (0-20 deg)
medial/lateral facets (20 deg)
Middle facet (45 deg)
superior facet (90 deg)
odd/lateral facets (beyond 90 deg)
23
Q

PF radiography

A

Merchant (sunrise view at 45 deg) allows to see the sulcus angle (in the trochlear groove) and congruency angle between the patella and trochlea.

24
Q

Ligament dominance vs. trunk dominance vs. quad dominance vs. leg dominance

A

Ligament dominance is due to poor use of the posterior chain (mainly the glutes) leads to excess IR/valgus. Train Technique.

Quad dominance is due to poor H/S recruitment which causes dec. opposition to anterior tibial translation. Presents with landing on extended knees. Train H/S and glute strengthening.

Leg dominance relates to females landing more frequently on single leg when tearing ACL, strength asymmetry compared to non-favored leg. Train leg symmetry.

Trunk/Core dominance relates to inability to control the trunk in space due to being “top heavy” and weak core.
Train core and perturbation.

25
Q

Best tests in isolation for meniscus lesion

A

Medial is TTP at joint line, Lateral is Thesaly at 5 degrees

26
Q

Knee OA predictors (3/4)

A

Knee pain/crepitus during AROM

Morning stiffness 38 or Bony enlargement

27
Q

PFPS causes

A

Muscle imbalances (Hams. tightness causes quads to work harder to extend the knee and increases compressive force) also caused by weakness in ABDuctors, quad atrophy and tightness of triceps surae

Patella Alta

OKC knee extension 0-40 degrees (increased compression on joint)

Compression from tight ITB/Lateral retinaculum decreases medial glide

Hypermobility/Instability with tibial torsion, anteversion, foot pronation (MOI usually valgus stress with ER)

Limb length

28
Q

PFPS tests

A 
Squat with pain (negative test rules out PFPS)
Patella tilt (try to lift lateral border of patella, + indicates tight retinaculum)
29
Q

Apophysitis conditions

A

Osgood-Schlater’s (tibial tuberosity)

SLJ syndrome (Distal patellar pole)

30
Q

Treating PFPS

A

Optimize eccentric control vs. hypertrophy
Strengthen Hip ABD

Long stride lunge without step (better than step lunge)
Straps during squatting alter timing to delay VL contraction

SIJ manip with PFJ mobilization (grade B evidence)

31
Q

MTSS Risk factors

A 
Female
Excessive pronation
Increased Hip IR/ER
BMI > 20
small calf girth
Previous MTSS
32
Q

MTSS DDx and treatment

A

MTSS is exercise induced leg pain with TTP 2/3 posteromedial tibial border. Best results with bony recovery (rest). Educated on use of shock absorbing shoe and increase strength/endurance of soleus. Stretching is not effective.

Exertional compartment syndrome demonstrates no TTP but anterolateral tightness/pain/neurologic symptoms related to exercise

Tibial stress Fx (TTP anterior/proximal 1/3 tibia)

Nerve entrapment

PT OCS Exam (8 decks)

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