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Musculoskeletal II > Knee > Flashcards

Knee Flashcards

1
Q

MSK: knee

Gold standard graft for ACL reconstruction

A

patella tendon graft since mid-1980s

  • Faster incorporation and healing
  • Better outcomes young patients
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2
Q

MSK: knee

During the swipe test, if the downward stroke produces a large bulge on the medial aspect of the knee

A

1+ grade

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3
Q

MSK: knee

Ottawa knee rules:

A
  1. Age 2-55
  2. No fibular head TTP
  3. No isolated patella TTP
  4. Able to flex knee 90 deg
  5. Able to WB for steps after injury AND in the emergency department (regardless of limping)
  • if the patient is negative for all criteria, the patient is likely not to have a knee fracture.
  • If any of the criteria are met, this patient may need knee imaging: the rule is sensitive to rule-out fractures, but not specific to suggest who may have a fracture.
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4
Q

MSK: knee

symptoms are aggravated with prolonged sitting, stairs, and kneeling:

A

Patellofemoral syndrome

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5
Q

MSK: knee

tear in the outer 1/3 of the menisci?

A

it may heal

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6
Q

MSK: knee

PCL especial tests:

A
  1. Posterior drawer test
  2. sag sign
  3. dial test
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7
Q

MSK: knee

Advantages of allograft bone-tendon

A
  1. Bone to bone healing
  2. Decreased surgical time
  3. Predictable graft size
  4. Availability
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8
Q

MSK: knee

The prepatellar bursa is located

A

between the skin and the anterior aspect of the patella.

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9
Q

MSK: knee

ACL ligament prevents…

A

anterior translation of the tibia

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10
Q

MSK: knee

LCL Provides the primary restraint for _____ and lateral rotation of the tibia, and is a secondary restraint to anterior and posterior translation of the tibia on the femur.

A

varus

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11
Q

MSK: knee

MCL tear treatment:

A

conservative unless another ligament is also torn

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12
Q

MSK: knee

Hamstring tendon autograft rehab:

A
  • Less aggressive
  • Delay hamstring strengthening 6 wks
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13
Q

MSK: knee

During the swipe test, If the downward stroke produces a small bulge on the medial aspect of the knee

A

a trace

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14
Q

MSK: knee

Bleeding into a joint is referred to as

A

hemarthrosis

associate with fractures

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15
Q
A

ITB FRICTION SYNDROME

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16
Q

MSK: knee

whatever the angle of knee flexion, the ACL absorbs nearly ______ of the force causing anterior translation. The anteromedial bundle of the ACL is taut in flexion, whereas in extension, the posterolateral fibers are stretched. These unique properties not only make the ACL the crucial, ligament of the knee joint, but also increase its potential for injury.

A

90%

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17
Q

MSK: knee

During CKC movements (such as during descent into a squat position), the intercondylar groove of the femur…

A

slides relative to the fixed patella.

The patella is held in place primarily by its connection to the tibia via the patellar tendon.

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18
Q

MSK: knee

Squating, think….?

A

Meniscus

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19
Q

MSK: knee

Compartment syndrome:

A

– Trauma
– Rigorous unaccustomed activity
– Severe leg pain intensified with passive stretching
– Paresthesias
– Decreased pulses

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20
Q

MSK: knee

Indications for TKA:

A
  • Can no longer stand the pain
  • Radiographic severity is not an inidcator
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21
Q

MSK: knee

Continue passive motion in ACL rehab

A

No long term benefit

(6 studies)

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22
Q

MSK: knee

Locking?

A

Meniscus

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23
Q

MSK: knee

Pt present with Hx of recent trauma, osteoporosis, unwillingness to bear weight, point tenderness to bony structure, and hemarthrosis:

A

FRACTURES

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24
Q

MSK: knee

the PCL is most taut with further ______ of the knee

A

flexion

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25
Q

MSK: knee

Injury (trauma), yes or no?

A
  • No, think PFPS
  • Yes, ligament or meniscus tears
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26
Q

MSK: knee

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

A

vascular intermittent claudication

Claudication is pain caused by too little blood flow, usually during exercise.​

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27
Q

MSK: knee

Most forces in the patella are in what direction?

A

lateral

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28
Q

MSK: knee

What gives passive stability to the knee?

A
  • Bony fit
  • Capsule
  • Menisci
  • Ligaments (ACL, PCL, MCL, LCL)
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29
Q

MSK: knee

treatment of osteoarthritis of the knee:

A
  • Manual therapy and exercise combined
  • Gait training: lack of terminal knee extension
    • they walk in flexion because knee extension is the closed pack position of the joint
  • Hip mobilization
    • Clinical Prediction Rule for patients with knee OA likely to benefit for hip mobilization
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30
Q

MSK: knee

MCL provides the primary restraint for ______ and lateral rotation of the tibia, and is a secondary restraint to anterior and posterior translation of the tibia on the femur.

A

valgus

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31
Q

MSK: knee

Advantages of using autograft bone tendon

A
  • Faster incorporation and healing
  • Better outcomes young patients
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32
Q

MSK: knee

Non-contact injury?

A
  • One ligament (may be ACL)
  • Pop? ACL
  • Swelling withing hours = ACL
  • Sweeling over night = meniscus
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33
Q

MSK: knee

The Ottawa Knee Rules are a set of rules used to

A

help physicians determine whether an x-ray of the knee is needed

  • if the patient is negative for all criteria, the patient is likely not to have a knee fracture.
  • If any of the criteria are met, this patient may need knee imaging: the rule is sensitive to rule-out fractures, but not specific to suggest who may have a fracture.
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34
Q

MSK: knee

The quadriceps (Q) angle can be described as the angle formed by the bisection of two lines, one line drawn from __________________, and the other line drawn from ____________________________ .

A
  1. the ASIS to the center of the patella
  2. the center of the patella to the tibial tubercle
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35
Q

MSK: knee

At 135 degrees of flexion, the patella contacts the femur primarily near its…

A

superior pole

In this position, the lateral edge of the lateral facet and the “odd” facet ​(medial) of the patella share articular contact with the femur

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36
Q

MSK: knee

Knee OA symptoms:

A
  • Pain with WB
  • Morning stiffness <30 min
  • Diffuse tenderness
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37
Q

MSK: knee

S & S ACL injury

A
  • Inability to continue to play
  • Immediate joint effusion
  • Commonly feel/hear pop
  • Instability
  • Limited ROM
  • Quad atrophy
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38
Q

MSK: knee

ACL tears special tests:

A
  1. Lachman
  2. anterior drawer
  3. Pivot-shit test
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39
Q

MSK: knee

First most common injury in runners

A

PFPS

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40
Q

MSK: knee

During stationary standing, the primary function of the ITB is

A

to maintain knee and hip extension, providing the thigh muscles an opportunity to rest

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41
Q

MSK: knee

Because of the bony attachment of the patellar tendon to the tibial tuberosity, the patella follows the direction of the_____ during knee flexion

A

tibia

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42
Q

MSK: knee

PCL prevents….

A

posterior translation of the tibia

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43
Q

MSK: knee

can menisci produce pain?

A

no, aneural

the pain comes from the inflammatory process

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44
Q

MSK: knee

Long term consequences of ACL injuries remains under debate:

A
  • Meniscal injuries
  • Failure secondary stabilizers
  • Early onset of OA
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45
Q

MSK: knee

Q Angles of greater than ______ degrees are considered abnormal and may be indicative of potential displacement of the patella.

A

20

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46
Q

MSK: knee

Swipe test: it is impossible to stroke the medial fluid away

A

grade 3+

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47
Q

MSK: knee

ACL surgery indications:

A
  • Patients who are athletically active and unwilling to modify their lifestyle and want to return to pre-injury level of function
  • Patients who demonstrate functional instability despite adequate conservative therapy
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48
Q

MSK: knee

After ACL reconstruction, return to sport assessments tests?

A
  • Limb Symmetry Index of less than 85%
  • Quad strenght
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49
Q

MSK: knee

As the knee extends through the last 20 to 30 degrees of flexion, the primary contact point on the patella migrates to its

A

inferior pole

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50
Q

MSK: knee

Menisci are avascular except

A

the outer 1/3 or perifery

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51
Q

MSK: knee

Home-based rehab: 6 studies

A

No deleterious effects with motivated patients

(measure motivation)

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52
Q

MSK: knee

The circumstances that cause the highest loads and strains on the ACL during daily function are quadriceps-powered extension of the knee, moving it from approximately ____ to ___; hyperextension of the knee; excessive internal tibial rotation; or excessive varus or valgus stress on the tibia if a collateral ligament is torn.

A

40 degrees of flexion to full extension

53
Q

MSK: knee

OKC vs CKC exercises (few studies)

A

OKC activities safe after 6 weeks

54
Q

MSK: knee

Pellegrini-Stieda lesions

A
  • are ossified post-traumatic lesions at (or near) the medial femoral collateral ligament adjacent to the margin of the medial femoral condyle.
  • One presumed mechanism of injury is a Stieda fracture (avulsion injury of the medial collateral ligament at the medial femoral condyle).
  • Calcification usually begins to form a few weeks after the initial injury.
  • MCL injury complication
55
Q

MSK: knee

True or false: there is no patella-femur contact with the femur in full knee extension or during standing

A

true

56
Q

MSK: knee

Factors for return to sport:

A
  • Functional test (Limb Symmetry Index) <85%
    • Hope distance
    • Triple hop distance
    • Crossover hop distance
    • Quad strength 90%
  • Soreness rules
57
Q

MSK: knee

Non-contact, traumatic injury with swelling that occurs over night. Think…..

A

Meniscus

58
Q

MSK: knee

Devastating condition where an osseofascial compartment pressure rises to a level that decreases perfusion; may lead to irreversible muscle and nerve damage

A

Compartment syndrome

http://www.orthobullets.com/video/view?id=500

59
Q

MSK: knee

Most pain when landing from a jump, think…?

A

Tondonitis

60
Q

MSK: knee

MOI: blow in MVA, sports may result in

A

Tibial and fibular Fx

61
Q

MSK: knee

functional assessment of the knee

ex.

A
  • Squat
  • Step down
  • Walking
62
Q

MSK: knee

Disadvantages of using autograft bone tendon

A
  1. Prolonged surgical time
  2. PFPS
  3. Risk of fracture
63
Q

MSK: knee

PCL Provides the primary restraint for ________ translation and medial rotation of the tibia on the femur and is a secondary restraint to valgus and varus rotation of the tibia.

A

posterior

64
Q

MSK: knee

in open chain motions, the patella

A

slides on intercondylar groove of the femur

65
Q

MSK: knee

Discoid lateral meniscus

A
  • Lateral meniscus is round and large
  • Clinical exam: click, extension block
  • Tx: reshaping or excision if symptomatic
66
Q

MSK: knee

Complications of MCL tears:

A
  • instability,
  • Pellegrini-Stieda lesion,
  • adhesions
67
Q

MSK: knee

Swipe test: the medial fluid returns to its position without performing a downward sweep:

A

grade 2+

68
Q

MSK: knee

Advantages of using allograft soft tissue

A
  • Decreased surgical time
  • Predictable graft size
  • Availability
69
Q

MSK: knee

ACL surgery indications:

A
  • Patients who are athletically active and unwilling to modify their lifestyle and want to return to pre-injury level of function •
  • Patients who demonstrate functional instability despite adequate conservative therapy
70
Q

MSK: knee

After ACL recontruction, what should be the quad strength before returning to play as compared to the other leg?

A

90%

71
Q

MSK: knee

contraindications for TKA:

A
  • Major psychiatric disorder (dementia)
  • Poor soft tissue coverage
  • Infection
  • PVD (peripheral vascular disease)
  • Poor motivation
  • Alcohol and drug abuse
72
Q

MSK: knee

Knee OA and RA account for over ____% TKAs

A

90

73
Q

MSK: knee

The bursae serve to

A

reduce friction and to cushion the movement of one body part over another.

74
Q

MSK: knee

Patellar tendon autograft rehab considerations:

A
  • more aggressive
  • early intro to balance and proprioception
75
Q

MSK: knee

ACL MOI

A

hyperextension, valgus, anterior tibial translation, rotation

76
Q

MSK: knee

The tensile strength of the ACL is equal to that of the knee collaterals, but is half that of the PCL. Since its fibers are unyielding, forcing the ACL more than _____ beyond its resting length may result in rupture. Several factors can influence the amount of tension on the ACL

A

5%

77
Q

MSK: knee

Disadvantages of using allograft soft tissue

A
  • Cost
  • Infection
  • Higher failure
  • Delayed incorporation
78
Q

MSK: knee

It is known that the PCL is _____ thicker and has twice the tensile strength of the ACL

A

50%

79
Q

MSK: knee

Neuromuscular stim (17 studies)

A

Up to discretion of PT with variation in study

combined with quad sets

80
Q

MSK: knee

Grading of the swipe test

A
  • 0 (zero) grade is given when there is no fluid-wave while performing a downward stroke
  • If the downward stroke produces a small bulge on the medial aspect of the knee, a trace is given
  • a larger bulge is scored with a 1+ grade
  • If the medial fluid returns to its position without performing a downward sweep, a grade of 2+ is given
  • And if there is such an excess of fluid that makes it impossible to stroke the medial fluid away, a 3+ grade is given.
81
Q

MSK: knee

Pathology?

A
  • A discoid meniscus is an abnormally shaped meniscus (cartilage that cushions the bones of the knee) present in 1% to 3% of people born in the United States.
  • The condition is the result of abnormal formation of the meniscus during development in the womb. While some people may be unaware of their discoid meniscus and never experience symptoms related to it, they live at a higher risk of injury than those born with a normal meniscus.
  • A discoid meniscus is commonly detected in childhood or adolescence, and often requires surgical intervention.
  • Physical therapists provide treatment prior to and following surgery, and for conditions not requiring surgery.
82
Q

MSK: knee

MOI: Direct blow or the result of a strong quad contraction may result in

A

Patella Fx

83
Q

MSK: knee

Descending stairs think….?

A

Patellofemoral

84
Q

MSK: knee

there are 4 compartments of the leg; anterior compartment function is dorsiflexion of foot and ankle

muscles?

A
  1. tibialis anterior
  2. extensor hallucis longus
  3. extensor digitorum longus
  4. peroneus tertius

all innervated by deep fibular nerve

85
Q

MSK: knee

4 days p/o TKR patient present with calf pain, tenderness to touch, edema >3cm compared to the other side. Homan’s sign is positive

A

DVT

86
Q

MSK: knee

ACL/PCL Intra-articular and….

A

Extrasynovial

87
Q

MSK: knee

What is the swipe test?

A

sweeling/effusion test

88
Q

MSK: knee

Joint line tenderness?

A

Meniscus or arthritis

89
Q

MSK: knee

Advantages of using autograft soft tissue

A
  1. Faster incorporation and healing
  2. Better outcomes young patients
90
Q

MSK: knee

Revision rates of TKA:

A

at 10 yrs 90% still funtional

91
Q

MSK: knee

Wells criteria score of 1 to 2

A

probability DVT 17% 95%CI (12-23%)

92
Q

MSK: knee

Pittsburg knee rules:

A
  1. No fall or blunt knee trauma
  2. Age 12-50 y/o
  3. Able to walk 4 WB steps in the emergency department
  • if the patient is negative for all criteria, the patient is likely not to have a knee fracture.
  • If any of the criteria are met, this patient may need knee imaging: more specific than Ottawa rules)
93
Q

MSK: knee

the PCL provides _______ of the total restraint to posterior translation of the tibia on the femur, with the remainder being provided by the collateral ligaments, posterior portion of the medial and lateral capsules, and the popliteus tendon

A

90–95%

94
Q

MSK: knee

Post-op bracing: 11 studies

A

No improvement in safety, ROM, other outcomes

95
Q

MSK: knee

The hip external rotators and abductors affect lower limb control, and a strengthening program that addresses these muscle groups should be integrated into the overall progression. For example, weakness of the hip external rotators may allow uncontrolled and excessive pronation of the foot to occur along with excessive femoral internal rotation, both contributing to an increase in the valgus alignment of the knee, thereby increasing the Q-angle

A

from text book

96
Q

MSK: knee

Early WB/motion: 1 study

A

– Significant decrease in PFP

97
Q

MSK: knee

Disadvantages of allograft bone-tendon

A
  1. Cost
  2. Infection
  3. Higher failure
  4. Delayed incorporation
98
Q

MSK: knee

Neuromuscular training (9 studies)

A

– Efficacy for its use (DiStasi 2013)

99
Q

MSK: knee

>55 y/o sedentary lifestyle Pt with type II diabetes, smoker, intermittent claudication, presents with decreased pulses, increased capillary refill time of (6 seconds), one LE is colder than the other.

A

Peripheral arterial disease

100
Q

MSK: knee

Non-modifiable FACTORS FOR RETURNING TO SPORT,

(graft, age, sex, sport level)

A
  • Increase odds returning pre-injury HS graft
  • > 25yo 50% less likely return pre-injury
  • > 32 2/3 not playing pre-injury level
  • Men 1.5X more likely return pre-injury
  • Elite athletes 2.5X more likely return pre-injury
  • Elite athletes 6X more likely return to competitive
101
Q

MSK: knee

consequences of ACL injuries remains under debate:

A
  • Meniscal injuries
  • Failure secondary stabilizers
  • Early onset of OA
102
Q

MSK: knee

disc herniation pressing on the L4 may cause what gait deviation?

myotome for dorsiflexion is L4

(UMN lesion because the spinal cord ends at L1-L2)

A

foot drop, can’t DF the foot so they trip

103
Q

MSK: knee

ACL reconstruction preoperatively rehabilitation:

A
  • Full passive extension
  • Good quad strength
  • Minimal swelling
  • Patient education regarding expectations
104
Q

MSK: knee

Both the ACL and PCL lie in the center of the joint, and each is named according to

A

their attachment sites on the tibia

105
Q

MSK: knee

ITB friction syndrome treatment

A

Conservative

106
Q

MSK: knee

ITB friction syndrome occurs at______ degrees knee flexion

A

20-30

107
Q

MSK: knee

Recommendations for nonsurgical OA Tx:

A
  • BMI < 25 encouraged to lose weight
  • Low to moderate impact aerobic fitness
  • Glucosamine
108
Q

MSK: knee

The middle 1/3 of the tendon 10-11mm wide is removed longitudinally along with 2-2.5 cm long bone blocks.

A

PATELLA TENDON AUTOGRAFT

109
Q

MSK: knee

Accelerated rehab (2 studies)

A

Neither shortened rehab to less than 6 months

110
Q

MSK: knee

MOI of fx: valgus or varus force and axial loading may result in

A

Tibial Plateau Fx

111
Q

MSK: knee

what is the target population of patella tendon autograft

A

young, active, returning to high level sport

  • bone to bone fixation.
  • Excellent Surgical Outcomes- 90-95%
112
Q

MSK: knee

ACL provides the primary restraint for _______ translation and medial rotation of the tibia on the femur and is a secondary restraint to valgus and varus rotation of the tibia.

A

anterior

113
Q

MSK: knee

Especial tests for PFPS

A
  • Patella grind test
  • Clarke’s test
114
Q

MSK: knee

Types of ACL allografts:

A
  • Bone Patella Tendon Bone
  • Tibialis Anterior/Posterior
  • Achilles Tendon

From cadaver tissues.
Used for older pt who need a revision

115
Q

MSK: knee

ACL reconstruction post-operative rehabilitation:

A
  • Decrease inflammation and swelling
  • Attain full ROM, particularly extension
  • Restore strength (careful with OKC last 30° first 6 weeks)
  • Restore patellar mobility
  • Re-establish neuromuscular control
  • Full return to sporting activities
116
Q

MSK: knee

Avulsion Fx of the Anterior Tibial Spine

A
  • ACL injury in children
  • Intra-articular Fx, hemarthrosis
  • ORIF or reduction by extending the knee
117
Q

MSK: knee

As the knee extends toward 90 degrees of flexion, the primary contact region on the patella starts to migrate toward its…

A

inferior pole

118
Q

MSK: knee

Risk factors of ITB friction syndrome:

A
  • > 20 miles running/week
  • Training on canted surfaces
  • Training on inclined or declined surfaces
119
Q

MSK: knee

Types of ACL autografts:

A
  • Bone Patella Tendon Bone 2977N
  • Hamstrings 4140N
  • Quadriceps Tendon 2353N
  • Iliotibial Band
120
Q

MSK: knee

Other functions of the PCL include acting as a secondary restraint to ______ of the tibia on the femur at 90 degrees of flexion

A

external rotation

121
Q

MSK: knee

Complications of LCL lesions:

A
  • traction injury of the peroneal nerve (foot drop)
  • instability
122
Q

MSK: knee

Bursitis:

A
123
Q

MSK: knee

Meniscus tears especial tests:

A
  1. McMurray
  2. Apley
  3. Thessaly

(palpation)

124
Q

MSK: knee

gold standard TKA surgery technique

A

median parapatellar

125
Q

MSK: knee

Second most common injury in runners:

A

ITB FRICTION SYNDROME

126
Q

MSK: knee

Allograft rehab considerations:

A
  • less aggressive due to graft fixation soft tissue
127
Q

MSK: knee

Wells criteria score for identifying DVT of 3 or more that 3:

A

probability DVT 75% 95%CI (63-84%)

128
Q

MSK: knee

ACL becomes increasingly taut as the knee approaches and reaches full

A

extension

129
Q

MSK: knee

screw home mechanism of the knee

A

During last 10 deg of extension in OKC, ER of the tibia

Because of the ACL tension, shape of medial condyle, and lateral pull of the quads

Musculoskeletal II (6 decks)

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