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OCS prep > Knee > Flashcards

Knee Flashcards

1
Q

Which radiograph view is best for assessing patellar position

A

axial oblique- “sunrise” or “skyline”

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2
Q

What tilt of patella may be associated with subluxation?

A

lateral tilt (greater than 16 degrees)

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3
Q

What is typical tilt of patella

A

6 degrees medial

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4
Q

How does axis of knee shift in SLS?

A

Shifts medially

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5
Q

Shape of menisci

A

lateral: O
Medial: C

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6
Q

Which meniscus is more mobile

A

lateral

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7
Q

What muscle attaches to medial meniscus?

A

semimembranosis

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8
Q

What muscle attaches to lateral meniscus

A

popliteus

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9
Q

LCL function

A

limit varus and tibial ER

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10
Q

Which position isolates LCL from other structures for testing?

A

flexion

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11
Q

Which position is best for testing MCL

A

flexion

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12
Q

Which two ligaments contribute most to valgus prevention

A

MCL, PCL

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13
Q

Does MCL have good blood flow

A

Yes

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14
Q

Which is more firmly attached to capsule, MCL or LCL

A

MCL

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15
Q

Which bundle of ACL is larger?

A

posterolateral

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16
Q

Which portion of ACL is tested more in flexion?

A

anteromedial

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17
Q

At which position is posterolateral bundle of ACL greatest restraint to translation

A

Less than 20 degrees of flexion

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18
Q

If anteromedial bundle torn, and posterolateral bundle intact, what will result of anterior drawer be?

A

positive- anteromedial provides more restraint in increased flexion

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19
Q

Which tibial rotation increases tension on ACL

A

medial/internal (specifically anteromedial bundle)

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20
Q

Which bundle of PCL is larger?

A

anterolateral (95% of size)

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21
Q

In which position is anterolateral bundle of PCL more taut

A

flexion

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22
Q

In which position is posteromedial bundle of PCL more taut?

A

extension

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23
Q

In which position does PCL provide more support against posteriorly driven forces?

A

flexion (anterolateral bundle is larger)

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24
Q

Which ROM will largest increase in posterior translation occur in PCL tear?

A

70-90 degrees of flexion- due to laxity of secondary supports

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25
Q

Can muscles generate and/or resist varus/valgus forces?

A

Yes

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26
Q

In which ROM of weight bearing activities are posterior shear forces greatest?

A

83-105

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27
Q

In nonweight bearing extension, which ROM is a posterior force at knee present?

A

between 60 and 100 degrees of flexion

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28
Q

In nonweight bearing extension, at which ROM is an anterior force present?

A

last 40 degrees, peaking in last 10

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29
Q

As knee flexion increases, what happens to patellar contact with femur?

A

increases, loading of odd and lateral facets occurs beyond 90 degrees flexion

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30
Q

In which knee position would compressive forces from quadriceps be higher on the patella?

A

flexion more than extension

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31
Q

Why may SLR be appropriate with patellar arthritis or patellofemoral contact pain?

A

Decreased compressive forces in extension and more favorable moment arm

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32
Q

Patellofemoral compression forces during walking, jogging, and sit to stand?

A

walking: 50%
jogging: 3-4x
sit to stand: 6.7x

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33
Q

Which facet of patella bears greatest load at patella up 70 degrees of flexion

A

medial

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34
Q

Normal Q angles

A

10-15 for men, 15-20 for women

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35
Q

ROMs to avoid to limit patellofemoral stress (OKC and CKC)

A

OKC: last 30 degrees of extension
CKC: beyond 90

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36
Q

Ottowa knee (5 items)

A 
Age greater than 55
Isolated patellar tenderness
Tenderness of fibular head
Inability to flex beyond 90
Inability to bear weight immediately and in ED
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37
Q

Risk factors for SCFE

A

Overweight/very tall or very thin prepubescent boys (8-17)

anterior knee/thigh pain with negative knee exam

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38
Q

Knee pain reproduced with FABER may be caused by?

A

SCFE

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39
Q

What hip ROMs may be present with SCFE

A

lack of IR with excessive ER

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40
Q

What is Legg-Calve-Perthes?

A

AVN of femoral head

pediatric

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41
Q

What is WOMAC used for?

A

OA of knee

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42
Q

What is benefit of Knee injury and Osteoarthritis Outcome score (KOOS) over WOMAC?

A

Designed to be more responsive to higher activity levels

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43
Q

What patient population is the Lysholm Knee Score designed for?

A

Ligamentous and meniscal injuries

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44
Q

Does quadriceps recruitment suffer in conditions of effusion?

A

Not supported by evidence.

Saline injections diminish function, but not demonstrated in situ

45
Q

If valgus stress test in full extension has <5 mm laxity, which additional ligaments other than MCL may be involved?

A

ACL (more likely) and PCL

46
Q

What is most specific position to test MCL?

A

30 degrees of flexion

47
Q

Which ACL bundle is tested primarily in anterior drawer?

A

anteromedial

48
Q

If anterior drawer is more pronounced with tibial ER, what else may be involved?

A

MCL, medial capsule, posterior oblique ligament

49
Q

Sensitivity and specificity of anterior drawer?

A

Poor in acute, good in chronic

50
Q

Sensitivity and specificity of Lachman

A

85% and 94%

51
Q

Which bundle of the ACL is tested primarily with Lachman test?

A

Posterolateral

52
Q

Sn and Sp of posterior drawer?

A

90% and 99%

53
Q

Posterior sag sign Sn and Sp

A

795, 100%

54
Q

Quadriceps activating test use and Sn/Sp

A

PCL tear. 97%/100%

55
Q

Tests used to identify posterolateral corner compromise?

A

posterolateral drawer test, proner ER, reverse pivot shift, ER recurvatum test

56
Q

What structures make up the posterolateral corner?

A

Arcuate ligament, LCL, popliteal tendon, lateral gastroc

57
Q

If posterior translation is slightly increased at 30 degrees, but normal at 90 degrees, what injury may have occured?

A

posterolateral injury

58
Q

If increased ER of tibia noted at 30 degrees but not 90, what may be indicated?

A

posterolateral corner injury

59
Q

If increased ER of tibia noted at 30 and 90 degrees, what may be indicated?

A

posterolateral corner and PCL injury

60
Q

What is stronger for McMurray test, Sn or Sp

A

Specificity, a negative test does not rule out condition

61
Q

If rotation is painful at knee, what motions can indicated ligament vs meniscus?

A

Worse with distraction=ligament

Worse with compression=meniscus

62
Q

Is joint line tenderness for meniscal damage more sensitive or specific?

A

Sensitive

63
Q

Which degree of knee bending is better for Thessaly test, 5 degrees or 20 degrees?

A

20 degrees is more Sn, Sp, and positive predictive value

64
Q

Meniscal Pathology Composite score (5 items)

A 
History of catching/locking
Pain with forced hyperextension
joint line tenderness
Positive McMurray
pain with maximal flexion

If all 5: 92.3% chance of meniscus tear

3/5: 75%

65
Q

Normal patellar excursion

A

25-50% of width.

Laxity known as sage sign

66
Q

Strongest tests for PFPS

A

pain with isometric quadriceps contraction
pain with squatting
pain with palpation

2/3= +LR 4.0

67
Q

Which hop tests had best correlation with self reported knee function?

A

cross over and 6m hop

68
Q

Loose packed position of knee

A

25-30 degrees of flexion

69
Q

What degree of quadriceps weakness should NMES be considered at?

A

15% deficit or greater

70
Q

Are eccentric exercises more beneficial than standard exercises for patellar tendonitis?

A

No, there is benefit to using them as part of plan, but no evidence of superiority

71
Q

Return to sport Quad-hamstring ratio goals

A

> 66% male, >75% female

72
Q

Does taping help with patellofemoral pain due to knee OA

A

Yes, but questionable evidence if any repositioning occurs

73
Q

Are unloading braces beneficial for knee OA

A

They can be.

Ineffective with obese, and only for unicompartmental degeneration

74
Q

Effect of bracing post ACL reconstruction

A

No effect on functional testing or laxity.

Decreased quadriceps strength if used for 1-2 years

75
Q

Bracing following PCL reconstruction

A

Not typically used, but if used d/c’d within 4 weeks.

76
Q

What criteria (4) are recommended for rehabilitation, not surgery following ACL tear

A

no more than 1 episode of giving way
>80% on hop test
KOS ADL >80%
global rating score >60%

77
Q

What has increased risk following patellar graft for ACL

A

anterior knee pain, mild increase in patellar fx in rehab

78
Q

What has increased risk following hamstring graft?

A

hamstring strain. (no strength deficits)

79
Q

What is ideal time frame for ACL reconstruction?

A

time not important, but acute inflammation should not be present

80
Q

At which ROM is strain greatest on ACL?

A

last 30 degrees of OKC knee extension

81
Q

What muscle group should be focus of ACL rehab?

A

quadriceps (hamstrings recover strength without targeted therapy, even if used for graft)

82
Q

ROM restrictions with ACL/meniscus repair?

A

weight bearing flexion past 45 degrees

83
Q

If chondroplasty performed with ACL tear, what weight bearing limitations may be present

A

NWB 3-4 wks

84
Q

If MCL tear present with ACL tear, is MCL typically repaired?

A

No, MCL will heal during ACL rehab

85
Q

If ACL and PCL both reconstructed, which protocol should be followed?

A

PCL

86
Q

Are ACL reconstructions typically performed in skeletally immature?

A

No, but risk for instability is high

87
Q

What 4 clinical signs may indicated that rewards from ACL reconstruction outweighs risks in skeletally immature?

A

older than 14
partial tear of >1/2 thickness
tear of posterolateral bundle
pivot shift grade B or greater

88
Q

Are most PCL tears complete or partial?

A

Partial, often can be rehabbed (potential 1-2 wk return to sport)

89
Q

What is typically used for PCL reconstruction

A

AT allograft, so no graft site morbidity

90
Q

ROM restrictions post PCL reconstruction

A

limit to 70-90 or less for 2-4 wks

91
Q

How long should resisted knee flexion be limited following PCL reconstruction

A

4 months or more due to high PCL stress with hamstring contraction

92
Q

What are primary restraints to varus/rotational instability?

A

LCL, popliteus, popliteofibular ligament

93
Q

Time frame for LCL reconstruction?

A

within 3 weeks to avoid retraction

94
Q

Which meniscus undergoes degenerative changes quicker?

A

lateral.

Due to this, repeated excision more common with lateral injury

95
Q

weight bearing limitations following meniscal repair

A

progressed over 8 wks.

If in outer 1/3 (vascularized): weight bearing in full extension.

96
Q

Squatting restrictions post meniscus repair

A

less than 45 degrees for 4 weeks,

less than 90 degrees for 8 weeks

97
Q

Meniscal transplant demographics

A

under 40, minimal OA, not TKA candidates, 2mm joint space

98
Q

Restrictions post meniscal transplants

A

no running for one year.

often not candidates for plyometrics

99
Q

Strongest predictor of functional limitations with knee OA?

A

quadriceps strength

100
Q

How much weight loss is associated with moderate improvements in pain/function with knee OA

A

13.5lbs

101
Q

Benefits of hyaluronic acid injections

A

joint lubrication, decreased swelling/inflammation

102
Q

What does a lateral wedge accomplish for knee OA

A

limits knee adduction force, limit medial joint load.

Short term benefits only

103
Q

Osteotomy for knee OA

A

Tibial for medial compartment

Femoral for lateral

104
Q

Should posterior glides be used for PCL sacrificing TKA?

A

May stress cam/post, so no

105
Q

What is important factor with use of NMES for quadriceps strength

A

early introduction

106
Q

Indications for microfracture surgery

A

full thickness lesion with no osseous defect

107
Q

Recovery from microfracture surgery

A

NWB for up to 4 weeks, 8 weeks till full weight bearing

108
Q

risk factors for PFPS

A

female, quad tightness, hypermobile patella, weak knee extension, altered VMO response,

OCS prep (12 decks)

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