Knee Flashcards
1
Q
Which radiograph view is best for assessing patellar position
A
axial oblique- “sunrise” or “skyline”
2
Q
What tilt of patella may be associated with subluxation?
A
lateral tilt (greater than 16 degrees)
3
Q
What is typical tilt of patella
A
6 degrees medial
4
Q
How does axis of knee shift in SLS?
A
Shifts medially
5
Q
Shape of menisci
A
lateral: O
Medial: C
6
Q
Which meniscus is more mobile
A
lateral
7
Q
What muscle attaches to medial meniscus?
A
semimembranosis
8
Q
What muscle attaches to lateral meniscus
A
popliteus
9
Q
LCL function
A
limit varus and tibial ER
10
Q
Which position isolates LCL from other structures for testing?
A
flexion
11
Q
Which position is best for testing MCL
A
flexion
12
Q
Which two ligaments contribute most to valgus prevention
A
MCL, PCL
13
Q
Does MCL have good blood flow
A
Yes
14
Q
Which is more firmly attached to capsule, MCL or LCL
A
MCL
15
Q
Which bundle of ACL is larger?
A
posterolateral
16
Q
Which portion of ACL is tested more in flexion?
A
anteromedial
17
Q
At which position is posterolateral bundle of ACL greatest restraint to translation
A
Less than 20 degrees of flexion
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
19
Q
Which tibial rotation increases tension on ACL
A
medial/internal (specifically anteromedial bundle)
20
Q
Which bundle of PCL is larger?
A
anterolateral (95% of size)
21
Q
In which position is anterolateral bundle of PCL more taut
A
flexion
22
Q
In which position is posteromedial bundle of PCL more taut?
A
extension
23
Q
In which position does PCL provide more support against posteriorly driven forces?
A
flexion (anterolateral bundle is larger)
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
25
Can muscles generate and/or resist varus/valgus forces?
Yes
26
In which ROM of weight bearing activities are posterior shear forces greatest?
83-105
27
In nonweight bearing extension, which ROM is a posterior force at knee present?
between 60 and 100 degrees of flexion
28
In nonweight bearing extension, at which ROM is an anterior force present?
last 40 degrees, peaking in last 10
29
As knee flexion increases, what happens to patellar contact with femur?
increases, loading of odd and lateral facets occurs beyond 90 degrees flexion
30
In which knee position would compressive forces from quadriceps be higher on the patella?
flexion more than extension
31
Why may SLR be appropriate with patellar arthritis or patellofemoral contact pain?
Decreased compressive forces in extension and more favorable moment arm
32
Patellofemoral compression forces during walking, jogging, and sit to stand?
walking: 50%
jogging: 3-4x
sit to stand: 6.7x
33
Which facet of patella bears greatest load at patella up 70 degrees of flexion
medial
34
Normal Q angles
10-15 for men, 15-20 for women
35
ROMs to avoid to limit patellofemoral stress (OKC and CKC)
OKC: last 30 degrees of extension
CKC: beyond 90
36
Ottowa knee (5 items)
```
Age greater than 55
Isolated patellar tenderness
Tenderness of fibular head
Inability to flex beyond 90
Inability to bear weight immediately and in ED
```
37
Risk factors for SCFE
Overweight/very tall or very thin prepubescent boys (8-17)
anterior knee/thigh pain with negative knee exam
38
Knee pain reproduced with FABER may be caused by?
SCFE
39
What hip ROMs may be present with SCFE
lack of IR with excessive ER
40
What is Legg-Calve-Perthes?
AVN of femoral head
pediatric
41
What is WOMAC used for?
OA of knee
42
What is benefit of Knee injury and Osteoarthritis Outcome score (KOOS) over WOMAC?
Designed to be more responsive to higher activity levels
43
What patient population is the Lysholm Knee Score designed for?
Ligamentous and meniscal injuries
44
Does quadriceps recruitment suffer in conditions of effusion?
Not supported by evidence.
Saline injections diminish function, but not demonstrated in situ
45
If valgus stress test in full extension has <5 mm laxity, which additional ligaments other than MCL may be involved?
ACL (more likely) and PCL
46
What is most specific position to test MCL?
30 degrees of flexion
47
Which ACL bundle is tested primarily in anterior drawer?
anteromedial
48
If anterior drawer is more pronounced with tibial ER, what else may be involved?
MCL, medial capsule, posterior oblique ligament
49
Sensitivity and specificity of anterior drawer?
Poor in acute, good in chronic
50
Sensitivity and specificity of Lachman
85% and 94%
51
Which bundle of the ACL is tested primarily with Lachman test?
Posterolateral
52
Sn and Sp of posterior drawer?
90% and 99%
53
Posterior sag sign Sn and Sp
795, 100%
54
Quadriceps activating test use and Sn/Sp
PCL tear. 97%/100%
55
Tests used to identify posterolateral corner compromise?
posterolateral drawer test, proner ER, reverse pivot shift, ER recurvatum test
56
What structures make up the posterolateral corner?
Arcuate ligament, LCL, popliteal tendon, lateral gastroc
57
If posterior translation is slightly increased at 30 degrees, but normal at 90 degrees, what injury may have occured?
posterolateral injury
58
If increased ER of tibia noted at 30 degrees but not 90, what may be indicated?
posterolateral corner injury
59
If increased ER of tibia noted at 30 and 90 degrees, what may be indicated?
posterolateral corner and PCL injury
60
What is stronger for McMurray test, Sn or Sp
Specificity, a negative test does not rule out condition
61
If rotation is painful at knee, what motions can indicated ligament vs meniscus?
Worse with distraction=ligament
| Worse with compression=meniscus
62
Is joint line tenderness for meniscal damage more sensitive or specific?
Sensitive
63
Which degree of knee bending is better for Thessaly test, 5 degrees or 20 degrees?
20 degrees is more Sn, Sp, and positive predictive value
64
Meniscal Pathology Composite score (5 items)
```
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
Normal patellar excursion
25-50% of width.
Laxity known as sage sign
66
Strongest tests for PFPS
pain with isometric quadriceps contraction
pain with squatting
pain with palpation
2/3= +LR 4.0
67
Which hop tests had best correlation with self reported knee function?
cross over and 6m hop
68
Loose packed position of knee
25-30 degrees of flexion
69
What degree of quadriceps weakness should NMES be considered at?
15% deficit or greater
70
Are eccentric exercises more beneficial than standard exercises for patellar tendonitis?
No, there is benefit to using them as part of plan, but no evidence of superiority
71
Return to sport Quad-hamstring ratio goals
>66% male, >75% female
72
Does taping help with patellofemoral pain due to knee OA
Yes, but questionable evidence if any repositioning occurs
73
Are unloading braces beneficial for knee OA
They can be.
Ineffective with obese, and only for unicompartmental degeneration
74
Effect of bracing post ACL reconstruction
No effect on functional testing or laxity.
Decreased quadriceps strength if used for 1-2 years
75
Bracing following PCL reconstruction
Not typically used, but if used d/c'd within 4 weeks.
76
What criteria (4) are recommended for rehabilitation, not surgery following ACL tear
no more than 1 episode of giving way
>80% on hop test
KOS ADL >80%
global rating score >60%
77
What has increased risk following patellar graft for ACL
anterior knee pain, mild increase in patellar fx in rehab
78
What has increased risk following hamstring graft?
hamstring strain. (no strength deficits)
79
What is ideal time frame for ACL reconstruction?
time not important, but acute inflammation should not be present
80
At which ROM is strain greatest on ACL?
last 30 degrees of OKC knee extension
81
What muscle group should be focus of ACL rehab?
quadriceps (hamstrings recover strength without targeted therapy, even if used for graft)
82
ROM restrictions with ACL/meniscus repair?
weight bearing flexion past 45 degrees
83
If chondroplasty performed with ACL tear, what weight bearing limitations may be present
NWB 3-4 wks
84
If MCL tear present with ACL tear, is MCL typically repaired?
No, MCL will heal during ACL rehab
85
If ACL and PCL both reconstructed, which protocol should be followed?
PCL
86
Are ACL reconstructions typically performed in skeletally immature?
No, but risk for instability is high
87
What 4 clinical signs may indicated that rewards from ACL reconstruction outweighs risks in skeletally immature?
older than 14
partial tear of >1/2 thickness
tear of posterolateral bundle
pivot shift grade B or greater
88
Are most PCL tears complete or partial?
Partial, often can be rehabbed (potential 1-2 wk return to sport)
89
What is typically used for PCL reconstruction
AT allograft, so no graft site morbidity
90
ROM restrictions post PCL reconstruction
limit to 70-90 or less for 2-4 wks
91
How long should resisted knee flexion be limited following PCL reconstruction
4 months or more due to high PCL stress with hamstring contraction
92
What are primary restraints to varus/rotational instability?
LCL, popliteus, popliteofibular ligament
93
Time frame for LCL reconstruction?
within 3 weeks to avoid retraction
94
Which meniscus undergoes degenerative changes quicker?
lateral.
Due to this, repeated excision more common with lateral injury
95
weight bearing limitations following meniscal repair
progressed over 8 wks.
If in outer 1/3 (vascularized): weight bearing in full extension.
96
Squatting restrictions post meniscus repair
less than 45 degrees for 4 weeks,
| less than 90 degrees for 8 weeks
97
Meniscal transplant demographics
under 40, minimal OA, not TKA candidates, 2mm joint space
98
Restrictions post meniscal transplants
no running for one year.
| often not candidates for plyometrics
99
Strongest predictor of functional limitations with knee OA?
quadriceps strength
100
How much weight loss is associated with moderate improvements in pain/function with knee OA
13.5lbs
101
Benefits of hyaluronic acid injections
joint lubrication, decreased swelling/inflammation
102
What does a lateral wedge accomplish for knee OA
limits knee adduction force, limit medial joint load.
Short term benefits only
103
Osteotomy for knee OA
Tibial for medial compartment
| Femoral for lateral
104
Should posterior glides be used for PCL sacrificing TKA?
May stress cam/post, so no
105
What is important factor with use of NMES for quadriceps strength
early introduction
106
Indications for microfracture surgery
full thickness lesion with no osseous defect
107
Recovery from microfracture surgery
NWB for up to 4 weeks, 8 weeks till full weight bearing
108
risk factors for PFPS
female, quad tightness, hypermobile patella, weak knee extension, altered VMO response,
