Knee

Question 1

What is unique about the knee’s size?

Answer 1

• Largest joint in body

- Sandwiched between the 2 largest levers in the body

Question 2

Due to the medial and lateral compartment of the knee, how is the arthrokinematic motion affected?

Answer 2

• Rotates around 2 axes

- Slides in 2 directions

Question 3

What is the major type of stability provided at the knee?

Answer 3

Ligamentous.

Question 4

What is the close packed position of the knee?

Answer 4

Maximal extension with ER.

Question 5

What is the loose packed position of the knee?

Answer 5

25 degrees flexion.

Question 6

What is the capsular pattern of the knee?

Answer 6

More limited flexion than extension.

Question 7

What are the shapes of the medial and lateral meniscii?

Answer 7

Medial: C shaped
Lateral: O shaped

Question 8

Which meniscus is thicker posteriorly in transverse cross-section?

Answer 8

The medial meniscus.

Question 9

What are the shapes of the menisci in sagital cross section?

Answer 9

Wedge shaped.

Question 10

What are 3 functions of the menisci?

Answer 10

• Shock absorption
• Joint motion
• Joint nutrition

Question 11

What are the 3 zones of the menisci?

Answer 11

• Interior: White
• Middle: White/red
• Peripheral: Red

Question 12

What type of effusion results from injury to the menisci?

Answer 12

Clear (synovial)

Question 13

Which meniscus is more commonly injured?

Answer 13

The lateral meniscus.

Question 14

How well innervated are the menisci?

Answer 14

Poorly.

Question 15

Which joint has the thickest articular cartilage in the body?

Answer 15

Patellofemoral.

Question 16

What are 2 functions of the patella?

Answer 16

• Increases moment arm of the quads

- Protects femoral articular cartilage

Question 17

Which facet of the patella is often the first affected by injury? Why?

Answer 17

• Odd facet (on medial facet)

- Contact at greater angles knee flexion

Question 18

What is the plica?

Answer 18

An extension of the synovial capsule of the knee.

Question 19

How much weight can the superior tibiofibular joint bear?

Answer 19

10 % of the ground reaction force

Question 20

What type abnormal arthrokinematic motion leads to knee pain in the superior tibiofibular joint?

Answer 20

• Hypomobility

Question 21

What are the 3 conditions of the Pittsburgh Knee rule?

Answer 21

• Blunt trauma or fall
• Inability to take 4 steps immediately and in clinic
  OR
• Age < 12 or > 50

Question 22

What two rules can be used to determine if an X-ray should taken for a fracture?

Answer 22

• Pittsburgh knee rule

- Ottawa knee rule

Question 23

What are the 4 conditions of the Ottawa Knee Rule?

Answer 23

• Age > 55
• Tenderness at fibular head or patella
• Inability to flex knee > 90 degrees
• Inability to take 4 steps immediately and in clinic

Question 24

What type of injury results from rotary forces?

Answer 24

Meniscii injury.

Question 25

What type of injury results from varus/ valgus forces at the knee?

Answer 25

- Collateral ligament injury | - Sometimes secondary cruciate injuries

Question 26

What type of injury results from anterior/ posterior force at the knee?

Answer 26

- Cruciates | - Someimtes secondary collateral

Question 27

What type of injury results from non-contract hyperextension or deceleration injuries?

Answer 27

- ACL | - Menisci may or may not be involved

Question 28

If there is a popping sound during a knee injury, what is indicated?

Answer 28

A soft tissue tear.

Question 29

What are 3 common subjective scales for knee injury?

Answer 29

- Cincinnati Knee Score - Lysholm Score - Knee Outcome Survey - Lower Extremity Functional Score

Question 30

Which knee subjective scale is specific to to ligamental and meniscal injury?

Answer 30

- Lysholm score.

Question 31

What are 3 measures of alignment of th eknee?

Answer 31

- Varus/ valgus (q angle, hyperextension) - Tone in/ toe out (tibial torsion or hip anteversion) - Patellar positioning

Question 32

What are the 5 variations of patellar positioning?

Answer 32

- Alta/ baja - Glide - Tilt "squinting" - Rotation - A/P

Question 33

What 6 observations should be made during an exam of the knee?

Answer 33

- Alignment - Leg lengths - Equal weightbearing (with/ without shoes) - Atrophy/ hypertrophy - Swelling, scars. redness. hair loss - Gait deviations

Question 34

What structures should be felt for tenderness during a knee exam?

Answer 34

- Bony prominences - Joint line - Muscle insertions - Ligaments - Fat pads

Question 35

What is normal AROM of knee flexion, extension, IR, and ER?

Answer 35

FLX: 0 - 135 EXT: 0 - 15 IR: 0 - 30 (knee at 90 degrees) ER: 0 - 40 (knee at 90 degrees)

Question 36

What 4 other tests of motion besides ROM may be necessary?

Answer 36

- Repetitive motions - Sustained end-range positions - Combined movements - Patellar excursion

Question 37

What ROM is greater in passive than in active in the knee?

Answer 37

- Flexion

Question 38

How much should the patella glide medial and laterally during motion testing? What position should the knee be in?

Answer 38

- Knee extended to 0 degrees | - Should extend past 1/2 patella width

Question 39

What structures are tested for flexibility when examining the knee?

Answer 39

- Hamstrings - Rectus femoris - ITB - Gastroc

Question 40

What resisted motions should be performed in a knee exam?

Answer 40

- Flexion extension - IR/ ER - Ankle plantar flexion/ dorsiflexion

Question 41

What are 10 functional tests of the knee from benign to aggressive?

Answer 41

- Walking - Ascending/ descending stairs - Squatting - Squatting with bounce at end range - Running straight - Running straight, then quick stop - Verticle jump - Figure 8, carioca running - Jumping with full squat - Hard cuts, twists, pivots

Question 42

What are 5 specific measurable functional tests of the knee?

Answer 42

- Single hop for distance - Triple hop for distance - Crossover triple hop for distance - Timed 6 meter hop

Question 43

What are 4 special tests for meniscal tears?

Answer 43

- McMurray - Apley - Ege's test - Dynamic test

Question 44

What are 3 ACL competence tests?

Answer 44

- Lachman's - Anterior drawer - Pivot shift