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PTA Ortho > Knee > Flashcards

Knee Flashcards

1
Q

Tibiofemoral Joint

A

biaxial modified hinge joint

Distal Femur-convex

  • medial and lateral condyle
  • medial condyle is larger and longer

Proximal Tibia-concave

  • composed of 2 tibial plateus
  • medial plateu larger than lateral
  • fibrocartilaginous menisci attached to each plateu
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2
Q

End feels

A

Knee extension-firm

Knee flexion-soft

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3
Q

Rectus femoris

A

hip flexion and knee extension

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4
Q

Vastus medialis, interedialis and lateralis

A

knee flexion

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5
Q

semitendinosus, semimembranosus, long head of biceps femoris

A

hip extension and knee flexion

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6
Q

short head of biceps femoris

A

knee flexion only

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7
Q

gastrocnemius

A

can assist with knee flexion

not a prime mover

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8
Q

Knee open pack

A

25 degrees of flexion

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9
Q

knee closed pack

A

full extension and tibial lateral rotation

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10
Q

Open Chain

A

concave tibial plateau slides on convex femoral condyle

knee ext: tibia glides anteriorly
Knee flex: tibia glides posteriorly

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11
Q

closed chain

A

convex femoral condyle slides on concav tibial plataeu

Knee extension: femur glides posteriorly
knee flex: femur glides anteriorly

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12
Q

Screw home mechanism Open Chain

A

ext:
tibia laterally rotates 30 degrees flexion to 0 degrees
most occuring last 5 degrees

Flex:
tibia medially rotates 0 degrees to 30 degrees-unlocking

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13
Q

Screw home mechanism Closed chain

A

ext:
femur rotates medially 30 degrees flexion to 0 degrees–locking

flex:
femur rotates laterally 0-30 degrees flexion –unlocking

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14
Q

Menisci

A

two fibrocartilaginous structures are located on the superior surface of the tibia

serve as a shock absorbers/ load transmission

Menisci deepen the flat superior surface of the tibia

  • improves congruency of the articulating surfaces
  • improves joint stability
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15
Q

Lateral Meniscus

A

oval shaped
lies on smaller lateral tibial plateau
smaller

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16
Q

Medial Meniscus

A

semilunar shaped
lies on larger medial plateau
*more like a moon shape
*Tightly bound to the tibia

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17
Q

effect of knee movement on menisci

A

Extension:
-femoral condyles tend to push to menisci anteriorly

Flexion:
-femoral condyles pull meniscus posteriorly

Medial and lateral tibial rotation:

  • menisci tend to move with the femoral condyles
  • follow femoral condyles
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18
Q

Anterior cruciate ligament

A

anterior tibia to posterior femur
prevents abnormal anterior translation of tibia on femur
resists extremes of knee extension

named for where it originates on tibia and what movement it prevents

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19
Q

Posterior cruciate ligament

A

posterior tibia to anterior femur
prevents abnormal posterior translation of tibia on femur
resists extremes of knee flexion

Named for where it originates on tibia and what movement it prevents

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20
Q

medial collateral

A

protects the knee form lateral/valgus stress

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21
Q

lateral collateral

A

protects the knee from medial/varus stress

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22
Q

Patellofemoral joint

A

formed by patella and anterior distal femur
increasesmoment arm of quadriceps muscle
redirects forces-pulley
increases the lever arm of the quads increasing the quads strength by 35-50%

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23
Q

patella

A

sesamoid bone

articulates with trochlear groove on anterior distal femur
artiluating surface is covered with smooth hyaline cartilage

embedded in anterior joint capsule
connected to tibia by patellar tendon

slides superiorly with extension
slides inferiorly with flexion

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24
Q

forces maintaining alignment of patella with trochlear groove of femur

A

lateral-IT band and lateral retinaculum
medial: VMO, medial retinaculum
Inferior-patellar tendon
superior: quad tendon

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25
Q

Open pack position of patella

A

full knee extension

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26
Q

Q angle/measurement

A

angle of 2 lines intersecting
ASIS to midpoint of patella
Tibial tuberosity and midpoint of patella

normal Q angle: 10-15 degrees

women usually have a greated angle

angles greater than 19 degrees the patella tracks more laterally

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27
Q

Medial collateral ligament stability test

A

valgus stress test
identifies MCL instability

apply pressure and valgus stress at 0 degrees and 30 degrees extension

+ test= excessive gapping at medial joint line

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28
Q

lateral collateral ligament stability test

A

varus stress test
identifies LCL instabilty

apply varus stress at 0 degrees and 30 degrees extension

+test= excessive gapping at lateral joint line

**gapping at 0 degrees suggest a more severe injury such as ACL or PCL

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29
Q

Lachman’s Test

A

identifies ACL tear
patient supine with knene flexed 20-30 degrees
*more comfortable and muscles put on slack but ACL is tighter

stabilize distal femur with one hand and grasp proximal tibia

moves tibia anteriorly on femur

+test= excessive movement of tibia

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30
Q

Anterior Drawer Test

A

Identifies ACL tear
patient supine with knees in hook lying position
sits on patients foot to stabilize lower leg
pull anteriorly on proximal tibia
knee bent to 90 degree
+=excessive anterior movement of tibia

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31
Q

Posterior Drawer Test

A

identifies PCL tear
pt. supine with knees in hook lying position
sit on patients foot to stabilize lower leg
push posteriorly on proximal tibia
+test = excessive posterior movement of tibia

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32
Q

Sag Test =Godfrey’s test

A

identifies PCL tear

pt. supine with hips and knees flexed to 90 degrees
lower legs resting in therapist hand or chair
+sign= observable posterior translation of tibia

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33
Q

apley’s compression Grind Test

A

identifies meniscal tear
patient prone with knee flexed to 90 degrees
therapist applies compressive force through foot and rotates tibia medially and laterally
+test = pain

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34
Q

Apley’s distraction test

A

identifies lateral or medial ligament tear
pt. prone with knee flexed to 90 degrees
apply distraction force through foot and rotates tibia medially and laterally
+=Pain

35
Q

McMurray’s Test

A

identifies meniscal tear
pt. supine
grasps foot of patient with one hand and palpates joint line

knee is passively extended while applying a rotation force (internal/external) while also applying valgus/varus stress

+=a click or crepitus over joint line

36
Q

micro fracture

A

small holes down to subchondral bone to stimulate growth of articular cartilage

37
Q

osteochondral autograph

A

articular cartilage plugs taken form non WB portion of joint and placed in area of damage

38
Q

Autlogous chondral implantation

A

hyaline cartilage cells removed and then grown in a lab

surgically transplanted in area of damage

39
Q

OA

A

wearing of joint surfaces which may include bone spurs
may cause genu valgum or varum

possible treatments for mild-mod: cortisone or hyaluronan injections

40
Q

TKA/TKR

A

indication:

severe pain from OR or RA and/or significant impairment in functional mobility

41
Q

Acute Care for TKa

A

gait- WB depends on if cemented or non-cemented
transfers, stairs
ROM
quad sets, SLR,heel slides,hip abd/add, gluteal sets, ankle sets

42
Q

Post acute care

A

progression of ROM with goal of functional ROM for patient

Gold standard 120 degrees or more

normalize gait pattern
strengthening/functional activities

43
Q

High Tibial Osteotomy

A

attempts to realign tibiofemoral joint by surgically creating a wedge in proximal in tibia or distal femur

rehab considerations:

  • No CKC exercises until secure bone union
  • immobilizer
  • initially NWB
44
Q

Common causes of poor patella tracking

A 
large Q angle
muscle and fascial tightness
pronatory forces at foot
hip muscle weakness
Medial VMO knee weakness
45
Q

patellofemoral syndrome

A

misalignment of patella in trochlear groove

SIGNS:
patellar misalignment
pt. can c/o knee buckling
dull ache of knee at rest, sharper pain with stairs

Chondromalacia= crepitus
-softening/degeneration of articular cartilage underside of patella

46
Q

miserable malalignment syndrome

A

wide Q angle
femoral anteversion - IR femur
femoral trochlear groove now medially rotated
patella faces more medially
forces on the patella pull on it laterally

47
Q

Non-surgical rehab management of patellofemoral syndrome

A

chondromalacia of patella

strengthen quadcrips-VMO
stretching/mobilization of tight structures pulling laterally on patella

patella alignment brace
patella taping

48
Q

surgical management- lateral retinaculum release

A

release of lateral retinaculum with goal of improved neutral patellar tracking

49
Q

if histroy of patellar dislocations

A

surgery using hamstring graft

reconstruction of medial patellofemoral ligament

50
Q

ACL injury/ Tear

A

ACL functions to prevent anterior translation of tibia on femur

Injury:
-forceful hyperextension
blow to knee
+/or twist with foot planted

CLINICAL SIGNS:
-person may hear or feel a pop usually with immediate pain
immediate swelling-intracapsular

TESTS:

  • lochmans
  • anterior drawer sign
51
Q

ACL injuries in females

A 
2-10 x more common in females than males
LE alignment-increased Q angle
estrogen/progestrone and joint laxity
Biomechanical risk factors:
-increased lateral trunk motion and valgus torques on the knee
52
Q

Non Op Acute phase-ACL

A 
immobilization
control swelling
increase ROM
strengthening
may need brace to protect against rotation forces
53
Q

Operative management ACL

A

Autografts:
middle third of patellar tendon
hamstrings
Artificial-may degenerate over time

54
Q

special rehab considerations after ACL repair

A

follow MD protocol
graft goes through a point of necrosis during first few months-it becomes fragile and stresses must be controlled
PROTECT GRAFT
brace-may be locked into extension at first
NO OPEN CHAIN EXTENSION
**NO TKE in from 15-45 degrees
Avoid CKC 60-90 degrees of flexion early on
Quad working will cause anterior translation
no additional resistance to distal tibia with quad strengthening

55
Q

PCL injury/tear

A

PCL prevents posterior translation

occurs when there is excessive force that moves the tibia posteriorly

falling on knee

blow to anterior knee with knee flexed

56
Q

Clinical signs of PCL injury

A

immediate pain

immediate swelling

57
Q

Tests for PCL injury

A

Sag test

posterior drawer sign

58
Q

NON OP management PCL-ACUTE

A

RICE
immobilization
Quadricep strengthening-reinforces knee and decreases posterior translation
No open chain hamstring strengthening
**avoid for 6-12 weeks
**pulls/contracts causes a pull on tibia posteriorly

59
Q

NON OP management PCL-SUB ACUTE

A

closed kinetic chain exercises as tolerated

strengthening of hamstrings once quadriceps strength is good

60
Q

PCL Graft options

A

can be from quad, hamstring or gastroc
allowgraft
can be from donor

61
Q

Special rehab considerations for PCL

A

follow MD protocol

avoid exercises and activities that place excessive posterior shear forces and causes posterior displacement of the tibia on the femur

NO open chain AROM knee fleixion for 2-3 motnhs

Be aware as patient progresses toward functional exercises:

  • avoid downhill inclines
  • avoid activities that involve rapid deceleration with both feet planted
62
Q

MCL injury

A

provides medial stability

  • valgus stress
  • lateral to medial blow to the knee
63
Q

Tests for MCL

A

valgus stress test

64
Q

unhappy triad

A

MCL tear
ACL tear
medial meniscus tear

65
Q

LCL tear/injury

A

varus stress
medial to lateral blow to the knee
lateral stability of knee

66
Q

Tests for LCL

A

Varus stress test

67
Q

management of MCL/LCL injuries

A

can be nonsurgical or surgical management
may have other injured/torn ligaments
acute management=RICE
follow MD protocol

68
Q

Meniscus tear

A

degenerative tear
sudden trauma to knee
-often occurs when leg s planted and body twists over leg

69
Q

Medial Meniscus movements

A

ABD

IR

70
Q

Lateral Meniscus movements

A

ABD

ER

71
Q

clincial signs of meniscus tear

A

locking or catching of knee
swelling
constant or intermitten pain along joint line

72
Q

tests for mensiscus tear

A

McMurray’s Test

Apley Compression Test

73
Q

4 Types of meniscus tears

A

Vertical
transverse
bucket handle
flat

74
Q

Options for MCL tear

A

location of tear will predict management of tear due to vascularity
–OUTER EDGE: more vascular, may do well without surgery

–INNER PORTION: less vascular and will need surgery

75
Q

Partial meniscectomy

A

usually in white zone
often outpatient surgery
physical therapy immediately
slowly return to weight bearing

76
Q

Meniscus repair

A

usually associated with other ligamentous repairs
follow MD protocol-depending on what was repaired
usually weight bearing precautions

77
Q

RED ZONE of meniscus

A

decent blood supply

78
Q

WHITE ZONE

A

compromised blood supply

79
Q

Patellar fracture

A

blow to knee or fall

signs;

  • pain
  • swelling
  • xray

treatment:

  • non displaced= immobilization
  • displaced or comminuted= WB limitations, Quad contraction restriction
  • -painful-> follow MD protocol
80
Q

Supracondylar femur fracture and Tibiofemur fracture

A

follow MD protocol

81
Q

Post-surgical general PT guidelines for knee

A 
IN PATIENT:
-bed mobility, transfers
OKC exercise program
-femoral nerve block or no quad control=use knee immobilizaer
-ambulation training with AD
-enviornmental barrier training
-compression and cold packs-DVT prevention
-1-4 days in hospital
82
Q

Max protection phase of Knee

A

pt. education of procedure and long term outcomes

well joint motion

knee ROM: 0-90 ASAP
GOAL:
Max 0-full flexion

STM

gait training, progressive AD weaning

strengthening: isometrics, isotonics, OKC, CKC

balance

supportive modailities

83
Q

Controlled motion phase guidelines

A

CRITERIA:
Ind. SLR, decreasing Edema, improving ROM, full WB

  • wean from AD
  • max ROM
  • max strength: OKC, CKC
  • max mobility and tissue
  • max balance
  • functional acitivities
  • environmental barriers
84
Q

Return to function phase Knee

A

CRITERIA:
weaned from AD if appropriate, appropriate balance strategies, normalized gait on level surfaces and env. barriers, resolved edema, nearly full ROM, minimal to no pain

  • functional activities
  • return to recreational acitivies with support of new joint limitations
  • if applicalble: plyometrics and return to sports activities

PTA Ortho (5 decks)

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