Knee Flashcards
What are the most compressive joint angles for the PFJ in WB?
What is the average Q angle for men and women?
30-0 and >90
Men 10-15, women 15-20
What are the Ottawa knee rules?
What are the University of Pittsburg rules?
If any of the following, then X-ray needed: Age>55 Isolated tenderness at patella Tenderness at fibular head Unable to flex to 90 Unable to WB immediately and in ER
Patient needs following if:
Blunt trauma/fall
And
Age<12 or >50 OR unable to walk 4 WB steps
What is the joint effusion grading for the knee
0 none 0.5? Trace 1+ swelling returns with lateral sweep 2+ swelling returns immediately \+ cannot milk out swelling
How do you grad medial/lateral ligament laxity?
What other ligaments might be involved with certain movements?
1+ 3-5mm movement
2+ 5-10 mm
3+ >10mm
MCL>5mm at 30 deg flex, might be PCL too
>10mm look for ACL
What structures are in the posterolateral corner?
What are the tests for PLC?
Structures: arcuate ligament, LCL, popliteus tendon, lateral head of gastroc Tests: Posterolateral drawer Prone ER test Reverse pivot shift ER recur atom test
What is the cluster for meniscal pathology?
Catching Joint line tenderness Pain with hyperextension Pain with Max passive knee flexion Pain with McMurray or click (3/5)
What is the cluster for Patellofemoral pain (9 items)
Pain with…
- Manual compression of PFP
- Palpation posteromedial and posterolateral borders of patella
- Resisted isometric quad contraction
- Stair climbing
- Kneeling
- Prolonged sitting
- Isometric quad contraction
- Squatting
- Palpation
What is return to sport criteria for hop tests?
What are the best item predictors of that test?
What is predictor value for Y-balance test?
> 90% uninvolved limb for hop test
6m timed hop test and crossover are best predictors of self-reported knee function
Anterior >4cm means increased risk of injury
What are the knee soreness rules?
Soreness at warm-up that continues - 2 days off and down 1 step
Soreness at warm-up that goes away - stay at that step
Soreness at warm that goes away but comes back during session - 2 days off and then down 1 step
Soreness the day after lifting (not muscle) - 1 day off, do not advance
No soreness - advance 1 step per week
How long is bracing good for ACL?
Can be helpful but not after 3 months
What are tissue healing rains of the following: Tendon - tendinitis & lacerations Muscle - Ligament Ligament graft Bone
Tendinitis: 3-8 weeks
Tendon laceration: 5 weeks-6months
Muscle: I 0-3 weeks; II 4 days-3months; III 3 weeks-6months
Ligament: I 1-7 days; II 3 weeks-6 mo; III 5 weeks-1 year
Ligament graft: 2 months to 2 years
Bone: 5 weeks - 3 months
Who are likely to be ACL copers?
Who are non-surgical rehab candidates?
Copers ( within 2 months of injury)
- isolated ACL tear, full pain-free ROM, no joint effusion, values = 70% of other knee, tolerate SL hopping without pain
Rehab candidates: can do 10 treatment perturbation training program
- 1 or less episodes of giving way
- Hop test >805
- KOSADL scale >80%
- Global rating score >60%
What are 6 measures for successful outcomes following ACL reconstruction?
- < consistent mild effusion
- > 90% quadriceps strength and hamstring strength
- 0 episodes of giving way
- Participation in 1 or 2 seasons of sports
- Patient reports outcomes
What are 4 signs that earlier ACL reconstruction surgery is better?
Age>14
Partial tear >1/2 thickness
Tear of posterolateral bundle
Pivot shift grade 3 or greater
What type of PCL tears are slower with rehabilitation?
What are concerns?
Grade III tears
Avoid knee flexion>70 initially and isolated hamstring exercises
What is the function of the PLC?
What are post-op considerations?
Prevent hyperextension, varus angular ion, and tibial ER Post-op: 6 weeks NWB but with quad activation No knees crossed or toes out ROM to 90 week 6 Balance week 7 No isolated hamstring until 4 months
When is meniscal surgery considered?
What area is repaired? What area is excised?
What is recovery time for excision? Repair?
When there are episodes of giving way
Outer 1/3 with good blood supply is repaired
Inner 2/3 with poor blood supply is excised
Excision recovery 2-6 weeks
Repair: 0-4 weeks no WB knee flexed >45 degrees and 4-8 weeks no WB knee flexed >90
OKC quadriceps ok
No pivoting for 6-9 months
Who is recommended for meniscal transplant?
Who is contraindicated?
Recommended: <40-50y.o, minimal OA and not candidate for TKA -> needs 2mm joint space at 45 deg flexion
Contraindications: malalignment, advanced arthritic changes, uncontrolled knee instability, knee arthrofibrosis, muscle atrophy, obesity
What are risk factors for PFP?
What are the two classifications of PFP?
Female Decreased quad flexibility Hyper mobility of patella Altered VMO timing Decreased knee extension strength Decreased quad explosive strength Classification: malalignment or muscular dysfunction
What is a high tibial/femoral osteotomy?
Tibial: for unicompartmental medial degeneration
Femoral: unicompartmental lateral degeneration
- helps redistribute load from diseased compartment; might delay need for TKA
No full WB 0-4 weeks and no ankle weights
When is a unicompartmental knee arthroplasty indicated?
Post-op protocol?
When osteotomy fails or young, active with >90 deg flexion and <15 deg varus/valgus deformity
Full WB and 90 deg flexion in week 1
When is micro fracture indicated for articular cartilage injury?
What are debridement and chondroplasty post-op protocols And how do they compare to microfracture?
- full thickness lesion <2cm^2 with no osseous defect
Early PROM with limited WB 3-5 days (2-4 weeks for micro fracture)
Full impact activity @ 4 week (4-6 months small microfracture, 8 months large microfracture)
What is OATS and ACI?
What is the post-op protocol?
Osteochondral autograft transplant: bone plug covered with hyaline cartilage from NWB femoral condyle
Autologous chondrocyte implantation: articular cartilage from knee grown in lab and then put into patch into knee to allow to mature into hyaline (1-10cm^2 lesions)
4 phases:
- Proliferation (0-6 weeks): milestones: 0-120 ROM, min swelling and voluntary quad activity
- Transition phase (6-12 weeks) full ROM, hamstring 20%, quad 30%, ability to walk 1 mi or bike 30 min
- Remodeling (12-26 weeks) - focus on strength
- Maturation (26-52 weeks) strength 80-90%, balance 75-80%, no pain, inflammation, swelling
What is the difference between Osgood Schlatters and Sinding-Larson-Johansson?
Osgoo Schlatters is traction apophysitis of tibial tuberosity
Sinding-Larson-Johansson is traction apophysitis of inferior pole of patella
