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SCS Prep > Knee > Flashcards

Knee Flashcards

1
Q

Femoral

A

L2-L4

sartorius, quads

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2
Q

Sciatic

A

L5-S2

biceps fem

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3
Q

Tibial

A

S1-S2 - semis, gastroc

L4-S1 - pop, plant

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4
Q

Obturator

A

L3-L4

gracilis

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5
Q

Valgus Stress Test

A

0 - MCL (possible ACL, PCL, PMC)

30 - MCL (check other ligaments with grade III)

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6
Q

Varus Stress Test

A

0 - LCL (possible ACL/PCL)

30 - LCL (check other ligaments with grade III)

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7
Q

Anterior Drawer

A

neutral - ACL
15 ER - ACL, PMC, possible MCL
30 IR - ACL, PLC

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8
Q

Lelli’s Test or Lever Sign

A

ACL

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9
Q

Pivot Shift

A

ACL, ALC

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10
Q

Slocum’s

A

ACL, ALC

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11
Q

Jerk (Hughston)

A

ACL, ALC

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12
Q

Losee Test

A

ACL, ALC

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13
Q

Posterior Drawer

A

PCL

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14
Q

ER Recurvatum (tibia ER)

A

PCL, PLC

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15
Q

Posterior Sag

A

PCL

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16
Q

Reverse Pivot Shift

A

PCL

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17
Q

McMurray’s

A

IR - lat men

ER - med men

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18
Q

Apley’s

A

med men

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19
Q

Thessaly’s

A

med and/or lat men

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20
Q

ACL Injury

A

over 70% noncontact
C - decel, hypertext, rotational movement
common when knee is stressed closed to full ext
landing from jump with min flex knee
inc quad vs HS = inc translation

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21
Q

ACL Non-op vs OP

A

Non-op best

  • single/crossover/triple/timed jumping (80% of unaffected)
  • < 1 giving way episodes during testing
  • knee outcome survey 80%, subjective global rating 60%

OP Best prognosis

  • full ROM, dec swell, good leg control
  • excellent mental state
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22
Q

Allograft

A

Adv

  • dec morbidity, op time, incident of fibrosis
  • preservation of flex/ext mech, availability of larger graft

Disadv

  • risk of infection, slow healing or incomplete graft
  • inc cost, tunnel enlargement
  • alteration of structural properties w/ sterilization/storage
23
Q

ACL Risk Factors

A

Intrinsic - intercondylar notch size, ACL size, physiologic laxity, hormonal fluctuations

Extrinsic - kinematics, kinetics, muscle strength, muscle activation

24
Q

ACL Rehab Protocol

A

Day 1-7 - crutches, WBAT after nerve block wears off, AROM 0-90, no quad lag, normal WB at end of stage

Wk 1-2 - stationary bike for ROM, gait training, partial squat to 30 deg on shuttle/total gym

Wk 1-4 - 0-120 by 3 wks, full by 4 wks, normal giat, SLR w/o quad lag, SL standing

Wk 4-8 - B squat to 60, min pain, mild effusion, no giving way
**graft is weakest

Wk 8-12 - advance balance exercise, lap swimming except breast stroke (no fins), stationary bike, nearly equal quad girth, SL squat to 60, SLS 60
**watch for pat tendinopathy

Wk 12-16 - elliptical, perturbation training, shuttle jumping, jogging in place

  • *hop test 80% of unaffected prior to running
  • *perturbation training - normal gait/ROM/SLR, min effusion, SLS > 60 EO, SLS 45 deg no valgus

Wk 16-24 - progressive jumping, then running program; progressive plyometrics, cutting and sport specific week 20

25
Q

ACL Considerations after HS graft

A

no active HS exercises for 2 weeks
no OKC HS exercises for 4 weeks
delayed HS resistive strengthening for 12 weeks

26
Q

PCL Injury

A

normal - pop works with PCP to control ER, varus, and post translation

C - direct trauma to prox tib, fall on knee with PF foot, excessive hypertext
S - post draw, post sag, reverse pivot shift, ER recurvatum
T - grade I/II conservative, III surgery

Grade I/II (isolated) - protected WBing, return 2-4 wks
III - splint in ext 2-4 wks; non-op (older, inactive), post-op (active, young, chondrosis cont dysfunction)

Combined PC - surgery within 2 weeks

27
Q

PCP Non-Op Protocol

A

Days 1-7 - ROM 0-60, WBing w/ crutches, SLR, mini squats/leg press 0-45

Wk 2-3 - ROM 0-60, WBing w/o crutches, bike at 3 weeks, leg press 0-60
@ 3 weeks - DC brace; bike, stairmaster, rowing; mini squat/leg press 0-60

Wk 5-6 - continue exercise with weight, pool running, fit for functional brace

Wk 8-12 - no pain, swelling or laxity; functional and quad testing > 85% contra; begin running program

28
Q

PCP Post-Op

A

Guidelines - no OKC initially, avoid post tib trans, resistance or hip resistance exercise placed above knee, rehab protocol more conservative due to greater post shear forces

Wk 0-4 - brace locked at 0 for 1 wk, unlocked after; WBAT w/ brace locked at ext; achieve full knee ext, 60 flex
**pillow under post tib to prevent sag

Wk 4-6 - brace unlocked for gait training (wk 6-8 for all activities)
Wk 4-12 - knee flex 90-100; wall slide, mini squat, hip strengthening, leg press 0-90

Mo 3-6 - 10 flex can lack up to 5 mo, normal gait, OKC exercises, jogging in pool

Mo 6 - normal ROM, strength equal to unaffected, jumping/running progression, sport specific and RTP

29
Q

MCL/LCL (CESI)

A

tight in ext, lax in flex
C - direct blow to outer or valgus force (MCL); inner or varus (LCL)
**noncontact from rotation can occur, usually includes cruciate
E - tender at jt ling along ligament, laxity
**extra-articular surface, effusion not common
S - valgus/varus testing
I - A/P, lat, merchant (X-ray; T2 MRI

30
Q

MCL/LCL Grades and Surgery Indications

A

I - 1-2 weeks return, no inc jt line opening, some tenderness along lig
II - 3-4 weeks; 5-10 mm opening, firm end pt
III - 6+ weeks; > 10 mmm complete disruption, vague end pt (brace/immob possible)

Indications - bony avulsion, tib plat fx, cruciate lig, intra-articular entrapment of ligament`

31
Q

Meniscal Injury

A

Lat meniscus more mobile than medial
ant horn more mobile than post horn
*less mobility = more vulnerable

C - direct contact, rotational mechanism, cut/pivot, degeneration
E - pain, stiffness, locking/catching, giving way
T - rehab, meniscectomy, repair (limit WBing, flex)

32
Q

Meniscal Repair (conservative)

A

Day 1 - Wk 3 - brace locked at 0 for ambulation, ROM 0-90, WBAT w/ crutches and brace at 0
**post horn - no resisted HS for 6 weeks

Wk 4-6 - PREs (1-5 lbs), cycling, mini squat within 90
Wk 6-10 - continue CKC strengthening, cycling, balance exercises, possible initiation of plyometrics
Wk 11-15 - continue plyometrics, begin running progression

33
Q

Patellar Fx (CEIT)

A

C - indirect cause by pull of pat tendon when knee part flex, fall or direct blow
E - swelling, possible bone separation
I - X-ray
T - immob, usually 2-3 mo

34
Q

Articular Cartilage Procedure

A

Progressive WBing 6-8 wks after surgery (if debridement only done, pt can WB)

Unloaded A/PROM begin immediately (CKC avoided for 6 weeks)

35
Q

Osteochondritis Dissecans (CEIT)

A

C - partial or complete separation of articular cartilage and subchondral knee due to lack of blood flow
E - clicking, locking, swelling (lesions more common at med fem condyle)
I - tunnel view
T - surgery if conservative tx fails

36
Q

Acute Patellar Dislocation (CESIT)

A

C - direct blow or sudden twist
E - misalignment, tender of med aspect, effusion
S - patellar apprehension, lat glide test
I - sunrise view
T - must be relocated (relocation often happens with knee ext)

often bracing, splinting, casting up to 6 weeks

37
Q

Segond Fx

A

avulsion fx at LCL insertion

C - excessive IR and varus

38
Q

Patellar Instability, Overuse, Fx, Direct Trauma

A

acute and chronic patellar dislocations, recurrent subluxations

tendinopathy, OS, SLJ

fx, fx/dislocation, OCD

art cart lesion

39
Q

Patellar Compression Syndrome, Soft Tissue Lesions, Biomechanical

A

excessive lateral pressure, global patellar pressure

ITB, plica, Hoffa’s (inflamed fat pad), bursitis, MPFL pain

foot hyperpronation, LLD, loss of flexibility

40
Q

J-Sign

A

lat pat tracking when flex and ext

41
Q

Pat Glide Test

A

hypo < 1/4 of pat

hyper > 3/4 of pat

42
Q

Patellar Tilt

A

no up movement due to tight retinaculum

43
Q

Basset Sign

A

tenderness over med epi of femur

44
Q

Sulcus Sign

A

line draw med/lat walls of trochlea

> 150 deg shallow, may be predisposition for instability

45
Q

Q angle

A

angle between ASIS and tib tub (going through center of patella)
Men 13, Women 18

46
Q

Ottawa Knee Rules

A

trauma, > 55
tender over pat/fib head, unable to flex > 90, 4 steps

for patellar pathology:
A/P - best for tib plat, joint space at 30 deg flex
axial image

47
Q

X-ray Views

A

A/P - jt space narrowing
Lat w/ Part flex - pat and jt effusion
Sunrise/Merchant - relationship of pat and femur
Tunnel - tib and fem condyles

48
Q

Patellar Tendon Rupture (CEIT)

A

C - strong quad contraction vs fixed LE, fall on part knee flex
E - unable to WB, dec knee ext AROM, instability, effusion
I - MRI, US, may see pat alta on X-ray
T - surgery

49
Q

Acute Pat Rupture Repair

A

Wk 0-2 - hinged knee brace full ext, TTWB w/ B crutches, ROM 0-15, quad isos

Wk 3-6 - brace 0-45 (0-60 wk 4, 0-90 wk 5-6); WBAT w/ brace in ext, FWB and full ROM wk 6; balance and prop in brace]

Wk 7-12 - CKC strengthening < 70
Wk 12-16 - progress to SL squat, leg press, light agility drills
Wk 16-24 - advance agility drills, running progression, begin plyometrics, sport interval progression

50
Q

OS and SLJ (CET)

A

C - condition affect adolescents; OS - pain of attachment of pat tendon to tib tub; SLJ - pain at inf pole of pat

E - swelling, pain, pt tender, pain with kneel/run/jump
T - dec activity, iso strengthening, ice

51
Q

Pat Tendinitis (Jumper’s Knee) (CET)

A

C - jumping, kicking, running
E - pain at pat tendon (can be after, during and after, and even just at rest)
T - ice, pat tendon strap, friction massage

52
Q

Runner’s Knee (ITB Friction Syndrome) (CET)

A

C - repetitive and overuse, possible structural abnormalities at foot (common with genu varum and over pronated)
E - pain at lat knee, + Ober
T - address foot structure, possible orthotics, ice, proper warm up, rest

53
Q

Peroneal Nerve Contusion (CET)

A

C - compression of nerve as it goes behind fibula; most often with direct contact
E - local pain after radiating down ant leg into foot, numbness usually lasts short time
T - RICE, return as soon as symptoms as gone and no weakness

54
Q

Bursitits (CET)

A

C - prepatellar most common, usually from pressure such as kneeling
E - localized swelling (not intra-articular)
T - eliminate cause (kneeling)

SCS Prep (16 decks)

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