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OCS Cards > Knee > Flashcards

Knee Flashcards

1
Q

Which condyle of the femur is larger to compensate for the alignment of the knee?

A

Medial - lateral more directly aligned with shaft

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2
Q

Which condyle has a larger interface with the tibia?

A

Medial

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3
Q

Define the sulcus angle:

A

Angle between highest points of the condyles and lowest point of intercondylar sulcus

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4
Q

What is the average sulcus angle?

A

138 +/- 6

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5
Q

Is a shallow sulcus angle larger or smaller?

A

Larger - flat like straight line

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6
Q

What does the congruence angle reflect?

A

Patellar position in trochlear groove

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7
Q

What is normal for the knee, medial or lateral tilt? and is the congruence angle positive or negative?

A

Medial tilt is normal - negative value

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8
Q

What congruence angle is associated with patellar subluxation?

A

+ 16 indicative of lateral tilt

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9
Q

What alignment is normal for knees, valgus or varus?

A

Valgus - angle >185 deg

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10
Q

What is considered more varus type alignment?

A

Angle of < 175 deg

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11
Q

What shape is the medial meniscus?

A

C

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12
Q

What shape is the lateral meniscus?

A

O

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13
Q

What third of the meniscus gets blood supply from the capsular arteries?

A

Peripheral third (red-red zone)

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14
Q

What zone is the white-white zone and has very little blood flow?

A

Central aspect of the meniscus

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15
Q

What unique area of the lateral meniscus is separated from the capsule by the popliteus and as a result is relatively avascular?

A

Posterior lateral corner

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16
Q

What are the functions (4) of the meniscus?

A

1) inc contact area of the joint
2) assist with gliding
3) limit hyperextension
4) provide cushion/support

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17
Q

Are mensici innervated?

A

Yes - two types; pain receptors, joint mechanoreceptors -> affects proprioception

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18
Q

What ligament fixes the meniscus to the edge of the joint capsule?

A

Coronary ligament

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19
Q

What ligament joints the two menisci together anteriorly?

A

Transverse ligament

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20
Q

What ligament attaches the mensici to the patella?

A

Patellomeniscal ligament - thickening of anterior capsule

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21
Q

What muscle can create motion in the lateral meniscus?

A

Popliteus

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22
Q

Does the lateral mensicus attach to any other ligamentous structures?

A

PCL

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23
Q

What muscle has a posterior attachment to the medial meniscus?

A

Semimembranosus

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24
Q

Does the medial meniscus attach to any other ligamentous structures?

A

ACL (anterior horn) and PCL (posterior horn)

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25
Q

Which meniscus is less mobile?

A

Medial = higher incidence of injury

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26
Q

What muscle creates movement for the medial mensicus?

A

Semimembranosus

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27
Q

The posterior lateral compartment is supported by what complex?

A

Arcuate complex (LCL, arcuate ligament and popliteus)

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28
Q

What muscles reinforce the arcuate complex?

A

Biceps femoris, popliteus, lateral gastroc head

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29
Q

What is the name of the sesamoid bone found in the LCL that is in 15-30% of people?

A

Fabella - attaches by fabellofibular ligament

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30
Q

The LCL shares a common insertion with what muscle on which bony landmark?

A

Biceps femoris on the fibular head

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31
Q

Is the LCL intra or extracapsular?

A

Extra

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32
Q

What ligament in the posterior medial compartment provides resistance to valgus at near full extension?

A

Posterior oblique ligament, which is a thickening of the medial caspular ligament

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33
Q

What ligament is an expansion of the tendon sheath of the semimembranosus, which inserts across the joint into the proximal lateral gastroc head?

A

Oblique popliteal ligament

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34
Q

MCL has two layers; superficial and deep - which layer restricts vaglus, which restricts anterior translation and supports the medial meniscus?

A

Superficial primarily restrains valgus

Deep provides mensical support and probably restrains anterior translation

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35
Q

Does the MCL or LCL have a rich blood supply?

A

MCL - up to grade 2+ will heal under proper conditions

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36
Q

Which other major ligament plays a secondary role in valgus restriction?

A

PCL

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37
Q

Which ligament is a thick medial expansion of the medial retinaculum?

A

Medial patellofemoral ligament

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38
Q

Where does the medial patellofemoral ligament insert?

A

With the VMO on the patella

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39
Q

What ligament is an expansion of the ITB?

A

Lateral patellofemoral ligament

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40
Q

What artery is the blood supply for the cruciate ligaments?

A

Genicular artery

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41
Q

What nerve innervates the cruciate ligaments?

A

Tibial nerve

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42
Q

Do the cruciate ligaments have mechanoreceptors?

A

Yes - Ruffini corpuscles, Pacinian corpuscles, Golgi tendon organs

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43
Q

What motions does the ACL provide stabilization against?

A

Hyperextension (femur on grounded tibia - tibia on open chain femur) as well as IR

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44
Q

ACL has two bundles: what motions are the small and large bundles taut in?

A

Small: (anterior medial) taut in flexion from 20-90 deg, limiting anterior translation
Large (posterior lateral) taut in extension - largest restraint until 20 deg of flexion

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45
Q

What is the PCL’s primary restraint motion?

A

Posterior displacement (esp between 30-90 deg of flexion)

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46
Q

In what arc of flexion does the greatest posterior translation occur?

A

Between 70-90 deg of flexion - PCL is most taut is inflexion esp the large anterolateral bundle

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47
Q

What percentage of the PCL makes up the small posteromedial bundle and where is it taut?

A

5% and it’s taut in extension

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48
Q

What motions do both the ACL and PCL provide secondary assistance with restricting?

A

Valgus and varus forces

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49
Q

What are the IRs of the knee?

A

Popliteus, gracilis, sartorius, semimembranosus, semitendinosus

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50
Q

What are the ERs of the knee?

A

Biceps femoris, TFL

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51
Q

What four muscles make up the insertion for pes anserine?

A

Sartorius, gracilis, semimembranosus, semitendinosus

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52
Q

What 3 muscles place a valgus force on the knee?

A

Biceps femoris, lateral gastroc head, popliteus

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53
Q

What 5 muscles place a varus force on the knee?

A

Semimembranosus, semitendinosus, medial head gastroc, sartorius, gracilis

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54
Q

During knee flexion, what are the arthrokinematics of the knee?

A

Posterior glide of tibia on femur (open chain) / posterior roll with anterior glide (closed chain)

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55
Q

During knee extension, what are the arthorkinematics of the knee?

A

Anterior glide of tibia on femur (open chain) / anterior roll with posterior glide (closed chain)

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56
Q

What direction in rotation does terminal knee extension include?

A

Lateral or external rotation -> screw home mechanism

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57
Q

What direction direction in rotation does the knee unlock into?

A

Medial or internal rotation

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58
Q

Where is the odd facet located?

A

On the extreme medial aspect of the medial facet

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59
Q

When does the odd facet contact the trochlea?

A

During deep knee flexion > 135 deg

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60
Q

During flexion ROM, when does the patella initially contact the trochlear groove?

A

20 deg of flexion

61
Q

During manual therapy, what directions are combined to improve PFJ mobility due to tilting and rotation?

A

Superior lateral

Inferior medial

62
Q

What are plicae?

A

Synovial membrane folds

63
Q

What area of the knee are plica most commonly irritated

A

Medially

64
Q

What area of the knee are plica least commonly located?

A

Laterally

65
Q

What compresses the patella more, flexion or extension?

A

Flexion - during deep flexion; odd and lateral facets engage to decrease contact pressure

66
Q

What are the compressive forces associated with:
Standing from a chair
Walking
Running/jogging

A

Chair - 6.7 x
Walking - 2x
Jogging - 3-4x

67
Q

During deeper flexion, what function does the quadriceps tendon serve regarding dissipating forces?

A

Makes greater contact in trochlear groove beyond 90 deg to dec forces

68
Q

When the subjective complaints are of PFJ, what ROM of flexion is safe to avoid compressive forces?

A

30-90 deg - lack of compressive/contact forces

69
Q

What are 3 anatomical reasons for PFJ instability?

A

1) shallow trochlear groove
2) lateral femoral condyle less prominent
3) soft tethers of PFJ lax

70
Q

What are the two ligamentous tethers for the PFJ?

A

Medial patellofemoral ligament vs lateral patellofemoral ligament

71
Q

What is the open pack position for the knee?

A

Extension

72
Q

Define the Q-angle:

A

Angle between ASIS to patellar midpoint to tibial tuberosity

73
Q

What are normal Q-angles for men vs women?

A

Men 10-15

Women 15-20

74
Q

What Q-angle tends to be associated with lateral subluxation?

A

> 20 deg

75
Q

What are the 5 component parts of the Ottawa Knee Rules?

A

1) age >55
2) isolated tenderness of patella
3) tenderness at fibular head
4) inability to flex knee to 90 deg
5) inability to bear weight

76
Q

What 3 additional components were added to the Ottawa ankle rules (Pittsburgh Rules)?

A

1) blunt trauma/fall
2) under 12 over 50 years
3) unable to walk 4 WB steps

77
Q

What diagnosis should be considered with anterior knee pain with a negative knee exam, with excessive ER of the hip, with loss of IR of the hip?

A

SCFE - slipped capital femoral epiphysis

78
Q

What diagnosis should be considered with pain in the hip and/or knee, with a negative knee exam and found in active adolescents (5-12 y.o.s)?

A

Legg-Calve-Perthes syndrome

79
Q

What outcome measure is directed at knee OA and/or TKA?

A

WOMAC - looks at pain, stiffness and function

Western Ontario and McMaster Universities OA index

80
Q

What index as an extension of the WOMAC, looks at person’s with OA with higher levels of activity?

A

KOOS - knee injury and OA outcome score

81
Q

What is the MDC and MCID for the Knee Outcome Score?

A

MDC 9

MCID 7

82
Q

What outcome measure has been adapted to long term outcomes for ACLRs?

A

Tampa Kinesiophobia Scale - TKS

83
Q

Describe the grades for effusion:

A

0: none
Trace: medial sweep, lateral small amt return
1+: milk out, does not return on own but does with lateral sweep
2+: milk swelling and returns immediately
3+: cannot milk the swelling out

84
Q

What tool can augment MMT measurements due to standardized positions with readings?

A

Dynamometer - but can be dependent on strength of examiner

85
Q

In ligamentous assessment: what are the grading systems for joint laxity?

A

1+: 3-5 mm
2+: 5-10 mm
3+: 10+ mm

86
Q

How many deg of flexion are the MCL and LCL tested at?

A

30 deg of flexion

87
Q

What structures may be affected with positive varus testing at 0 deg/neutral?

A

ACL, PCL, LCL

88
Q

What bundle is the anterior drawer test assessing of the ACL?

A

Anteromedial

89
Q

What degree of motion is considered a positive test for the anterior drawer?

A

> 6 mm with empty/soft endfeel

90
Q

When testing the anterior drawer with excess ER, what area of the knee is being assessed?

A

Anterolateral instability

91
Q

What has greater sensitivity/specificity for ACL assessment - Lachman’s or Anterior drawer?

A

Lachman’s

92
Q

What bundle does Lachman’s assess with the ACL?

A

Posterolateral

93
Q

Does the pivot shift test have a high specificity or sensitivity?

A

High specificity

94
Q

Does the pivot shift test require IR or ER of the knee?

A

30 deg of hip flexion/abduction, knee in extension with valgus force at fibula, knee IR -> tibial subluxation at 30-40 deg of flexion

95
Q

What muscle is isometrically activated to assess for posterior sag?

A

90 deg of knee flexion -> activate QUAD and see if tibial anterior reduction

96
Q

What motion is added to the posterior drawer to assess the posterolateral corner?

A

ER

97
Q

What 4 structures make of the posterolateral corner?

A

1) LCL
2) arcuate ligament
3) popliteal tendon
4) lateral head of the gastroc

98
Q

When performing posterior drawer test: 1) what two positions is the test conducted 2) what are implications of positive testing at each location

A

30 and 90 deg of flexion

If increased at 30 deg, compared to 90 deg -> posterolateral corner injury

99
Q

What two degrees of flexion are the Dial test performed at? What direction of rotation is the tibia rotated?

A

30 and 90 degrees - ER

If increased at 30 deg, compared to 90 deg -> posterolateral corner injury
If excessive at both -> PCL

Positive test = 10 deg or greater

100
Q

What applications of force on the knee are provided during the Reverse pivot shift test?

A

Knee flexed 70-80 deg, valgus force at proximal fibula, with ER of tibia and moving into extension with axial load

101
Q

During McMurray’s test - which rotational application will provoke the medial and lateral aspects of the meniscus?

A

Medial/IR will affect lateral meniscus

Lateral/ER will affect medial meniscus

102
Q

Is joint line assessment for mensical pathology more sensitive or specific?

A

Screening tool -> sensitive

103
Q

Which degree of flexion is the Thessaly test more sensitive, specific and have a greater positive predictive value?

A

20 degrees

104
Q

What are the five items which have a large positive predictive value indicating meniscal pathology?

A

1) hx of catch/locking
2) joint line tenderness
3) pain with forced hyperextension
4) pain with maximal passive knee flexion
5) pain/audible click with McMurrays
3 = 75% ppv, 5 =92%

105
Q

Define the Sage sign:

A

Greater than 25-50% displacement of patella in PFJ

106
Q

What is a positive test for Apprehension with PFJ testing?

A

Expression of apprehension when trying to manually sublux the patella at 20-30 deg of flexion

107
Q

What is a positive patellar tilt test?

A

Normally can flip patella laterally over horizontal - positive test is tight retinaculum and unable to do so

108
Q

Cook cluster testing for PFJ pain (6 items):

A

1) manual compression of PFJ
2) pain during palpation of posteromedial/lateral borders of patella
3) pain during squat
4) pain while kneeling
5) pain with resisted quad testing
6) pain with prolong sitting

109
Q

There is no gold standard for return to sport, but what assessments are commonly used?

A

Hop testing: single, triple, cross over triple, timed 6 meter test - 80-85% of uninvolved leg

110
Q

Which two hop tests are considered strongest predictors per self-reported function comparison?

A

Cross over hop, 6-m timed test

111
Q

Which direction during Y-balance/Star excursion testing has a 2.5x greater risk of injury?

A

Anteriorly with >4 cm difference

112
Q

What are optimal ratios for hamstring/quad strength for males/females respectively for return to sport?

A

> 66% males, >75% females

113
Q

What muscle is keenly focused to strengthen post-operative ACL?

A

Quadriceps - even with use of HS graft

114
Q

What dictates post-surgical protocol in ACL and meniscal/cartilage injury?

A

Meniscal or cartilage restrictions

115
Q

When undergoing both ACL and PCL repair, which dictates protocol?

A

PCL

116
Q

Is surgical approach same for skeletally immature person versus adult?

A

No - consideration for physis/growth plate as well as different fixations used

117
Q

What reasons are found that females are 4.8x more likely to tear their ACLs?

A

1) less absorptive landing pattern
2) muscle weakness
3) excessive quad activation
4) inc joint laxity
5) more narrow femoral notch
6) hormonal influences
7) wider pelvis -> genu valgum

118
Q

Where is graft site for PCL?

A

Achilles - replicates anterolateral bundle

119
Q

What ROM is often limited for at least 2 if not 4 weeks with PCL repair?

A

70-90 deg of flexion due to maximal tension placed on PCL

120
Q

Can NWB resisted knee extension 70-90 deg place stress on the PCL?

A

Yes - maximal tension between 85-95 deg NWB

121
Q

Does a posterior corner injury typically occur in isolation?

A

No - concurrent PCL injury

122
Q

What are the primary stabilizers for the posterior corner?

A

Popliteus tendon, popliteofibular ligament, LCL

123
Q

What are the secondary stabilizers for the posterior corner?

A

Arcuate ligament, posterolateral capsule, coronary ligament, oblique popliteal ligament

124
Q

Meniscal tears in what area of the knee tend to be repaired due to blood flow?

A

Peripheral third - red/red zone
Middle third - red/white zone
Inner third - white/white zone

125
Q

What is the single strongest predictor of function in those with OA and chondral damage?

A

Quad weakness

126
Q

What is looked at as predictor of functional ability one year after TKA?

A

Preoperative quad strength

127
Q

When does most pain relief occur with hyaluronic acid joint injections?

A

2-3 months after completion of series

128
Q

What version of glucosamine oral supplementation has some positive benefits for OA?

A

Glucosamine sulfate with chondroitin

129
Q

What amount of weight lost results in moderate improvement in pain and function in OA (meta-analysis)?

A

13.5#

130
Q

What is the surgical option for medial compartment degeneration?

A

High tibial osteotomy

131
Q

What is the surgical option for lateral compartment degeneration?

A

Femoral osteotomy

132
Q

What has higher failure rate, unicompartmental UKA or TKA?

A

UKA

133
Q

Which surgical option results in greater ROM and return to function more quickly? (TKA vs UKA)

A

UKA

134
Q

Which version of the TKA has progressive WB over the first 6 weeks? (Cemented vs. non-cemented)

A

Non-cemented - AD with WB restriction

135
Q

In performing manual therapy for TKA, is there value for PFJ or tibiofemoral joint mobilizations?

A

PFJ - unsure of benefit of tibiofemoral mobs

136
Q

In regard of use of NMES, is early or late initiation more beneficial?

A

Early

137
Q

What impacts wound healing in TKA?

A

DM, RA, obesity, steroids

138
Q

Does stiffness preoperatively correlate with stiffness post-operatively?

A

Yes - as well as deg of OA, poor physical health (obese, DM)

139
Q

In articular cartilage injury, what three methods stimulate bleeding to create a clot and stem cells to grow fibrocartilage?

A

Debridement, chondroplasty, microfracture

140
Q

Which is the three surgical options for cartilage repair has restrictions for WBing?

A

Microfracture - can WB right away with debridement and chondroplasty

141
Q

In both OATs (osteochondral autograft transplant) and ACI (autologous chondrocyte implantation), what is a huge indicator in progressing WB exercise?

A

Edema in the joint - reassessed before progression

142
Q

What are six loosely associated groups of PFPS? (factors contributing)

A

1) hip abductor weakness
2) quad weakness
3) patellar hypomobility
4) patellar hypomobility
5) pronated foot posture
6) lower limb biarticular muscle tightness (quads/hams)

143
Q

In those with a subluxation hx for PFPS, what ROM is most comfortable and safe due to seeding in the PFJ?

A

70-90 deg of flexion

144
Q

What two surgical approaches are used to reduce number of dislocations in PF subluxors?

A

1) medialization of tibial tubercle: medialized and elevated to realign tibial tubercle in more anatomical position
2) lateral release with/without medial patellar ligament repair

145
Q

What is bipartite patella?

A

A congenital anomaly that may become apparent when patella sustains direct trauma creating instability between two fragments - may need surgical fixation

146
Q

Define Osgood-Schlatter disease:

A

Inflammation (apophysitis) of patellar tendon on tibial tubercle

147
Q

Define Sinding Larson Johasson (SLJ) syndrome:

A

Inflammation (apophysitis) of patellar tendon at inferior pole of patella

148
Q

In sport-specialized versus multi-sport athletes, what diagnoses are 4x more common?

A

Apophyseal injuries - Osgood & Sinding Larson Johasson

OCS Cards (23 decks)

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