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OCS Prep > Knee > Flashcards

Knee Flashcards

1
Q

Subjective: Immediate swelling

A
  • Immediate swelling
    • hemarthrosis
    • Intracapsular injury(acl,pcl, capsule)
    • good blood supply, therefore quick bleed and swelling
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2
Q

Subjective: Delayed Swelling>24 hours

A
  • Intrasynovial or extra capsular
    • menisci, collateral ligaments, patella tendon, patella subluxation
    • menisci are bathed in synovial fluid- synovitis type swelling occurs over a longer period
  • exception is Grace 3 mcl injuries that swell immediately due to attachment to the capsule
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3
Q

Subjective: Giving Way

A 
Straight walking
 - Patella instability
Cutting movements
- Acl, Pcl, Capsule
Descending stairs
- quad inhibition
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4
Q

Ottawa knee rules for radiographs

A
  • Age 55 or older
  • isolated tenderness to patella( no other bony tenderness)
  • tenderness to fibular head
  • active flexion < 90 degrees
  • inability to WB 4 steps immediately after injury
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5
Q

What is the MOI for ACL?

A

No contact

  • acceleration/ deceleration activities; excessive quad/ diminished hamstring activation
  • quad force + valgus load + knee Ir, WB, deceleration
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6
Q

What is the mode of injury for PCL?

A
  • Dashboard/ anterior tibial blow injury
  • fall on flexed knee with ankle in plantar flexion
  • violent hyper extension
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7
Q

What is the mode of injury for MCL?

A

Valgus torque to the knee

- typically hot to lateral knee with foot on the ground

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8
Q

What is MOI for PLC?

A

Knee hyper extension + ER + varus
Complete knee dislocation
Flexed and Er knee that receives AP blow to tibia

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9
Q

What is CPG for ACL?

A
  • MOI - deceleration+ acceleration motions with non contact valgus load
  • hearing a “pop” at time of injury with hemarthrosis within 2 hours
  • loss of end range extension
    • Lachmans and pivot shift
  • single leg hop less than 80% of unaffected limb
  • MVIC less than 80% of uninvolved limb
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10
Q

What are two graft types used in ACL repair?

A
  1. Bone- patella - bone
    - patella tendon pain during quad pre’s
  2. Hamstring Graft
    - no hs PRE for 12 weeks
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11
Q

What is the return to sport criteria for ACL repair?

A
  • Minimum of twelve weeks and 90% or greater in most outcome measures ( quad index, KIS, hop test)
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12
Q

What are four common factors for female acl injuries?

A
  1. Ligament dominance
    - results in valgus position upon landing
  2. Quadriceps dominance
    - increased knee flexion during landing
  3. Leg dominance
    - Bears weight mostly on 1 leg
  4. Trunk dominance
    - inability to control trunk in 3D space
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13
Q

Treatment strategy for ligament dominant.

A

Train proper landing technique

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14
Q

Treatment strategy for quadriceps dominant?

A

Strengthen posterior chain muscles

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15
Q

Treatment strategy for leg dominant .

A

Train side to side symmetry, single leg balance, single leg hopping

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16
Q

Treatment strategy for trunk dominance.

A

Core training, pertubations, TA , multifidus and pelvic stabilizers

  • emphasize hip
  • eccentric control is paramount
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17
Q

What are goals of week 1of acl rehab?

A

Week 1: AROM/PROM to 90, active quad contraction, superior patella glide, knee extension ROM
Treatment : wall slides, patellar mobs, gait training, nmes

18
Q

What are goals of week 2 acl rehab?

A

Knee flexion > 110, walking without AD, full knee extension, stair climber, SLR without lag
- ckc(0-60) OKC ( 90-45)
Treatment: step ups in pain free range, stair master, wall squats, prone hangs, functional brace if decreased swelling, patellar mobs

19
Q

What are goals week 3-5 acl.

A

Week 3-5
- knee flexion within 10 degrees of uninvolved side
- quad strength greater than 60% of uninvolved side
Treatments: balance and proprioception, progress bike, stair climber

20
Q

What are goals of late post operative phase?

A 
Week 6-8
Quadriceps strength greater than 80%
Normal gait 
Full rom
Treatments: begin running progression, transfer to fitness facility
21
Q

What are goals of transitional phase?

A

Weeks 9-12
Maintain or greater than 80% quad strength
Hop test greater than 85%
KOS sports questionnaire greater than 70%
Treatments: sports specific exercises, agility drills, functional testing

22
Q

Follow up testing for acl 4,5,6,months to 1 year.

A

Maintain quad at 90% or greater than uninvolved side
Hop test 90% or greater
KOS sports 90% or greater
Return to sport criteria

23
Q

What is the occurrence of MCL injuries?

A

MCL is injured in 42% of knees with ligamentous injuries.

Males affected twice as much as females

24
Q

At what degree is the MCL the primary restraint against valgus force.

A

25 degrees flexion, mcl provides 78% restraint

- in extension the mcl provides 57% of valgus restraining force

25
Q

What are three grades of MCL injury?

A

Grade 1- no gapping
Grade 2 - 6-10 mm gapping
Grade 3 greater than 10 mm gapping with no endpoint

26
Q

What is the CPG for meniscus tear?

A
  • twisting, tearing at time of injury
  • delayed effusion
  • joint line tenderness
  • Hx of catching, locking
  • Pain with passive knee extension and max flexion
  • (+) mcmurrays
  • (+) Thessaly at 5 or 20 degrees flexion
27
Q

Management of meniscus tear

A

Best evidence
- therex - focus on quads and hamstrings
- Estim
-

28
Q

Meniscal repair repair guidelines

A
  • Wait 8 weeks prior to initiating ROM >90

- CKC 3-4 weeks

29
Q

Ruling in LCL

A
  • joint line tenderness
  • (+) Mcmurrays
  • (+) Thessaly at 20 Degrees and 5 degrees
30
Q

What are predisposing factors for ACL injury?

A

Non contact

  • shoe surface interaction
  • high BMI
  • narrow femoral arch
  • increased joint laxity
  • strong quad activation during eccentrics
  • valgus positioning of LE upon landing
31
Q

Acl with chondral defect guideline:

A
  • chondral debreidment
  • WBAT 3-5 days post op, no modification
  • microfracture procedure
    • NWB crutches 2-8 weeks
32
Q

Acl with MCL repair guidelines

A

Exercises performed in Sagittal plane 4-6 weeks

- maintain tibial IR during exercises to minimize valgus stress in mcl

33
Q

Acl with posteriorlateral corner repair

A

Minimize ER torque and varus stress x 6 weeks

-no resisted knee flexion x 12 weeks

34
Q

Soreness rules

A
  • soreness during warmup that continues - 2 days off, drop 1 level
  • soreness during warm up that goes away, stay at same level
  • soreness during warmup they goes but redevelops mid session- 2 days off drop 1 level
  • soreness the day after lifting- 1 day off, do not advance next level
  • no soreness- advance 1 level per week
35
Q

CPG for PCL

A

MOI: posterior force on proximal tibia
Abrasions/ ecchymosis on anterior/ proximal tibia
(+) posterior drawer, (+)posterior sag- better to rule in
(+) modified stroke sign
Loss of knee extension during ambulation
-Posteriorlateral corner injury- Pain with terminal stance and push off

36
Q

Management of pcl injuries

A

PWB 2-4 weeks

- avoid varus, hyperextension, ER of tibia

37
Q

CPR for hip mobilizations for knee OA

A
  • Hip/ groin pain or parasthesia
  • anterior thigh pain
  • Pain with distraction
  • knee flexion less than 122
  • hip ir rom less than 17
    • used hip ap/pa mobs, caudal glide, posterior glide with flex,abd, Er
38
Q

PFS diagnostic tests

A
  • Squat with pain

- patella tilt test

39
Q

Symptoms of PFS

A
  • symptoms of anterior knee pain x 1 month
  • average knee pain 3/10 with 9.8” step down
  • anterior knee pain/ retro patella knee pain with at least of:
    • prolonged sitting, stairs, kneeling, hopping, squatting
  • presence of two of the following: pain with apprehension test, patella compression, crepitation
40
Q

Lateral patella pain is linked to the development of:

A

Knee OA

41
Q

Osgood - schlatter disease

A

Apophysis of tibial tubercle

  • young males with rapid growth spurt
  • ttp along tibial tubercle, worse with jumping, squatting, kneeling
  • treatment: ice massage, strengthen quads and hamstrings

OCS Prep (7 decks)

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