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Ther Ex I > Knee > Flashcards

Knee Flashcards

0
Q

What happens in the Screw Home Mechanism

A

This is the rotation that occurs beween the femoral condyles and the tibia during the FINAL degrees of extension.

When tibia is fixed, terminal extension results in the femur rotating INTERNALLY

When the knee is unlocked, the femur rotates internally

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1
Q

What are the 2 functions of the knee?

A

Mobility and Stability

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2
Q

If a patient lacks full hip extension, how is knee function affected?

A

The patient will not be able to stand upright and lock the knee

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3
Q

If a patient lacks full hip extension, what muscles should be addressed and how?

A

Stretch the quads

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4
Q

What influences alignment of the patella in the frontal plane?

A

The Q Angle

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5
Q

What is the Q Angle?

A

The line of pull of the quads and by its attachment to the tibial tubercle via the patella tendon.

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6
Q

What is te effect of the forces created by the Q Angle?

A

It causes a bowstring effect of the patella, causing it to track laterally.

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7
Q

What is the normal range for the Q Angle?

A

10-15 degrees

It is typically greater in women due to their wider hips.

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8
Q

What are the landmarks for measuring the Q Angle?

A

The ASIS to mid-patella and the tibial tubercle to the mid-patella.

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9
Q

What things can cause an increased Q Angle?

A 
A Wide pelvis
Femoral Anteversion
Coxa Vara
GenuValgum
Laterally displaced tibial tuberosity
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10
Q

What motions occur in the transverse plane which could cause an increased Q Angle?

A

External tibial rotation
Internal femoral rotation
Pronated Subtalar Joint
Functional Knee Valgus that occurs during dynamic activities

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11
Q

How might a tight IT Band and lateral retinaculum affect patellar alignment and tracking?

A

This could prevent medial gliding of the patella

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12
Q

How might tight ankle PF affect patellar alignment and tracking?

A

It may cause lateral displacement of the tibial tuberosity in relation to the patella.

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13
Q

How might an insufficient vastus medialis oblique affect patellar alignment?

A

Weakness or poor timing of the VMO contractions will increase the lateral drifting of the patella.

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14
Q

How do weak hip abductors and external rotators affect patellar alignment?

A

This can cause adduction of the femur and valgus at the knee under loaded weight bearing.

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15
Q

How many degrees of motion does the knee go through during a normal gait cycle?

A

60 Degrees

From 0 at full extension to 60 at the end of the initial swing.

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16
Q

What muscles affect knee control during gait?

A

Quads
Hamstrings
Soleus
Gastrocnemius

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17
Q

Is the ACL an intracapsular or extracapsular ligament?

A

Intracapsular

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18
Q

What are the mechanisms of injury for an ACL tear?

A

Can be contact or non-contact
Rotation of the tibia on a planted foot
Forceful hyperextension
A lateral blow to the knee (valgus force)

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19
Q

What is the “Terrible Triad?”

A

A knee injury that involves damage to the

ACL, MCL and medial meniscus

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20
Q

CLINICALLY, what is the most common combination of knee ligament injuries?

A

ACL, MCL & LATERAL meniscus

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21
Q

What are the signs and symptoms of an ACL tear?

A

Swelling
Pain
Instability

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22
Q

What tests are commonly performed to test the instability of the ACL?

A

Lachman

Anterior Drawer Test

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23
Q

What are the 4 elements of conservative treatment of an ACL tear?

A
  1. Joint protection
  2. Activity modification
  3. Treat inflammation
  4. Exercise
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24
Q

What tendons are typically used in an Autograft repair of a torn ACL?

A

Gracilis Tendon
Fascia Lata
Semitendinosus Tendon
Quadriceps muscle tendon

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25
Q

What is the strongest Autograft repair for ACL reconstruction?

A

The bone-patellar tendon-bone

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26
Q

What are the risks associated with an Allograft repair?

A

Disease transmission

Problems with effective sterilization techniques

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27
Q

What type of healing occurs in the firs 6-8 weeks following a tendon graft?

A

Avascular necrosis occurs gradually

Graft is quite fragile during this time

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28
Q

What is the typical strength of a tendon graft after 12 weeks (3 months)?

A

50% of its original strength

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29
Q

What exercise precautions should be taken following an ACL repair?

A

No open chai extension from 40 degrees of knee flexion to 0 degrees

Recognize that the greatest amount of stress on the graft occurs between 20 degrees of knee flexion and full extension

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30
Q

What kind of transfers should be avoided following an ACL repair?

A

Pivot Transfers

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31
Q

What is the time frame for the Maximum Protection Phase following an ACL repair?

A

The first 6 weeks

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32
Q

What restrictions are there during the Maximum Protection Phase of ACL recovery?

A

The knee is generally locked in extension or 10 degrees of flexion for the first 2 weeks
WB at 25-50%

0-90 degrees fter 2 weeks
FWB after 3-4 weeks

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33
Q

What are the goals of the Maximum Protection Phase of ACL recovery?

A

Control swelling
Encourage quad control / HS Strength
Begin strengthening & ROM w/in precautions
Work on extension ROM

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34
Q

Is patellar mobilization appropriate during the Maximum Protection Phase of ACL recovery?

A

Yes

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35
Q

Are closed chain exercises appropriate during the Maximum Protection Phase of ACL recovery?

A

Yes - but the brace must be on the leg and all activity must stay within the ROM limitations for the period.

36
Q

What is the time period of Moderate Protection following ACL reconstruction?

A

Weeks 7-12

37
Q

At what point during recovery from ACL reconstruction is the graft at its weakest?

A

Between 6-8 weeks

Use extreme caution during this period

38
Q

What is the time period of Minimum protection following ACL reconstruction?

A

After 12 weeks

39
Q

What are the methods of injury for a PCL tear?

A

Forceful blow to the anterior tibia when the knee is flexed

Dashboard Injury

Fall

40
Q

What test is commonly performed to verify a PCL tear?

A

The Godfrey tibial sag test

41
Q

What are the signs and symptoms of a PCL tear?

A

Pain

Swelling

42
Q

Are Open Chain HS curls appropriate following a PCL injury?

A

NO!!

Patient needs to be braced to prevent too much knee flexion

43
Q

What are the 4 goals of conservative treatment of a PCL tear?

A

Joint protection
Activity modification
Treat Inflammation
Exercise

44
Q

Does rehab for PCL repair follow the same guidelines as ACL repair?

A

NO - WB is progressed much slower

Some prefer limited FWB for 4-6 weeks or longer

Some prefer initial WBing with no more than 50-60 degrees of knee flexion

45
Q

What is the time period for Max protection following PCL repair?

A

The first 12 weeks

46
Q

What is the time period for moderate protection following PCL repair?

A

Weeks 13-24

47
Q

What kind of interventions are recommended during the Max protection phase of PCL repair?

A

Early isometrics

CKC for quads

48
Q

What kind of interventions are recommended during the Mod protection phase of PCL repair?

A

Progression of CKC exercises

49
Q

What is the time period for min protection following PCL repair?

A

Beyond 24 weeks

50
Q

What is the method of injury for an MCL injury?

A

Valgus force against the medial joint line

51
Q

What is the treatment for an MCL injury?

A

RICE

PT to strengthen & gain compensatory stability with muscles

52
Q

What is the method of injury for an LCL injury?

A

Traumatic varus force across the knee

This can occur with joint capsule and lateral meniscus damage

53
Q

What is the treatment for an LCL injury?

A

RICE

PT to strengthen and gain compensatory stability with muscles

54
Q

What are the methods of injury for a Meniscus tear?

A

Fixed tibia + rotation of the femur

Degeneration plus relatively normal force (squatting, getting out of the car)

55
Q

Which meniscus is torn more often? Lateral or Medial

A

The Medial Meniscus

56
Q

What are the signs and symptoms of a meniscus tear?

A

“Locking” of he knee
Pain with WBing
Swelling

57
Q

When is surgery appropriate for a meniscal tear?

A

When the avascular part is torn

58
Q

What percentage of the meniscus is the most vascular portion?

A

10-30%

59
Q

What are the interventions during post-op Meniscus repair?

A

WB precautions vary: TTWB at 1st FWB by 6-8 weeks

Initially braced in locked in extension

Ice & Elevate

ROM & Strengthening w/in precautions

Gait Training

61
Q

What are the goals 3 months s/p Meniscus repair?

A

Protection of surgery significantly decreases
CKC exercise progression
Balance
Return to activity/functional training

62
Q

What are the signs/symptoms of patellofemoral pathological conditions?

A

Anterior knee pain

- often caused by mechanical deviation of patellar tracking

63
Q

List 5 things that may cause mechanical deviation of patellar tracking?

A
  1. Tight IT band and hamstrings
  2. Weak Quads
  3. LE bony alignment
  4. Large Q Angle
  5. Chondromalacia
64
Q

How are patellofemoral pathological conditions treated?

A

Stretching and/or strengthening to overcome impairments

Exercises based on PT assessment of what is going on at the ankle/foot as well

65
Q

What is Degenerative Joint Disease?

A

OA - Osteoarthritis

66
Q

What is the most common disease affecting weight bearing joints?

A

OA

67
Q

What deformities commonly develop in individuals with OA?

A

Genu Valgum

Genu Varum

68
Q

What are the 3 basic things to focus on when treating OA?

A

Joint Protection
Increasing ROM
Increasing strength

69
Q

What type of interventions are contraindicated in OA patients with cardinal signs of inflammation?

A

Stretching

Resistance exercises

70
Q

What condition is a common reason for performing TKA/TKR?

A

OA

71
Q

What are the 2 types of knee implants?

A

Constrained

Unconstrained

72
Q

What is important to know about a constrained knee implant?

A

a/k/a “conforming implants”

Significant congruency of the components

Offer most stability, but considerable limitations of motion

73
Q

What is important to know about unconstrained knee implants?

A

a/k/a “resurfacing implants”

No inherent stability in the implant design

Used primarily with unicompartmental arthroplasty

74
Q

List 8 goals of TKA treatment during the Max protection phase:

A
  1. Reducing stresses that may loosen the prosthesis
  2. Stimulate mm strength
  3. Increase ROM
  4. Reduce Pain
  5. Reduce Inflammation
  6. Gait Training
  7. Transfer Training
  8. Education
75
Q

List 3 goals of the Mod protection phase of TKA:

A
  1. Progress gait training
  2. Patella mobilization
  3. Scar mobilization
76
Q

List 5 goals of TKA treatment during the Min protection phase:

A
  1. Progress to isotonic knee extension ex
  2. Isokinetic knee flexion and extension
  3. Stationary cycling for improved knee ROM
  4. Various Closed Kinetic Chain functional activities (walking, stair climbing)
  5. Balance Training
77
Q

What is the time frame for the Max protection phase following TKA?

A

0-8 Weeks

78
Q

What is the time frame for the Mod protection phase following TKA?

A

6-12 Weeks

79
Q

What is the time frame for the Min protection phase following TKA?

A

12-24 weeks

80
Q

What 4 criteria need to be met before a patient can progress from Max to Mod protection following TKA?

A
  1. Minimal swelling & pain
  2. Well-healed incision w/no signs of infection
  3. Independent basic ADL/ambulation w/appropriate AD
  4. AROM approaching full/nearly full, active knee extension and 90 degrees knee flexion
81
Q

What 3 criteria need to be met before a patient can progress from Mod to Min protection following TKA?

A
  1. AROM: full knee extension and 110 degrees knee flexion
  2. Quads/HS and hip mm strength of at least 70% (4/5 MMT) compared to uninvolved leg
  3. Minimal to no pain during ex/ambulation
    (with or without a cane)
82
Q

What are the exercise precautions following TKA?

A

Integrity of surgical incision during flexion

No SLRs in side-lying for 2 wks after cemented / 4-6 wks for cementless

No low-intensity resistance ex until approved by surgeon (anywhere between 2 wks to 3 mos)

No HS strengthening in sitting position following Posterior cruciate-sacrificing prosthesis surgery

Discuss appropriateness of tibiofemoral jt mobs (for knee flex/ext) with surgeon.

No unsupported/unassisted WBing until strength in quads/HS is sufficient to stabilize the knee.

83
Q

What is the purpose of an Anterior Drawer Test?

A

To approximate the degree of anterior tibial translation relative to the fixed femur

84
Q

What is the purpose of the Hughston Jerk Test?

A

To sublux & reduce the tibia relative to the femur.

85
Q

What is the purpose of the Lachman examination?

A

For identifying ligament stability of ACL

86
Q

What is the purpose of the Pivot Shift Test?

A

To sublux & reduce the tibia relative to the femur.

87
Q

What is Apley’s Test?

A

Test for Meniscal Lesion

Pt prone with knee 90 degrees flexion
Downward compression while internally/externally rotating the foot

Reproduction of pain = positive test

88
Q

How is the Anterior Drawer Test performed?

A

Pt supine with knee 90 degrees flexion
PTA sits on foot & cups hands around the knee and draws the tibia anteriorly (ant. translation)

Laxity = positive test

89
Q

How is the Lachman Test performed?

A

Pt supine with knee 30 degrees flexion
Femur stabilized w/one hand
Other hand draws tibia anteriorly (anterior translation)

Laxity = positive test

Ther Ex I (5 decks)

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