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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
What tendons are typically used in an Autograft repair of a torn ACL?
Gracilis Tendon Fascia Lata Semitendinosus Tendon Quadriceps muscle tendon
25
What is the strongest Autograft repair for ACL reconstruction?
The bone-patellar tendon-bone
26
What are the risks associated with an Allograft repair?
Disease transmission | Problems with effective sterilization techniques
27
What type of healing occurs in the firs 6-8 weeks following a tendon graft?
Avascular necrosis occurs gradually | Graft is quite fragile during this time
28
What is the typical strength of a tendon graft after 12 weeks (3 months)?
50% of its original strength
29
What exercise precautions should be taken following an ACL repair?
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
30
What kind of transfers should be avoided following an ACL repair?
Pivot Transfers
31
What is the time frame for the Maximum Protection Phase following an ACL repair?
The first 6 weeks
32
What restrictions are there during the Maximum Protection Phase of ACL recovery?
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
33
What are the goals of the Maximum Protection Phase of ACL recovery?
Control swelling Encourage quad control / HS Strength Begin strengthening & ROM w/in precautions Work on extension ROM
34
Is patellar mobilization appropriate during the Maximum Protection Phase of ACL recovery?
Yes
35
Are closed chain exercises appropriate during the Maximum Protection Phase of ACL recovery?
Yes - but the brace must be on the leg and all activity must stay within the ROM limitations for the period.
36
What is the time period of Moderate Protection following ACL reconstruction?
Weeks 7-12
37
At what point during recovery from ACL reconstruction is the graft at its weakest?
Between 6-8 weeks Use extreme caution during this period
38
What is the time period of Minimum protection following ACL reconstruction?
After 12 weeks
39
What are the methods of injury for a PCL tear?
Forceful blow to the anterior tibia when the knee is flexed Dashboard Injury Fall
40
What test is commonly performed to verify a PCL tear?
The Godfrey tibial sag test
41
What are the signs and symptoms of a PCL tear?
Pain | Swelling
42
Are Open Chain HS curls appropriate following a PCL injury?
NO!! Patient needs to be braced to prevent too much knee flexion
43
What are the 4 goals of conservative treatment of a PCL tear?
Joint protection Activity modification Treat Inflammation Exercise
44
Does rehab for PCL repair follow the same guidelines as ACL repair?
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
What is the time period for Max protection following PCL repair?
The first 12 weeks
46
What is the time period for moderate protection following PCL repair?
Weeks 13-24
47
What kind of interventions are recommended during the Max protection phase of PCL repair?
Early isometrics | CKC for quads
48
What kind of interventions are recommended during the Mod protection phase of PCL repair?
Progression of CKC exercises
49
What is the time period for min protection following PCL repair?
Beyond 24 weeks
50
What is the method of injury for an MCL injury?
Valgus force against the medial joint line
51
What is the treatment for an MCL injury?
RICE | PT to strengthen & gain compensatory stability with muscles
52
What is the method of injury for an LCL injury?
Traumatic varus force across the knee This can occur with joint capsule and lateral meniscus damage
53
What is the treatment for an LCL injury?
RICE | PT to strengthen and gain compensatory stability with muscles
54
What are the methods of injury for a Meniscus tear?
Fixed tibia + rotation of the femur Degeneration plus relatively normal force (squatting, getting out of the car)
55
Which meniscus is torn more often? Lateral or Medial
The Medial Meniscus
56
What are the signs and symptoms of a meniscus tear?
"Locking" of he knee Pain with WBing Swelling
57
When is surgery appropriate for a meniscal tear?
When the avascular part is torn
58
What percentage of the meniscus is the most vascular portion?
10-30%
59
What are the interventions during post-op Meniscus repair?
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
What are the goals 3 months s/p Meniscus repair?
Protection of surgery significantly decreases CKC exercise progression Balance Return to activity/functional training
62
What are the signs/symptoms of patellofemoral pathological conditions?
Anterior knee pain | - often caused by mechanical deviation of patellar tracking
63
List 5 things that may cause mechanical deviation of patellar tracking?
1. Tight IT band and hamstrings 2. Weak Quads 3. LE bony alignment 4. Large Q Angle 5. Chondromalacia
64
How are patellofemoral pathological conditions treated?
Stretching and/or strengthening to overcome impairments Exercises based on PT assessment of what is going on at the ankle/foot as well
65
What is Degenerative Joint Disease?
OA - Osteoarthritis
66
What is the most common disease affecting weight bearing joints?
OA
67
What deformities commonly develop in individuals with OA?
Genu Valgum | Genu Varum
68
What are the 3 basic things to focus on when treating OA?
Joint Protection Increasing ROM Increasing strength
69
What type of interventions are contraindicated in OA patients with cardinal signs of inflammation?
Stretching | Resistance exercises
70
What condition is a common reason for performing TKA/TKR?
OA
71
What are the 2 types of knee implants?
Constrained | Unconstrained
72
What is important to know about a constrained knee implant?
a/k/a "conforming implants" Significant congruency of the components Offer most stability, but considerable limitations of motion
73
What is important to know about unconstrained knee implants?
a/k/a "resurfacing implants" No inherent stability in the implant design Used primarily with unicompartmental arthroplasty
74
List 8 goals of TKA treatment during the Max protection phase:
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
List 3 goals of the Mod protection phase of TKA:
1. Progress gait training 2. Patella mobilization 3. Scar mobilization
76
List 5 goals of TKA treatment during the Min protection phase:
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
What is the time frame for the Max protection phase following TKA?
0-8 Weeks
78
What is the time frame for the Mod protection phase following TKA?
6-12 Weeks
79
What is the time frame for the Min protection phase following TKA?
12-24 weeks
80
What 4 criteria need to be met before a patient can progress from Max to Mod protection following TKA?
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
What 3 criteria need to be met before a patient can progress from Mod to Min protection following TKA?
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
What are the exercise precautions following TKA?
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
What is the purpose of an Anterior Drawer Test?
To approximate the degree of anterior tibial translation relative to the fixed femur
84
What is the purpose of the Hughston Jerk Test?
To sublux & reduce the tibia relative to the femur.
85
What is the purpose of the Lachman examination?
For identifying ligament stability of ACL
86
What is the purpose of the Pivot Shift Test?
To sublux & reduce the tibia relative to the femur.
87
What is Apley's Test?
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
How is the Anterior Drawer Test performed?
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
How is the Lachman Test performed?
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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