Knee Flashcards
Overweight, very tall, and thin prepubescents males (8-17 y/o) w/ ant thigh and/or knee pain - negative examination (Dx?)
Slipped Capital Femoral Epiphysis
identifying slipped capital femoral epiphysis
FABER test - flexion, abduction, ER of hip with overpressure
Legg Calve Perthes syndrome
- age demographic
- pain location (most often)
- presentation, onset, and mobility
- 5-12 y/o
- anterior thigh and possibly knee
- knee swelling, gradual onset, with locking
PFP provocative tests (6 total)
- pain w/ manual compression of PFJ
- pain w/ palpation of posteromedial and posterolateral patellar borders
- pain w/ resisted isometric quadriceps femoris contraction
- pain w/ squatting
- pain during kneeling
- pain during prolonged sitting
Four biological phases of cartilage maturation
proliferation, transitional, remodeling, and maturation
Motions to avoid following meniscal injury (4)
squatting, pivoting, cutting, and running
Squatting angles permitted for meniscal repair at 4 and 8 weeks post-op
<45 deg and <90 deg (respectively); >90 deg permitted after week 8
Two most important things for most knee surgery rehabs
Obtaining terminal knee extension and quadriceps strengthening
Hyaluronic acid
Shock absorber and lubricant in synovial fluid - directly injected
Posterolateral corner is comprised of…
arcuate ligament
LCL
popliteal tendon
lateral head of the gastrocnemius
Five measures - Meniscal Pathology Composite Score
ALSO THE CPR FOR THE KNEE (John Snyder, DPT site)
- history of catching/locking
- joint line tenderness
- pain with forced hyperextension
- pain with max knee passive flexion
- pain or an audible click with the McMurray test
Step down test - how do you do it?
step down with measuring painful angle
Sage sign
greater than 50% of patellar width displacement (25-50% of patellar width change is normal)
Patellar tilt test - knee positioning
Completed in 20 deg of knee flexion
Cluster testing for patellofemoral pain
positive reproduction of pain with isometric quadriceps muscle contraction and/or pain during squatting and/or pain during palpation (PL and PM borders)
Important functional knee tests - walking for elderly and pt’s with OA (4)
- Timed Stair-climbing test
- Six-minute walk test
- Timed Up and Go test (TUG)
- Five time sit to stand
Four phase of rehabilitation following osteochondral autograft transplantation (OATS) and autologous chondrocyte implantation (ACI) procedures
- Proliferation phase (0-6 weeks)
- Transition phase (6-12 weeks)
- Remodeling phase (12-26 weeks)
- Maturation phase (26-52 weeks)
Distal Patellar Realignment Surgeries (3)
- Fulkerson Osteotomy
- Hauser
- Elmslie Trillat
Posterolateral drawer test - positive finding
Posterolateral rotation of tibia when NEGATIVE; when POSITIVE, tibia rotates posterolaterally and posteriorly subluxes
Prone external rotation test
- tests what?
- position and testing?
- positive findings indications?
- posterolateral (PL) corner of the knee
- prone position with B knees flexed 30 deg; both lower limbs ER
- greater than 10 deg difference of ER on affected side may indicate PL corner injury
Lachman’s test
- tests what?
- position and testing?
- findings?
- ACL
- 30 deg knee flexion with anterior tibial translation
- Empty end-feel with testing is positive
Step-down test
record the angle of flexion achieved along with subjective pain report (VAS or VRS) during descent.
Noyes Hop Test
- purpose
- how completed
- describe the four variants (cluster)(4)
Commonly used functional test for return to sports.
- involve hopping distance and time to that of uninvolved limb
- tests are: single hope for distance, triple hop for distance, crossover triple hop for distance, and a timed 6 m. hop
Non-surgical ACL screen
- Episodes of giving a way
- Noye’s hop test
- KOS ADLs
- Global rating score
- 1 or less since injury
- > 80%
- > 80%
- > 60%
Level 1 sports vs Level 2 sports
- Level 1 encompasses jumping, cutting, and pivoting types of maneuvers for 50 hours or more per year
- Level 2 are those that involve lateral movement (e.g. racquet ball and skiing)
PCL - ranges restricting posterior tibia translation
- Anterolateral - purpose
- Posteromedial - purpose
PCL restricts 95% of posterior displacement of tibia on femur between 30-90 deg.
- AL bundle bears 50-74% of the posterior force between 40-120 deg.
- PM responsible for 57% of posterior force beyond 120 deg.
Measures when determining a successful ACL rehab outcome:
- less than mild persistent perfusion
- > 90% quad and hamstring muscle strength
- absence of giving way episodes
- participation in 1 or 2 seasons of sports
- patient-reported outcomes
Anterior drawer
+ translation with tibial ER? if so what is wrong?
+ translation with tibial IR? if so what is wrong?
Anterior drawer: positive with 6 mm change with translation with soft end-feel
Increased excursion with tibial ER may indicate anteromedial instability (MCL, med capsule, post. oblique ligament)
Increased exc. with tibial IR –> possible anterolateral instability
Ideal testing position of LCL and MCL (pure test)
20-30 deg knee flexion
Full knee extension varus and valgus tests what structures
Varus: LCL, ACL, and PCL
Valgus: MCL, ACL, and PCL
What may happen that could interfere with testing using the pivot shift test?
Pt’s will tend to guard, anticipating a shift or pain.
Level B evidence of what regarding ACL bracing immediately post-operative - to use or not to use?
Not using a brace
Cryotherapy (per CPG) for ACL rehab has what level evidence
Level C evidence
MCL pathology CPR
Rotational trauma
Trauma by external force to the leg
Pain with valgus stress test at 30 deg flexion
Laxity with valgus stress test at 30 deg flexion
- Pittsburgh (CPR) knee rules
2. what is this used for?
- Blunt trauma or fall as mechanism of injury plus…
- >50 y/o or <12 y/o
* and/or*
- inability to walk 4 steps WB steps in the emergency dept. - identify need for radiographs of the knee
