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Knee: acute Flashcards

1
Q

Extra knee SE qns

A
  • Clicking/ clunking → meniscal tear/ loose body/instability
  • Giving way → instability
  • Crepitus/ grating → OA/ cartilage disruption
  • Locking→ meniscus getting caught between tibia and fibula
  • Mechanism of injury (Hx) → structures
  • Activities –squat, stairs, twist, prolonged sitting
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2
Q

ACL Tear grade 2 vs 3

A
  • Grade 2, excessive range but end feel

* Grade 3, excessive range but no end feel

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3
Q

ACL Tear SE

A
  • Immediate pain+ (deep)
  • Ceased participation
  • Instability (“giving way”), swelling can initially mask instability
  • Can be irritable
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4
Q

ACL Tear OE

A
  • Acute haemarthrosis ++
  • Antalgic gait
  • Decreased WB
  • Decreased ROM (F and E)
  • Knee held in slight F
  • Unable to fully E
  • +ve Lachman’s test & ant draw
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5
Q

Conservative ACL tear management

A

Conservative
• If knee clinically stable, usually grade 2
• If no high demands on knee for sport or occupation Otherwise….
• Surgical reconstruction of ACL (can’t just ‘repair’ the ACL)

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6
Q

Surgical ACL Management

A
  • Bone-Patellar tendon-Bone graft (B-Pt-B)
  • Semitendinosis (hamstring HS) +/- gracilis graft
  • HS graft – ? Earlier return to sport and fewer knee ROM problems or patella tendinopathies
  • Long term function not significantly different
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7
Q

ACL Rehab post-reconstruction

B-Pt-B vs HS

A
  • B-PT-B graft – often have anterior knee pain •

* Semitendinosus graft – rehab + treat like H/S strain

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8
Q

ACL tear and return to sport

A

RTS (6-12/12)
• Graft maturation 6/12
• 90% Q/S strength
• 100% + H/S strength

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9
Q

ACL rehab: 0-2 weeks goals and PT

A 
Goals:
• PWB-FWB
• Eliminate swelling
• 0-100o ROM
• 4+/5 Q/S strength
• 5/5 H/S strength

Physio:
• Cryotherapy
• EPAs
• Compression
• Manual therapy
• Gait retraining
• Education
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10
Q

ACL rehab: 2-12 weeks goals and PT

A 
Goals:
• No swelling
• ROM: HE-130oF
• Full squat
• Normal gait
• Good balance & control 
Physio:
• Cryotherapy
• EPAs
• Compression
• Manual therapy
• Exercise modification
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11
Q

ACL rehab: 3-6 months goals and PT

A 
Goals:
• Full ROM
• Full strength
• Full power
• Jogging, running, agility
• Restricted sport-specific exs

Physio:
• Manual therapy with accessory movements
• Exercise modification & supervision

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12
Q

MCL Sprains SE

A
  • Pain local to MCL
  • Aggravated by:Walking, Valgus stress & tibial ER, Knee extension
  • Ease by: Rest, Ice
  • Mechanism: Strong valgus force, Closed kinetic chain, Usually with foot at PG & knee 0-90° F, Often due to a direct blow to lateral aspect of knee
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13
Q

MCL Sprains OE

A
  • TOP MJL
  • Swelling not common (avascular)
  • Knee E often painful
  • Valgus stress test +ve (lax, painful, endfeel depends on grade)
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14
Q

Meniscal tear SE

A 
•Mechanism: 
Combination of knee F, compression and rotation, Closed kinetic chain.
Usually with knee 0-90° F
•Deep pain over jt line
•Locking, catching, clicking
\+/- giving way due to pain
•Pain on squatting
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15
Q

Meniscal tear OE

A
  • Minor swelling – delayed (largely avascular structure)
  • TOP joint line
  • AROM: Locking, catching, pain through ROM
  • Apley/McMurray’s +ve
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16
Q

Meniscal tear Management

A

Repair indicated for:
• peripheral and longitudinal tears (esp with locking)
• concurrent ACL reconstruction
• younger patients
• Rehab similar to post ACL recon
• Reduced RTS time 3-5 weeks
• Extra care needed with WB and CKC knee F.

17
Q

Lateral Collateral Ligament Injury Mechanism and Management

A

Mechanism: blow to the medial knee
• Rare on its own
• Associated with cruciate injury if torsional force
• Managed conservatively if it does occur on its own

18
Q

Posterior Cruciate Ligament SE

A

Mechanism:
• Direct blow to the anterior tibia while in knee F
• Less commonly HE
• Poorly localised pain (post > ant)

19
Q

Posterior Cruciate Ligament OE

A
  • Minor swelling (extra-synovial structure)

* Posterior drawer +ve

20
Q

Posterior Cruciate Ligament Management

A
  • similar to ACL reconstruction (0-10 weeks), but

* Unlike ACL it can be beneficial to have stronge quads and not As strong hamstrings

21
Q

Articular cartilage damage – Classification

A
  1. Superficial Lesions
    A – soft indentation
    B – superficial fissures or cracks 2. Lesions < 50% cartilage depth
  2. A. Lesions > 50% cartilage depth
    B. Down to calcified layer
    C. Down to but not through subchondral bone D. Blisters
  3. Very abnormal into subchondral bone

MSK Patterns (7 decks)

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