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Knee and ankle Flashcards

1
Q

Tibiofemoral Joint

A
  • biaxial, modified hinge joint

- menisci and ligaments provide cushion and stability

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2
Q

Tibiofemoral joint distal and proximal end

A

convex portion at distal end of femur

concave portion at proximal end of tibia

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3
Q

Patellofemoral joint

A

knee flexion: patella slides caudually

knee extension: patella slides superiorly

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4
Q

Dynamic stability of the knees comes from

A
  1. cruciate and collateral ligaments
  2. neuromusclar system to coordinate motor control of surrounding muscle groups
  3. nervous system to modulate muscle stiffness & provide proprioceptive feedback
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5
Q

Stability of knee during gait is controlled by:

A

Quadriceps
Hamstrings
Soleus
Gastrocnemius

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6
Q

How many degrees does the knee go through during gait?

A

60 degrees

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7
Q

Common source of referred pain to the knee:

A
  1. common peroneal nerve (L2-4)
  2. saphenous nerve (L2-4)
  3. L3 refers to anterior aspect
  4. S1-S2 refers to posterior aspect
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8
Q

Possible nonoperative causes of knee joint hypomobility

A

Osteoarthritis or Degenerative Joint Disease
Rheumatoid arthritis
Postimmobilization
Edema

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9
Q

Knee Treatment Options :Goals: control pain and protect the joint

A 
Patient education
Functional adaption
PROM
AAROM
AROM
Grade I or II tractions or glides
Isometric “setting” exercises
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10
Q

Hemi/Partial/ Unicompartmental Knee Arthroplasty Disadvantages of TKA

A

Less predictable pain relief

Potential need for more surgery

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11
Q

Hemi/Partial/ Unicompartmental Knee Arthroplasty Advantages of TKA

A

Quicker recovery
Less pain after surgery
Less blood loss
Pt report it “feels more natural”

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12
Q

ACL injuries

A

Noncontact

Contact valgus force to knee

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13
Q

PCL injuries

A

Forceful blow to the anterior tibia while the knee is flexed

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14
Q

MCL injuries

A

Valgus force across medial joint line of knee

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15
Q

LCL injuries

A

Varus force across the knee

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16
Q

ACL reconstruction: patellar tendon autograft

A
  • middle third of patellar tendon of patient along w/bone from shin and kneecape
  • “gold standard”
  • lower rate of graft failure compared to hamstring graft
  • for high demand athlete
  • not recommended for people who kneel
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17
Q

ACL reconstruction: patellar tendon autograft disadvantages

A
  1. post-op pain behind kneecap
  2. pain with kneeling
  3. somewhat increased risk of post op stiffness
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18
Q

ACL reconstruction: hamstring tendon autograft

A
  • inner side of the semitendiosus tendon
  • some surgeons also use gracilis
  • 2-strand or 4-strand tendon graft is created
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19
Q

Hamstring tendon advantageous to patellar autograft due to:

A

fewer problems with anterior knee pain or kneecap post op
less post-op stiffness
smaller incision
faster recovery

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20
Q

ACL reconstruciton: hamstring tendon autograft disadvantages:

A
  1. no one plugs so function limited by strength & type of fixation
  2. susceptible to graft stretching causing joint laxity
  3. possible decreased hamstring strength post-op
  4. not recommended for hypermobile patients
  5. contraindicated for patients w/MCL laxity/injury
  6. loss of stability
21
Q

ACL reconstruction: quadriceps tendon autograft

A
  • middle third of quadriceps tendon and bone plug from upper end of kneecap
  • used for patients with failed ACL reconstructions
  • generates larger graft for taller and heavier patients
22
Q

ACL reconstruction: quadriceps tendon autograft disadvantages:

A

fixation is not as solid as patellar tendon graft due to only having one bone plug
high association with post-op anterior knee pain
low risk of patella fracture
incision is not cosmetically appealing

23
Q

ACL reconstruction: allograft

A
  • graft taken from cadavers (patellar & achilles tendon)

- used to repair failed ACL reconstruction

24
Q

Advantages of ACL reconstruction with allograft

A
  1. eliminate pain to patient at donor site for autograft
  2. decreased surgery time
  3. smaller incisions
25
Disadvantages of ACL reconstruction with allograft
1. risk of infection including HIV and Hep C 2. possible death from bacterial infection from allograft 3. susceptible to graft stretching with causes joint laxity 4. higher failure rate (23-34.4%) compared to autograft (5-10%) for young athletes returning to high demand sports
26
Patellofemoral Dysfuntion: causes of pain
``` Plica syndrome Fat pad syndrome Tendinitis IT band friction syndrome Prepatellar bursitis Patellar pressure syndrome OCD lesions Traumatic patellar chondromalacia Patellofemoral OA Apophysitis Trauma ```
27
Patellofemoral Treatment options:
``` Patient education HEP Increase flexibility of restricting tissues Patellar mobilization Patellar tipping Patellar taping VMO strengthening Quad sets ```
28
Patellofemoral surgery
Alter alignment of patellofemoral joint Correct imbalances Decrease abnormal Q-angle Debride or repair articular surfaces
29
Patellofemoral surgery procedures:
Lateral retinacular release Proximal realignment of extensor mechanism Distal realignment of extensor mechanism
30
Meniscal tears
Can cause acute locking of the knee or chronic intermittent locking Pain along the joint line Increased swelling Some quad atrophy possible
31
Joints of ankle and foot
-tibiofibular joints Ankle (talocrural) joint Subtalar (talocalcaneal) joint Talonavicular joint Transverse tarsal joint Remaining intertarsal and tarsometatarsal joints Metatarsophalangeal and interphalangeal joints of the toes
32
Tibiofibular joints include:
- superior tibiofibular joint characteristics - inferior tibiofibular joint characeristics - accessory motions
33
Muscle control of the ankle and foot during gait
``` Ankle dorsiflexors Ankle plantarflexors Ankle evertors Ankle inverters Intrinsic muscles ```
34
Referred pain in foot and ankle
- L4 - L5 - S1
35
Major nerves subject to pressure and trauma
Common peroneal nerve Posterior tibial nerve Plantar and calcaneal nerves
36
Possible nonoperative causes of foot and ankle hypomobility
Rheumatoid arthritis Degenerative Joint Disease or Osteoarthritis Postimmobilization Gout
37
Foot and Ankle Common Deformities
1. Hallux valgus 2. Hallux rigidus 3. Claw toe (hyperflexed) 4. Dorsal dislocation of the proximal phalanges on the metatarsal heads
38
Ankle supination
varus
39
Ankle pronation
valgus
40
Foot and Ankle treatment options
Patient education Joint Mobilization Soft Tissue Mobilization Balance Training
41
TKA focuses on:
normalizing gait strengthening muscles independent transfer increasing proprieception
42
Hemi/Partial/ Unicompartmental Knee Arthroplasty
Progress more quickly than TKA Less gait deviations noted Less post-op pain, less swelling, and easier rehabilitation
43
Goals for rehab of ACL reconstruction
decreasing knee swelling mobility of patella to prevent anterior knee pain problems regaining full ROM strengthening quadriceps and hamstring muscles Increase proprioception (typically takes 4-6 months)
44
What can patient return to sports after ACL reconstruction?
no pain or swelling, full knee ROM, and muscle strength, endurance and functional use of LE have fully returned
45
ACL reconstruction: patellar tendon autograft precautions
- no kneeling | - scar massage
46
ACL reconstruction: hamstring tendon autograft precautions
-no active hamstring contraction for 4-6 weeks
47
ACL reconstruction: allograft precautions:
some surgeons order NWB for 4-6 weeks
48
Achille's Repair
No PROM/AROM x 6 weeks
49
TAA
- NWB | - ROM restrictions

Acute (16 decks)

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