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Acute > Knee and ankle > Flashcards

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
Q

Disadvantages of ACL reconstruction with allograft

A
  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
Q

Patellofemoral Dysfuntion: causes of pain

A 
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
Q

Patellofemoral Treatment options:

A 
Patient education
HEP
Increase flexibility of restricting tissues
Patellar mobilization
Patellar tipping
Patellar taping
VMO strengthening
Quad sets
28
Q

Patellofemoral surgery

A

Alter alignment of patellofemoral joint
Correct imbalances
Decrease abnormal Q-angle
Debride or repair articular surfaces

29
Q

Patellofemoral surgery procedures:

A

Lateral retinacular release
Proximal realignment of extensor mechanism
Distal realignment of extensor mechanism

30
Q

Meniscal tears

A

Can cause acute locking of the knee or chronic intermittent locking
Pain along the joint line
Increased swelling
Some quad atrophy possible

31
Q

Joints of ankle and foot

A

-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
Q

Tibiofibular joints include:

A
  • superior tibiofibular joint characteristics
  • inferior tibiofibular joint characeristics
  • accessory motions
33
Q

Muscle control of the ankle and foot during gait

A 
Ankle dorsiflexors
Ankle plantarflexors
Ankle evertors
Ankle inverters
Intrinsic muscles
34
Q

Referred pain in foot and ankle

A
  • L4
  • L5
  • S1
35
Q

Major nerves subject to pressure and trauma

A

Common peroneal nerve
Posterior tibial nerve
Plantar and calcaneal nerves

36
Q

Possible nonoperative causes of foot and ankle hypomobility

A

Rheumatoid arthritis
Degenerative Joint Disease or Osteoarthritis
Postimmobilization
Gout

37
Q

Foot and Ankle Common Deformities

A
  1. Hallux valgus
  2. Hallux rigidus
  3. Claw toe (hyperflexed)
  4. Dorsal dislocation of the proximal phalanges on the metatarsal heads
38
Q

Ankle supination

A

varus

39
Q

Ankle pronation

A

valgus

40
Q

Foot and Ankle treatment options

A

Patient education
Joint Mobilization
Soft Tissue Mobilization
Balance Training

41
Q

TKA focuses on:

A

normalizing gait
strengthening muscles
independent transfer
increasing proprieception

42
Q

Hemi/Partial/ Unicompartmental Knee Arthroplasty

A

Progress more quickly than TKA
Less gait deviations noted
Less post-op pain, less swelling, and easier rehabilitation

43
Q

Goals for rehab of ACL reconstruction

A

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
Q

What can patient return to sports after ACL reconstruction?

A

no pain or swelling, full knee ROM, and muscle strength, endurance and functional use of LE have fully returned

45
Q

ACL reconstruction: patellar tendon autograft precautions

A
  • no kneeling

- scar massage

46
Q

ACL reconstruction: hamstring tendon autograft precautions

A

-no active hamstring contraction for 4-6 weeks

47
Q

ACL reconstruction: allograft precautions:

A

some surgeons order NWB for 4-6 weeks

48
Q

Achille’s Repair

A

No PROM/AROM x 6 weeks

49
Q

TAA

A
  • NWB

- ROM restrictions

Acute (16 decks)

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