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Knee Eval & Treat Flashcards

1
Q

Causes of knee injuries

A
  1. Sprains, strains, tendinopathies
  2. Contusions
  3. Meniscal or ligamentous
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2
Q

Tibio-Femoral Joint

A

-condyles of femur articulating with tibial plateaus
-Medial condyle: longer creating valgus
-Lateral Condyle: smaller and more mobile

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3
Q

Meniscus

A

-enhance stability and increase contact
-shock absorption (50-70% in flx, 85-90% in ext)
-lubrication

Movement:
-posterior with flx, anterior with ext
-helps nutrition and vascularization

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4
Q

Medial Meniscus

A

-C-shaped and larger
-less mobile

Attaches to:
-MCL
-ACL

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5
Q

Lateral Meniscus

A

-O shaped
-smaller
-less mobile

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6
Q

Anterior Cruciate Ligament

A

Motions:
-prevents ant tibial translation (post femur)
-Prevents tibial IR

Orientation:
-medial aspect of lateral femoral condyle
-anterior medial tibia

Anteromedial Bundle:
-taut in flexion

Posteriorlateral Bundle:
-taut in ext

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7
Q

Posterior Cruciate Ligament

A

Motions:
-prevents ant femoral translation (post femur)
-Prevents tibial IR
-Prevents varus/valgus forces

Orientation:
-posterior lateral tibia
-lateral aspect of medial femoral condyle

-taut in flexion

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8
Q

Medial Collateral Ligament

A

Motions:
-Valgus Stress: 25-30 deg flx only MCL, ext other structure support
-Prevents tibial ER
-Prevents ant tibial translation

Orientation:
-medial epicondyle of femur
-medial tibia
-attaches to medial meniscus

-tears can lead to bone bruises

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9
Q

Lateral Collateral Ligament

A

Motions:
-Varus Stress: 35 deg flx
-Prevents tibial ER
-Prevents ant tibial translation

Orientation:
-lateral epicondyle of femur
-fibular head
-attaches to biceps femoris

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10
Q

Joint Capsule: Anterior Reinforcement

A

-quads
-patellar retinacular fibers

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11
Q

Joint Capsule: Posterior Reinforcement:

A

-Oblique popliteal lig
-popliteus
-gastroc
-hamstrings
-Posteriorlateral complex

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12
Q

Joint Capsule: Medial Reinforcement:

A

-MCL
-Med. patellar retinacular fibers
-Semimem tendon
-Tendon of pes anserine

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13
Q

Joint Capsule: Lateral Reinforcement

A

-LCL
-Lat. Patellar retinacular fibers
-ITB
-Biceps femoris
-Popliteus
-Gastroc

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14
Q

Fat Pad

A

-highly innervated
-under patella
-source of anterior/inferior knee pain

DDx:
-patetllar tendonopathy

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15
Q

Plica

A

-loose synovial fold from fetal development
-Medial patellar plica MC
-innervated

MOI:
-repetitive flexion
-stretch of nerve

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16
Q

Tibio-Femoral: Open Packed Position

A

25 deg of flexion

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17
Q

Tibio-Femoral: Closed Packed Position

A

Extension

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18
Q

Tibio-Femoral: Capsular Pattern

A

Flexion > Extension

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19
Q

Open Chain Arthokinematics

A

-Rolling and gliding same

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20
Q

Closed Chain Arthrokinematics

A

-Rolling and gliding opposite

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21
Q

Screw Home Mechanism

A

-ER of tibial when knee fully extended

Cause by:
-medial femoral condyle
-passive tension of ACL
-Lateral pull of quads

Reversing:
-Popliteus causes tibial IR

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22
Q

Q-Angle

A

-angle between femur and tibia

Normal: 13-18

Increase:
-anteversion
-ER tibial torsion
-genu valgum

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23
Q

Genu Valgum

A

-<>
-increased forces on lateral condyles
-Patella lateral dislocation
-Lateral pull of quads
-Coxa varum
-Foot pronation

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24
Q

Genu Varum

A

-><
-increased forces on medial condyles
-coxa valgum
-foot supination

25
Patello-Femoral Joint
-articulation of patella within femoral groove -moves 7-8cm -dynamic and static restraints -sesamoid bone embedded in quad tendon -Protect distal femur and quad tendon -improve MA of quad -decrease stress on TF joint Knee Flexion: moves inf Knee Extension: moves sup
26
Lateral Patellar Subluxation
-imbalance of lateral forces -VL stronger than VM -lateral patellar retinaculum shorted -short ITB
27
Proximal Tibio-Fibular Joint
-plan joint Movements: -Knee flex: fibula anterior -Knee ext: fibula posterior
28
Acute Knee Injuries
-ligaments -Instabilities -Meniscal and articular cartilage injuries
29
Chronic Knee Injuries
-instabilities -OA -Patellofemoral pain -Patellar Tendonopathy
30
Order of Presentation for Knee Injuries
ACL > PCL > MCL > LCL > Rotary Instability > Relevant CPGs > Patella Pathology
31
Valgus Force
-MCL -ACL -Med Meniscus -Posteriormedial capsule
32
Hyperextension Injury
-ACL -Sometimes PCL -Meniscus
33
Flexion w/ Posterior Translation
-PCL
34
Varus Force
-LCL -Posterolateral capsule -PCL
35
ACL Tears
MOI: Contact: hyperext, valgus force Non-contact: deceleration valgus force near extension (cutting, popping) S/s: -hear/ feel a pop -rapid swelling -knee gives away -loss of end range ext Tests: -Lachman's -Anterior Drawer -6m Single Limb Timed Test
36
Segond Fracture
-avulsion of LCL -indirect sign of ACL tear
37
Concurrent Bone Bruising
- >80% of ACL tears -Lateral condyle MC
38
Copers/Non-Copers
-delayed surgery can increase damage to meniscus or cartilage -increase OA with increased activity -High preinjury activity has high probably to NOT return -consider costs, time, QOL -1/3: compensate well, could return to activity w/ brace, wouldn't return to sport
39
More likely to receive surgery ..
1. High activity level 2. More episodes of giving away 3. Lower KOS-ADL score 4. Lower score in Knee documentation 5. Lower limb symmetry on 6m Hop
40
PCL Tear
MOI: -trauma with posterior tibial shear in flx or hypertext -dashboard injury, sudden stopping S/s: -bruising or abrasion on tibia -loss of knee extension -localized knee posterior pain with kneeling or decelerating Tests: -Posterior Drawer -Posterior Sag Sign -Valgus Stress at 0 Deg
41
MCL Tear
MOI: -traumatic valgus force -rotational trauma S/s: -normal ROM -painful palpation -medial knee pain Tests: -Valgus Stress Test 20-30 deg flx *heals well on it's own*
42
LCL Tear
MOI: -traumatic varus force S/: -swelling over LCL -pain over LCL -lack of LCL Tests: -Varus Stress at 30 deg flx
43
Anteromedial Instabiltiy
-anterior and ER force -MCL, Medical Meniscus, ACL MOI: -valgus force and tibial ER -anterior sublux of medial tibial plateau Tests: -Anterior Drawer with ER
44
Anterolateral Instability
-anterior and IR force -ACL, LCL, Lateral mensiscus, ITB MOI: -valgus force and tibial IR -anterior sublux of lateral tibial plateau -ACL tear Tests: -Anterior Drawer Test with IR -Pivot shift
45
Posteromedial Instability
-Posterior and IR force -valgus force -PCL, MCL, Medial meniscus, Semimembranosis, ACL MOI: -force into extension and tibial IR -valgus movement Tests: -Hughston's Posteriormedial Drawer (posterior drawer with IR)
46
Posterolateral Instability
-posterior and ER force -Varus force -PCL, LCL, Biceps femoris MOI: -laxity of PCL in addition to other structures -tib posterior and ER Tests: -Dial Test/PLR Tests -Posterolateral Drawer -Reverse Pivot Shift
47
Posterolateral Corner Injury
MOI: -direct varus hit to tibial on an extended knee -posterior force on flexed knee with tibial ER -chronically after trauma to ACL or PCL S/s: -varus thrust gait -posterolateral instability -knee giving way -common fib irritation
48
RF for ACL
Non-Contact: -increased BMI -shoe -joint laxity -female -turf
49
ACL Diagnosis/Classification
1. Medical Screening 2. Classification through evaluation 3. Determining irritability evaluation 4. Outcome Measures 5. Intervention Strategies
50
ACL Interventions (Strong/moderate/weak)
Strong: -Therex -Estim -Neuro re-ed Moderate: -immobilization -cryo -rehab Weak: -CPM -knee bracing -early weight bearing
51
ACL Injury Prevention CPG
Strong: -review lit -use programs before sports -multiple components -high compliance Moderate: -handball players 15-17 -don't have to include balance -programs led by coaches and med prof
52
Meniscal Injuries (MOI & CPR)
MOI: -twisting -valgus/ hyperextension force CPR: -catching or locking -joint line tenderness -twisting MOI -pain with knee hyperextension or max flx -pain or click w/ McMurrays test >4 positive
53
Meniscal vs. Articular
Meniscus: -Young athletes -Older people -paired with ACL Articular Cartilage: -athlete knees -2/3 of femoral condyles and patella -higher after meniscectomy -PMH of surgery
54
Meniscus Tear Treatment
Moderate: -knee motion -weight bearing -Rehab -Therex -Estim Low Level: -progressive return to activity
55
Altman's Criteria for Knee OA
1. Knee Pain 2. >50 3. Knee Crepitus 4. Palpable bony enlargement 5. Bony tenderness 6. Morning stiffness <30mins 7. No warmth
56
Radiographic Evidence of Knee OA
-osteophytes, subchondral sclerosis, small joint space, subchondral cysts
57
Kellgren-Lawrence Scale for Knee OA
0: No radiographic evidence 1: doubtful narrowing of joint space, possible osteophyte flipping 2: Osteophytes, possible joint space narrowing 3: Multiples osteophytes, definite joint space narrowing, possible deformity 4: Large osteophytes, joint space narrowing, sever sclerosis
58
Knee OA Treatments
-Exercise -Weight control -Check hip -Mobilization and exercises for knee ROM

MSK (48 decks)

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