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MSK > Knee Eval & Treat > Flashcards

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
Q

Patello-Femoral Joint

A

-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
Q

Lateral Patellar Subluxation

A

-imbalance of lateral forces
-VL stronger than VM
-lateral patellar retinaculum shorted
-short ITB

27
Q

Proximal Tibio-Fibular Joint

A

-plan joint

Movements:
-Knee flex: fibula anterior
-Knee ext: fibula posterior

28
Q

Acute Knee Injuries

A

-ligaments
-Instabilities
-Meniscal and articular cartilage injuries

29
Q

Chronic Knee Injuries

A

-instabilities
-OA
-Patellofemoral pain
-Patellar Tendonopathy

30
Q

Order of Presentation for Knee Injuries

A

ACL > PCL > MCL > LCL > Rotary Instability > Relevant CPGs > Patella Pathology

31
Q

Valgus Force

A

-MCL
-ACL
-Med Meniscus
-Posteriormedial capsule

32
Q

Hyperextension Injury

A

-ACL
-Sometimes PCL
-Meniscus

33
Q

Flexion w/ Posterior Translation

A

-PCL

34
Q

Varus Force

A

-LCL
-Posterolateral capsule
-PCL

35
Q

ACL Tears

A

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
Q

Segond Fracture

A

-avulsion of LCL
-indirect sign of ACL tear

37
Q

Concurrent Bone Bruising

A
  • > 80% of ACL tears
    -Lateral condyle MC
38
Q

Copers/Non-Copers

A

-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
Q

More likely to receive surgery ..

A
  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
Q

PCL Tear

A

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
Q

MCL Tear

A

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
Q

LCL Tear

A

MOI:
-traumatic varus force

S/:
-swelling over LCL
-pain over LCL
-lack of LCL

Tests:
-Varus Stress at 30 deg flx

43
Q

Anteromedial Instabiltiy

A

-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
Q

Anterolateral Instability

A

-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
Q

Posteromedial Instability

A

-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
Q

Posterolateral Instability

A

-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
Q

Posterolateral Corner Injury

A

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
Q

RF for ACL

A

Non-Contact:
-increased BMI
-shoe
-joint laxity
-female
-turf

49
Q

ACL Diagnosis/Classification

A
  1. Medical Screening
  2. Classification through evaluation
  3. Determining irritability evaluation
  4. Outcome Measures
  5. Intervention Strategies
50
Q

ACL Interventions (Strong/moderate/weak)

A

Strong:
-Therex
-Estim
-Neuro re-ed

Moderate:
-immobilization
-cryo
-rehab

Weak:
-CPM
-knee bracing
-early weight bearing

51
Q

ACL Injury Prevention CPG

A

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
Q

Meniscal Injuries (MOI & CPR)

A

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
Q

Meniscal vs. Articular

A

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
Q

Meniscus Tear Treatment

A

Moderate:
-knee motion
-weight bearing
-Rehab
-Therex
-Estim

Low Level:
-progressive return to activity

55
Q

Altman’s Criteria for Knee OA

A
  1. Knee Pain
  2. > 50
  3. Knee Crepitus
  4. Palpable bony enlargement
  5. Bony tenderness
  6. Morning stiffness <30mins
  7. No warmth
56
Q

Radiographic Evidence of Knee OA

A

-osteophytes, subchondral sclerosis, small joint space, subchondral cysts

57
Q

Kellgren-Lawrence Scale for Knee OA

A

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
Q

Knee OA Treatments

A

-Exercise
-Weight control
-Check hip
-Mobilization and exercises for knee ROM

MSK (34 decks)

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