Knee (Exam 2) Flashcards
Incomplete stretching of ligament fibers. Giving away feeling.
Mild: Grade I or First Degree Sprain
Partial loss of ligament fiber integrity.
Moderate: Grade II or Second Degree Sprain
Rupture fiber bundles completely torn.
Severe: Grade III or Third Degree Sprain
Combined external rotation, valgus stress, and internal tibial rotation with knee hyper-extension with limb is planted.
ACL Injuries
Removal of Fluid
Athrocentesis
Blood
Ligament Tear
Blood with Fat Droplets
Fracture or Ligament Sprain
No Blood
Chronic Meniscus Lesion or Synovitis
Mild Instability. 5mm or less of joint surface separation.
Graded 1+
Moderate Instability. 5 - 10mm joint surface separation.
Graded 2+
Severe Instability. 10mm or greater joint surface separation.
Graded 3+
Graft is very fragile for ____ months after surgery.
2 months (6-8 weeks)
Graft slowly revascularizes. By ___ months tensile strength 50% of original strength.
3 months
Hardest motion to get back after ACL injury.
Extension
Maximum Protection (ACL)
Day 1 - 6 Weeks
Moderate Protection (ACL)
7 - 12 Weeks
Minimum Protection (ACL)
13 Weeks Post Op until Return
Posterior force on anterior knee when flexed. Hyper flexion of the knee.
PCL Injuries
Most important factor is quad strength. Need to develop strength to greater than 100% of uninvolved limb for success.
Nonoperative PCL Management
Most commonly injured knee ligament.
MCL Injury
Direct external valgus force applied to lateral knee. Non contact when foot is planted and tibia is rotated externally or abducted.
MCL Injury Cause
Grade I MCL Sprain
20% have other ligament injuries.
Grade II MCL Sprain
52% have other ligament injuries.
Grade III MCL Sprain
78% have other ligament injuries.
____ and ____ meniscus have an attachment to each other.
MCL and Medial Meniscus
MCL, ACL, and Medial Meniscus
Unhappy Triad
MCL, ACL, and Lateral Meniscus
More Commonly Injured Triad
90% Type I Collagen
Menisci
Stability, Shock Absorption, Load Transmission, Nutrition, Lubrication, Control of Motion
Function of Menisci
Most common in older population.
Horizontal Meniscus
50-90% of tears in young population.
Longitudinal Meniscus
Most common in younger, active population.
Traumatic Injury
Most common in greater than 40 population.
Degenerative Injury
A line drawn from the ASIS through the center of the patella and distally to the tibial tubercle.
Quadriceps Angle (Q Angle)
Femoral anterversion. Femoral Internal Rotation. Patella facing toward each other. Proximal external tibial torsion. Foot pronation.
Miserable Malalignment Syndrome
Anterior Knee Pain. Prolonged sitting. Stairs. Running. Crepitus. Swelling.
PFPS (Patellofemoral Pain Syndrome) Signs
Pelvic drop, femoral adduction, internal rotation, genu valgum, tibial internal rotation, and hyperpronation.
Dynamic Valgus
Occurs when hip musculature cannot overcome external torque caused by gravity acting on the body’s mass.
Dynamic Valgus
Frees up the lateral structures, allowing patella to shift medially.
Lateral Reticular Release with VMO Advancement
VMO surgically cut and advanced to a more mechanically advantageous angel to help produce a more midline pull of the patella.
VMO Advancement
Remove insertion of patellar tendon, elevate and reattach in a more mechanically advantageous.
Distal Realignment Procedure
Reduce severe patellofemoral compression loads and compression.
Distal Realignment Procedure
Softening or degeneration of articular cartilage on posterior patella.
Chondromalacia
Direct contact with hard surface. Violent quad contraction.
Fractures of the Patella
Prosthesis cemented or glued to bone. Most common.
Cemented
Bone grows directly into prosthesis. Used for Osteoarthritis (OA).
Porous
Less invasive than TKA. Arthritis on only one side.
Partial/Unicompartmental Knee Replacement
For DJD of one compartment. Usually medial compartment. Usually patients >60 years. Temporary solution for 7-10 years before having TKA.
High Tibial Osteotomy (HTO)
Attempts to realign tibiofemoral joint by surgically removing a wedge of bone from the tibia or distal femur depending on joint deformity.
Hip Tibial Osteotomy (HTO)
Jumper’s Knee. Inflammation of the patellar tendon. Most common in athletes who perform repeated jumping.
Patellar Tendinitis
Tenderness at the insertion of the quadriceps tendon to the patella. Pain with resisted knee extension.
Assessment for Patella Tendinitis
Inflammation at the growth plate of the tibial tuberosity. Usually 11-15 years old. More common in males.
Osgood Schlatters Disease
Involve articular surface of the knee joint. High risk of developing OA.
Tibial Plateau Fracture
Pain/Tenderness along medial aspect of knee. More common in the elderly.
Pes Anserine Bursitis
When does avascular necrosis occur?
First 6-8 Weeks
Zone I: Red on Red. Circulation on both sides of tear.
Repair
Zone II: Red on White. Circulation on one side of tear.
Repair
Zone III: White on White. No blood supply on either side of tear.
Partial or Total Meniscetomy