Knee Exam, Eval, & Interventions Flashcards
special tests for ACL tear
Lachman’s
anterior drawer
pivot shift
<___% of uninvolved side is a positive finding on the 6 m hop test
80%
what is a segond fracture?
avulsion of LCL from excessive tibial IR
(indirect sign of ACL tear)
where is bone bruising most common in knee?
lateral femoral condyle
rehab candidates criteria after ACL injury
single, cross over timed hop >80%
</= 1 episode of giving way since injury
KOS ADL and sport scale >80%
global rating scale >60%
for ACL injury, which criteria indicate high likelihood of receiving surgery?
- higher activity level
- more episodes of giving way
- lower KOS-ADL score
- lower score on IKDCSKF 2000
- lower score on limb symmetry index on timed 6 m hop tests
- lower quad strength index
PCL tear special tests
posterior drawer
posterior sag sign
valgus stress at 0 deg
what is the 2nd most common injury of knee?
MCL tear
T/F: an MCL tear will usually have normal ROM
T
special tests for MCL
valgus stress test at 20-30 deg flex
special tests for LCL
valgus stress test at 30 deg flexion
what structures are involved with anteromedial rotary instability?
MCL (superficial and deep)
what structures are involved with anterolateral rotary instability?
ACL
ITB
what structures are involved with posteromedial rotary instability?
sartorius
gracilis
semimembranosus
semitendinosus
medial gastroc
PCL
what structures are involved with posterolateral rotary instability?
LCL
popliteal tendon
lateral gastroc
MOI for anteromedial rotary instability
excessive valgus force and tibial ER
anterior sublux of medial tibial plateau
special test for anteromedial rotary instability
anterior drawer with tibial ER
special test for anterolateral rotary instability
anterior drawer with tibial IR
pivot shift (sublux near extension)
which instability is almost always associated with an ACL tear?
anterolateral rotary instability
MOI for anterolateral rotary instability
excessive valgus force with tibial IR
ACL tear
anterior sublux of lateral tibial plateau
special test for posteromedial rotary instability?
posterior drawer with slight IR
MOI for posteromedial rotary instability
force in extension and IR
valgus moment
MOI for posterolateral rotary instability
laxity of PCL
tibial posterior and ER force
special tests for posterolateral rotary instability
dial test/PLR test
posterior drawer with 15 deg tibial ER
reverse pivot shift (sublux at 20 deg)
increased tibial ER ROM at 90 deg indicates what injury? 30 deg?
90 - PCL
30 - PL corner
MOI for posterior lateral corner injury
*direct hit on proximal tibia with extended knee and varus force
- posterior force on flexed knee with tibial ER
- chronic after ACL, PCL, or LCL injury
gait of pt with posterior lateral corner injury
varus thrust
ACL reinjury incidence
1/3 will retear
risk factors for ACL injury
narrow femoral notch
dry whether
turf
female
eccentric quad activation
greater posterior slope of tibial plateau
joint laxity
grade A evidence for ACL diagnosis
medical screen
classification through eval
determine irritability
outcome measures
intervention strategies
grade A evidence intervention strategies for ACL
therapeutic exercise
NM e stim (NMES)
NM re-ed
grade B evidence intervention strategies for ACL
immediate mobilization
cryotherapy
supervised rehab
grade C evidence intervention strategies for ACL
CPM
knee bracing
early WB
MOI for meniscal injuries
closed chain TWISTING
combo valgus and hyperextension force
factors associated with meniscal tears
mechanical catching or locking
forceful twist of femur (esp. medial)
joint line tenderness***
pain w/ forced knee hyperextension
pain w/ maximum passive flexion
pain or click with McMurray test
(>/= 4 –> 81%)
where do 2/3 of articular cartilage injuries occur?
femoral condyles and patella
grade B evidence for meniscus and articular cartilage injury
progressive knee motion
progressive WB
ther ex
NM e stim
biofeedback
____% of people 63-94 yo have OA
33%
______ OA is the most common form of osteoarthritic disability in the US
knee
Altman’s criteria for knee OA
knee pain and:
- >50 yo
- palpable bony enlargement
- bony tenderness
- morning stiffness <30 mins
- no palpable warmth
characteristics of early stage knee OA
osteophytes
subchondral sclerosis
subchondral cysts
knee OA treatment key points
exercise
check hip
weight control
mobilize and exercise for knee ROM
which hip motions are weak with PFPS?
hip abduction and ER
intervention aims for PFPS
controlling hip and pelvic motion
controlling ankle/foot motion
what mechanics affect PFPS?
abnormal motion of tibia and femur
what is the hallmark of PFPS?
prolonged sitting (90 deg position for 30+ mins) causes knee pain
PFPS will have pain with step ____
down
PFPS pts will have what alignment during the step down test?
excessive hip adduction, IR, and knee valgus
CPR for lumbopelvic manip for PFPS
side to side diff in hip IR >14 deg
ankle DF >16
navicular drop >3 mm
no self reported stiffness in sitting >20 mins
squatting reported as most painful activity
patellar tendinopathy is an _____ injury
overuse
treatments for patellar tendinopathy
load the tendon after healing
decreased load initially
eccentric quad
jumping mechanics
what are the 4 stages of tendon rehab?
isometrics
isotonics
energy-storage exercises
progressive return to sport
how to load patellar tendon?
- 5x45 sec isometric @ 30-60 deg flex and 70% MVIC
- concentric and eccentric loading
- pain allowed (</=3/10)
- plyometric training
- gradually return to sport-specific training