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MSK 2 > Knee Interventions > Flashcards

Knee Interventions Flashcards

1
Q

Patellofemoral Pain Interventions

A
  1. Taping
  2. Bracing
  3. Surgical
  4. Strengthening
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2
Q

Patellofemoral Pain classifications

A
  1. Overuse/Overload without other impairment
  2. PFP with movement coordination deficits
  3. PFP with muscle performance deficits
  4. PFP with mobility impairments
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3
Q

describe taping for PFP

A
  1. minimal long-term effects
  2. neuromuscular and proprioceptive effect likely; biomechical correction unlikely
    • loose taping vs corrective taping → similar effects in pain management
    • biomechanical theory → improved patellar tracking/alignment leads to redistributed patellofemoral stress
      • imaging studies have not supported repositioning of patellar with taping
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4
Q

describe bracing for PFP

A
  1. certain braces (e.g Protronics) may be effective in pain reduction
  2. exact mechanisms unclear (similar to taping)
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5
Q

describe a surgical approach for PFP

A
  1. Lateral Release, debridement
    • early concentration on ROM, inflammation management, coordination/activation exercises
    • progression to w/b exercises, muscle performance exercise
    • progress to exercise based on activity limitations (progressing appropriately until remodeling phase)
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6
Q

describe the subtype: PFP overuse/overload without other impairments

A
  1. pain primarily due to overuse/overload
  2. pt presents with a history suggesting an increase in magnitude and/or frequency of PFJ loading at rate that surpasses the ability of his/her PFJ tissues to recover
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7
Q

describe the subtype: PFP muscle performance deficits

A
  1. may respond favorably to hip and knee resistance exercises.
  2. pt presents with LE muscle performance deficits in the hip and quads
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8
Q

describe the subtype: PFP with movement coordination deficits

A
  1. may respond favorably to gait retraining and movement re-education interventions leading to improvements in LE kinematics and pain
    • assess dynamic knee valgus during movement
  2. pt presents with excessive or poorly controlled knee valgus during dyanamic task, but not necessarily due to weakness of LE muscles
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9
Q

describe the subtype: PFP with mobility impairments

A
  1. may have impairments related to either hyper/hypomobile structures
  2. pt presents with higher than normal foot mobility and/or flexibility deficits of 1 or more of the following structures:
    • hamstrings
    • quads
    • gastroc
    • soleus
    • lateral retinaculum
    • ITB
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10
Q

Intervention strategies for PFP Overuse/overload without other impairment

A
  1. taping (B)
  2. activity modification/relative rest (F)
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11
Q

intervention strategies for PFP with movement coordination deficits

A
  1. gait and movement retraining (C)
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12
Q

intervention strategies for PFP with muscle performance deficits

A
  1. hip/gluteal muscle strengthening (A)
  2. quad strengthening (A)
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13
Q

Intervention strategies for PFP with mobility impairments

A
  1. Hypermobility
    • foot orthosis (A)
    • taping (B)
  2. Hypomobility
    • patellar retinaculum/soft tissue mobilization (F)
    • muscle stretching (F)
      • hamstrings
      • quads
      • gastroc
      • soleus
      • ITB
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14
Q

surgical options for articular deficits at the knee

A
  1. arthroscopic lavage and debridement
  2. microfracture
  3. grafts/chondrocyte implantation
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15
Q

arthroscopic lavage and debridement PT implications

A
  1. full extension ROM by week 1
  2. full flexion ROM by week 3
    • progress loading as tolerated once motion functional and inflammatory/pain permits
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16
Q

microfracture PT implications

A
  1. full extension (active assisted) ROM by ~week 1
  2. full flexion (active assisted) ROM by ~week 3
    • progress w/b over ~week 6-12
  3. avoid loading at lesion site until ~6-12 weeks
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17
Q

grafts/chondrocyte implantation PT implications

A
  1. Early PROM and active assisted ROM
  2. should restore:
    • full extension by end of ~week 1
    • flexion by ~week 6
    • avoid loading lesion site intially with AA ROM
  3. CKC exercises once full WBAT
  4. Full WB ~6 weeks
  5. Progressive loading ~6-12 weeks
    • avoid loading lesion site initially
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18
Q

osteoarthropathy intervention suggestions

A
  1. Pt edu → focus on pt empowerment/progression to independence and activity modification
  2. Manual therapy
    • sustained hold
    • +/- oscillation mobs
  3. LE strengthening/endurance exercise (hip and knee)
  4. Diet/weight loss
  5. Walking/gait training
  6. Pain control modalities +/-
19
Q

Management of Arthrofibrosis

A
  1. exercise, MT
  2. based on stage of progression
    • ​Acute stage → self management, ROM/mobility exercises, stretches, pain/inflammation control interventions, muscles performance as tolerated (adjacent joints and hip)
    • Chronic stage → aggressive joint mobs, stretching, strengthening, static stretching devices (crep)
20
Q

surgical managment of Arthrofibrosis

A
  1. MUA
  2. Arthroscopic capsular release
21
Q

conservative management of meniscus lesions

A
  1. address impairments per ICF model
    • pt edu
    • pain management
    • guarding
    • joint mobility
    • muscle performance: hip, knee (especially rotational stability)
22
Q

post-op management of meniscetomy

A
  1. early concentration on ROM (guarding), inflammation management, coordination/activation exercise
  2. quicker (as tolerated after acute healing phase) progression to:
    • w/b exercise (tissue loading, coordination, etc)
    • strengthening exercises (LE)
  3. Progress to exercises based on activity limitiations
    • progressing appropriately until remodeling phase
23
Q

post-op management of meniscus repair (6 weeks)

A
  1. greater protection phase (~6 weeks)
    • gradual increase in w/b and ROM
    • address inflammation
    • hip strengthening/endurance
    • Gait (AD as needed)
    • limit compressive loading on posterior menisci
      • limit flexion ROM accordingly
      • limit resisted knee flexion
    • coordination/activation exercises
24
Q

post-op management of meniscus repair (6-10 weeks)

A
  1. gradually increase loading on involved tissues
    • aerobic equipment, etc
    • address ROM
25
Q

post-op management of meniscus repair (>10 weeks)

A
  1. progress to exercise based on acitivty limitations
    • progressing appropriately until remodeling phase
26
Q

primary goal of conservative and surgical management of ACL tears

A

return functional stability to the knee

27
Q

Surgical management of ACL tears

A
  1. debridement
  2. repair (rare; scaffold placed)
  3. reconstruction
    • tissue → bone-patellar, tendon-bone, hamstring tendon, or synthetic
    • origin → allograft vs. autograft
28
Q

gold standard for ACL lesion surgical management

A
  1. double-bundle semitendinosus and gracilis autograft common
    • improved rotation stability
    • decreased likelihood of revision, development of knee OA, damage to the meniscus
    • improved function, satisfaction, and QOL as per pt self-report
29
Q

post-op phases for ACL reconstruction (via Adams)

A
  1. Immediate post-op phase (week 1)
  2. Early post-op phase (week 2)
  3. Intermediate post-op phase (weeks 3-5)
  4. Late post-op phase (weeks 6-8)
  5. Transitional phase (weeks 9-12)
  6. Follow-up testing (4, 5, 6, 12 months)
30
Q

immediate post-op phase

A

week 1

  1. Knee A/PROM 0-90 degrees
  2. active quad contraction (superior displacement of patella)
31
Q

ACLR early post-op phase

A

week 2

  1. knee flexion >110 degrees
  2. ambulation w/o crutch
  3. full knee extension w/ambulation
  4. knee outcome survey (ADL subscale) >65%
  5. no extension lag with SLR
  6. reciprocal stair climbing
  7. cycling
32
Q

ACLR intermediate post-op phase

A

weeks 3-5

  1. knee flexion ROM within 10 degree of non-affected LE
  2. quad strength >60% of non-affected LE
33
Q

ACLR late post-op phase

A

weeks 6-8

  1. full knee ROM
  2. quad strength >80% of non-affected LE
  3. normal gait
  4. knee effusion trace or less
34
Q

ACLR transitional phase

A

weeks 9-12

  1. maintaining/improving quad strength
  2. hop test >85% of non-affected side (week 12)
  3. KOS (sports subscale) >70%
35
Q

prognositic factors for conservative management of ACLR

A
  1. age
  2. gender
  3. occupation
  4. sports participation level
  5. radiographic findings
  6. KT-1000 arthrometric measurement
  7. knee function scores
  8. presence of additional knee injuries
36
Q

patellar tendinopathy management

A
  1. address impairments ID on exam
  2. Eccentrics
    • facilitating tendon remodeling
    • improved collagen fiber alignment
    • common exercise: squats on declined slant board
37
Q

tendon rupture repair <3 weeks

A

protection, pain/inflammatory management

38
Q

tendon rupture repair 3-6 weeks

A

light loading (resisted - free cycle)

  1. bracing (motion limited with hinge brace)
  2. motion commonly limited by surgeon (0-~45), progressive increase during this period
  3. active knee flexion
    • within limited range, common 45 degrees
  4. gait with AD
  5. minimal w/b exercises
  6. modalities PRN
  7. hip muscle performances
39
Q

tendon rupture repair 7-12 weeks

A

progression of loading

  1. progress to full w/b:
    • hinge locked 0-60 commonly
  2. knee extensor activation/coordination (sub-max)
  3. progress CKC exercises
40
Q

tendon rupture repair 9-12 weeks

A
  1. single leg CKC exercises
  2. increase tensile loading
    • max activation, knee extension exercises, etc.
41
Q

patellar fracture: non-surgical management in acute phase

A
  1. WBAT with AD and locked hinge brace initially
  2. coordination/activation exercises for knee, muscle performance of hip
  3. stretching/mobility/modified CKC exercises at ~3-4 weeks
  4. patellofemoral mobs
42
Q

patellar fracture: non-surgical management 6-12 weeks

A
  1. pain-free ranges (motion limitations)
  2. progress w/b exercises
43
Q

Joint mobilizations at the knee

A
  1. Tibiofemoral Joint
    • Posterior glide (M/L comparment)
    • Anterior glide (M//L compartment)
    • Traction
  2. Patellofemoral Joint
    • medial glide
    • lateral glide
    • caudal glide

MSK 2 (20 decks)

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