KNEE: Lectures 1 and 2 Flashcards

Question 1

Q

Pt Scenario

First contact practitioner

if OPEN INJURY

Answer

A

OBSERVE:

Active bleeding? Bone protruding?

Question 2

Q

First contact practitioner

if Fx:

Answer

A

OBSERVE:

WB w/out an AD?

Question 3

Q

First contact practitioner

if Knee Dislocation

Tibiofemoral vs.

Patellofemoral vs.

Muscular avulsions vs.

Vascular issues

Answer

A

Tib/Fib
- Is varus/valgus alignment similar to uninjured side?
Patellofemoral
- is patella centered in knee joint?
Muscular avulsions
- is there a loss of contour @ insertion site? Muscle retraction?
Vascular issues
- is the foot or lower limb cyanotic?

Question 4

Q

First contact practitioner

if Knee Jt Infection/Septic Joint

Answer

A

OBSERVE:

is the joint swollen and red?

Question 5

Q

First contact practitioner

Open Injury

Answer

A

PALPATE:

NOTHING IF OPEN!!

Question 6

Q

First contact practitioner

Fx:

Answer

A

PALPATE:

Fibular head, Patella

Question 7

Q

First contact practitioner

Knee Dislocation

Tib/fib vs.

Patellofemoral vs.

Muscular avulsions vs.

Vascular issues

Answer

A

PALPATE:

Contour of the limb:
- Tib/Fib
  - are injured knee mm’s more/less active vs. uninjured?
- Patellofemoral
  - Is patella tender on medial side?
- Muscular avulsions
  - Is there a loss of contour near muscular insertion?
- Vascular issues
  - are distal pulses intact?

Question 8

Q

First contact practitioner

Knee jt Infection/Septic Joint

Answer

A

PALPATE:

Joint swelling
- intra-articular vs. extra-articular
- **Sweep Test**

Question 9

Q

First Contact Practitioner

Stop the Party, Call ED ….

Answer

A

OPEN INJURY
Neurvascular injury
- diminished or absent pulses
- absent sensation
Obvious Fx OR
(+) Ottawa Knee/Ankle Rules
- HIGH index of suspicion Fx
Gross misalignment of limb
- Disloc. w/out reduction
- DO NOT try to reduce UNLESS transit time to ED is prohibitively long

Question 10

Q

First contact practitioner

Continue Exam; Refer out when finished:

Answer

A

Tib/Fib OR Patellofemoral Dislocation
- NO (or min.) neurovascular issues
- Normal alignment
  - spont. reduction
- Muscle avulsions

*NOTE: presentation is not emergent, BUT should be assessed by other providers to ensure medical stability

Question 11

Q

Knee Rules for det. Need for Radiography

Ottawa Knee Rules

Answer

A

Age 55+
Isolated tenderness of patella

OR

Tenderness over fibular head
Unable to flex knee past 90deg
Unable to bear wt. immed. OR in ED for 4 steps

***HIGHLY SENSITIVE BUT NOT VERY SPECIFIC***

*REMEMBER SnNout and SPpin

Question 12

Q

Knee Rules for det. Need for Radiography

Pittsburgh Knee Rules

Answer

A

Blunt trauma OR a fall as MOI + one of following:
- Age under 12
- Age over 50
- Unable to bear wt. in ED for 4 steps

Question 13

Q

JAMA and the Ottawa Knee Rules

Answer

A

DEC in need of radiography w/out missed fx’s
HIGHLY sensitive, reliable, very acceptable

Question 14

Q

Rehab after Prolonged Immob. (Fx)

Sx modulation and Impairment Resolution:

what do you want to focus on?

Answer

A

resolve effusion/edema
improve mm activation/DEC atrophy
- normalize painful mm contracts.
Restore limtd motion, DEC jt stiff.
Restore normal mvmt patterns

Question 15

Q

Neurovascular Assessment of Knee Joint

Circulatory Issues: 2

Answer

A

Vascular Injury
DVT

Question 16

Q

Neurovascular assessment of Knee

Circulatory Issues:

Vascular Injury

Answer

A

Arterial injury interrupts blood to distal tissues
Arteries are susceptible @ jts AND when making sharp turns around bony prominences

Question 17

Q

POST. KNEE JT DISLOCATION

Impacts what?

Answer

A

POST knee jt dislocation
- impacts Popliteal Artery
  - check Post. Tib pulse

Question 18

Q

POSTEROLATERAL KNEE JT INJURY

Impacts what?

Answer

A

Posterolateral knee jt injury
- impacts supply to Ant. Tibial Artery
- Check Dorsalis Pedis Pulse

Question 19

Q

DVT

what is it and what can it do ?

Answer

A

Clotting/blocking of a distal vein
- can dislodge and move thru circulatory system to Central Aspects —– heart & lungs

Question 20

Q

DVT

More common when and why?

Answer

A

More common after Sx
- hip, knee, leg/calf, abd, chest
  - Reduces bloodflow to a part of the body

Question 21

Q

DVT

Reasons why Sx can INC DVT risk: 3

Answer

A

1. Tissue debris, PRO, fats may move into veins following Sx
1. Vein walls damaged—> releases subs. that promote blood clotting
1. Prolonged bed rest

Question 22

Q

Arterial Assessment

Dorsalis Pedis Pulse

Check if POSTEROLATERAL KNEE JOINT INJURY bc Ant. Tib. Artery

Answer

A

Top of foot, lateral to EHL tendon

distal to Navicular

Question 23

Q

Arterial Assessment

Post. Tib. Pulse

Check if POST. knee jt dislocation bc impacts Popliteal Artery

Answer

A

Post to medial malleolus

Question 24

Q

Well’s Clinical Prediction Rule for DVT

Answer

A

Probability of DVT:
- 3pts==HIGH RISK 75%
- 1 to 2pts== MOD. RISK 17%
- <1 pt==LOW risk 3%

Question 25

Q

Circulatory Status for DVT:

risk INCs w/ AGE, esp. after 60

Lifestyle factors?

Answer

A

Sitting or inactive for long time
Long plane or car trips
Extra wt.
BC pills or patches
Smoking

Question 26

Q

S/S of DVT

NOTE: 1/2 of all DVT cause NO sx’s

Some you will see….

Answer

A

Swelling in one or both legs
Pain or tenderness in one or both legs
- MAY only occur during walking or standing
Warmth in the skin of affected leg
Red or discolored skin in affected leg
Visible surf. veins
Leg fatigue

Question 27

Q

Neuro Screening

Common Peroneal Nerve

Motor vs. Sensory Function

Answer

A

MOTOR:
- Ankle DF
- Great toe EXT
- Toe EXT
SENSORY
- 1st web space—-DEEP BRANCH
- Dorsal surf. toes 3-4—-SUPERFICIAL BRANCH

Question 28

Q

NEURO SCREENING

Tibial Nerve

Motor vs. Sensory Function

Answer

A

MOTOR:
- PF
- Toe FLEX
- little bit of Inversion
SENSORY:
- Plantar aspect of calcaneous
- Plantar aspect 5th toe

Question 29

Q

LE Peripheral Nerve Map

Question 30

Q

Expected Gait Devs in Acutely Injured Knee

2

Answer

A

Noticeable limp
Flexed Knee Gait

Question 31

Q

Gait Devs in Acutely Injured Knee

Noticeable Limp

Why?

Answer

A

avoiding WB on injured limb
Short stance time on injured limb
Short step length for uninjured limb

Question 32

Q

Gait Devs. for Acutely Injured Knee

Flexed Knee Gait

Why and theories?

Answer

A

avoids TKE
avoids eccentric knee flex.
Theories:
- Quad-avoidance gait vs. Optimal length-tension for quads
- Co-contract of quads/HS to LIMIT MOTION

Question 33

Q

Knee Joint Swelling:

Joint Effusion

Answer

A

Fluid contained W/IN a body cavity
Knee jt==Largest Synovial Cavity in body
- intra-art injury==intra-art swelling
- extra-art injury LIKELY WONT CAUSE INTRA-ART. SWELLING

Question 34

Q

KNEE JOINT SWELLING

Joint Edema

Answer

A

GEN term for swelling

*can likely move edema thru tissue

Question 35

Q

Effusion Assessment

Stroke Test, Sweep Test

Answer

A

UP medially

DOWN laterally

Question 36

Q

Interventions/Sx Modulation

Effusion Control

Answer

A

RICE

Rel. Rest
- avoid excess. WB
- use AD
Ice
- 20 on 20 off
Compress
- knee sleeve, ACE
  - mm pumps—-QUAD SETS!!!
Elevate
- Knee ABOVE heart

Question 37

Q

Assess & Tx of Limtd ROM and Pain Gen. structures

Sx Modulation

Knee EXT Measurements

Answer

A

Resting knee EXT
Knee EXT w/ Quad Set
Knee EXT during SLR

Question 38

Q

Knee EXT ROM Considerations

Resting Knee EXT

True PROM

Answer

A

Rest pos or Loose-pack pos.
- 20-30deg of FLEX
Check and see if indiv. can rest w/ their limb on table and no post. support
Can indiv. rest their limb w/ heel supported and nothing under knee?
Where is discomfort felt???
- POST
  - capsule vs. HS tendons vs. gastroc
- ANT
  - “pinching”

Question 39

Q

Knee EXT ROM Considerations

Knee EXT w/ Quad Set

AROM

Answer

A

does quad visibly contract?
does contraction produce sup. patellar glide?
does glute max. co-contract?
- typ see “reduction” in EXT when asked to contract quad
- knee stays same place, greater troch rises bc glute contracts
does this cause pain?
- ANT
  - patellar tendon vs. quad tendon vs. quad mm
- RETROPATELLAR
- POST.

Question 40

Q

Quad Lag

Lag Sign

Answer

A

indic’s mm is not capable of holding end range pos.
- ability of mm to maintain pos. lags behind total ROM
- NO ext. resist—-BW only

Question 41

Q

Quad Lag

Max EXT-EXT during SLR*****

Answer

A

quads not able to maint. full knee EXT when there is no support to Tibia
Formula:
- MAX EXT - EXT during SLR

Question 42

Q

Quad Lag

If present, what does this mean?

Answer

A

CONSIDERABLE mm weakness!

MMT >3/5

individual likely not strong enough to achieve ACTIVE TKE in gait
- Hyperextension thrust vs. Flexed knee gait

Question 43

Q

Quad Lag

What do you want to do to address this?

Answer

A

Restore mm activation towards End Range
- SUP patellar mobs
- Quad Sets***
  - can be combo’d w/ SUP patellar glide to facilitate quad contraction
- SAQ’s
- TKE ex’s
  - prone vs. standing vs. DF’d

Question 44

Q

Quad Lag

Isometrics

Muscle Setting Ex’s

Answer

A

LOW-MOD intensity iso. ex —– little to no resist.
- practicing mm activation
No appreciable inc in strenght—-MAY slow atrophy
- INC recruitment of mm
ADD. uses
- relaxation, circulation, reduce pain/spasm

Question 45

Q

Active/Passive Knee Flex.

Limitations in Knee FLEX freq. targeted w/ HEEL SLIDES

To INC FLEX

Answer

A

Active Heel Slide
- use HS to achieve MAX FLEX.
Active Assited Heel Slide
- hand or belt to apply overpressure @ end range
Passive Heel Slides
- fully use hand/belt

Question 46

Q

Interventions in Sx Modulation Phase

Painful MTU’s

Answer

A

LOAD CAREFULLY!!!

2-3/10 pain
soft tissue mobs
GENTLE stretching of mm’s
LOW grade Iso’s
- mult. angles

Question 47

Q

Interventions in Sx Modulation Phase

Limited ROM

Answer

A

Patellar mobs (as necessary) —– CAN ALWAYS MOBILIZE PATELLA!!!
AROM (if pain free OR min. pain)
- AAROM (if pain free)
- PROM (if pain free)
Cyclic ROM (flex/ext)—> helps w/ ROM + Effusion
- stationary cycling w/out resist.
Injured ligament….
- restore ROM w/out INC pain or overstressing ligament

Question 48

Q

Add. Interventions for TKE

when Acute or Symptomatic

Question 49

Q

Classification of Knee Related Sx’s in Motor Control Phase

Stiff Knee

Answer

A

Limtd ROM
Painful or Uncomfortable ROM
MM Length restrictions

Question 50

Q

Classification of Knee Related Sx’s in Motor Control Phase

Unstable Knee

Answer

A

Ligamentous instability
Meniscal Issues
Poor Neuromuscular control
Pain related instability

Question 51

Q

Classification of Knee Related Sx’s in Motor Control Phase

Weak “Knee”

Answer

A

Limtd Strength of a Muscle relevant to knee jt function
Pain-related weakenss

Question 52

Q

Simplified Tx Approach!!!

Answer

A

If its contributing to Activity Limitations or Participation Restrictions AND…

if its Limited
- Mobilize it!
if its Tight
- Stretch it!
if its Weak
- Strengthen it!
if it Moves Funny
- Retrain it!
if its Involved
- Load it thoroughly
If its Injured**
- Do all of this CAREFULLY!

Question 53

Q

Joint Mobilization to Improve Knee Flexion

Patellofemoral Joint

What happens as knee flexes?

Answer

A

patella glides INFERIORLY
lateral facet and odd facet contact femur
- greater compression laterally—-esp w/ effusion
- bc high lat. wall of trochlea

Question 54

Q

Joint Mobilization to Improve Knee Flexion

Patellofemoral Joint

Intervention:

Answer

A

Medial and Inf glides IN FLEX
Medial tilt mobs in Resting****
- when patello moves the most!

Question 55

Q

Joint Mobilization to Improve Knee Flexion

Tibiofemoral Joint

What happens as Knee Flexes?

Answer

A

Tibia glides POSTERIORLY
- MIN. tibial rotation
- MAYBE some post. pinching or impinge.

Question 56

Q

Joint Mobilization to Improve Knee Flexion

Tibiofemoral Joint

Intervention:

Answer

A

Jt distraction in Sitting
POST glides IN FLEX
If Post. Impinge.
- Ant/Rotational glide

Question 57

Q

Joint Mobilization to Improve Knee EXT

Patellofemoral Joint

What happens as knee EXTs

Answer

A

patella glides SUPERIORLY
FULL EXT== min. contact w/ walls of trochlea
- GREATER compression LAT.—-bc tilt of patella

Question 58

Q

Joint Mobilization to improve Knee EXT

Intervention:

Answer

A

Medial + Superior glides in FLEX
Medial tilt mobs in RESTING

Question 59

Q

Joint Mobilization to improve KNEE EXTENSION

Tibiofemoral Joint

What happens here when knee EXTs?

Answer

A

Tibia glides ANTERIORLY
- Tibia must Externally rotate to engage Screw Home Mechanism

Question 60

Q

Jt. Mobs to improve KNEE EXT

Tibiofemoral Joint

Intervention:

Answer

A

Jt. distraction in SUPINE
ANT glides in EXT
If missing TKE—–MAY need to bias Tibial ER

Question 61

Q

Proximal Tib/Fib Jt Mobs

When performed ?

Answer

A

PAIN in Distal Anterolateral Knee Jt OR specifically @ Fibular head
- mostly ANT/POST glide req’d for norm. ankle motion
- impacted w/ injury to biceps femoris

Question 62

Q

Assess. and Intervention of Muscle Performanc in Motor Control Phase

GOLD STANDARD for measuring QUADS Strength in clinical studies

Answer

A

Electromechanical Dynamometry

Isokinetic Machine

*HIGHLY reliable

*expensive

Question 63

Q

Assess. and Intervention of Muscle Performanc in Motor Control Phase

1-RM

Leg Extension

Can use SL leg press if needed

Answer

A

Procedure:
- alternating limbs
  - fully ext. knee
  - HOLD 2s
  - return under control
- Failure det’d by 3 unsuccessful attempts @ a single weight
- MAX wt. lifted recorded for ea. limb

Question 64

Q

Leg Press 1-RM

Standard Leg Press S/L

Answer

A

Knee @ 90
Hip ~90
Compensation avoided:
- gastroc-soleus min’d
- OPP limb suspended

Answer 63

A

knee @ 90
hip @ ~90
2 ranges tested:
- 90-0
- 90-45

Answer 64

A

Functional Tests!!!

L.EXT

L.Press

HHD’s

Answer 65

A

Sit to Stand/Chair Rise test
Forward Step Down Test
Lateral Step Down test
S/L Squat test

Answer 66

A

30s Chair Rise
- 5x S2S test
- SL 30s vs 5x ea leg
Forward step down—-endurance

Answer 67

A

glute max
glute med
ER’s
iliopsoas
sartorius

Answer 68

A

Gastroc/Soleus
Peroneals
Post. Tib
Ant. Tib

Answer 69

A

Strengthening Quads!!! during Motor Control Phase

Answer 70

A

ADD IN PICTURE!!!

SLIDE 32 IN FIRST KNEE LECTURE!!!!

Answer 71

A

trunk moves vertically

pelvis stays lvl

Knees stable in frontal plane (slight hip ABD encouraged)

foot should NOT over-pronate

Answer 72

A

no L/S flexion

pelvis + hips move trunk into Flex.

motion comes from knees

CoP should NOT shift into ball of foot

Answer 73

A

YOU CAN MAKE THE DISTANCE LOWER OR HIGHER!!!

Mini 30deg squats or Full 90deg squats

or anywhere in b/w!!!

Answer 74

A

Key points:

surgical leg BEHIND good leg
shift wt. onto sx limb
load thru heel
avoid excess. trunk flex

Answer 75

A

Progressive, purposeful manipulation of support surfs. to promote active stabilization and NMSK control of knee

Answer 76

A

Knee jt. mechs resemble uninjured indiv’s after completing ~10 sessions of perturbations
- Reduction of wear & tear
  - normal knee jt loading
  - normal knee jt flex/ext excursion during gait
  - reduction in knee Ext/Flex co-contraction
Improved confidence/reduced mvmt-related fear
SOME improves in clinical measures
- ex. hop tests

Answer 77

A

Pts w/ OA more heterogenous than pts after ACL injury

Answer 78

A

springy end feel
IMMEDIATE REPAIR
easy to screw up
meniscus flips over into joint

Answer 79

A

typ. older pts
does OK w/ repair

Answer 80

A

when you bear wt. w/ this tear—–> pushes edges closer together

Answer 81

A

does well w/ OR w/out Sx
Older pts—degenerative
you want to DEC mech. sx’s

Answer 82

A

Cutting/Pivoting
- sudden direction change w/ foot fixed ground
HYPERFLEXION
HIGH impact compression
MCL or ACL Mechs.

Answer 83

A

MCL
- deeper fibers connect to MCL
ACL
- connects to Ant. Horn or Med. Meniscus

Answer 84

A

Twist/tearing sensation @ time of injury
Severe pain ON injury—-Effusion 6-24 hrs POST-injury
Giving way on injury
- Later, intermittent pain, effusion
CATCHING OR LOCKING
Jt. line tenderness
Limtd ROM w/ premature end feel
- IF piece of meniscus IN joint
Repro. of sx’s w/ deep squatting or HYPERFLEX pain
**Quad inhibition**

Answer 85

A

1. Joint line palpation
  * be sure to go BEHIND KNEE!!!
1. McMurray
  * Axial loading
  - can combine IR, ER, ABD, ADD
1. FLEX overpressure
1. EXT overpressure
1. Hx of Catching or Locking

Answer 86

A

Studied 635 knees w/ 5 Dx (cluster tests) tests eval’d presence of meniscal lesions
- 1. Hx catching/locking
- 1. Jt line tenderness
- 1. Pain w/ forced HYPEREXTENSION
- 1. Pain w/ MAX passive Knee FLEXION
- 1. Pain or Audible click w/ McMurray

Answer 87

A

see pics

The “Dancing” one

Answer 88

A

Exactly what it sounds like…..the Med/Lat rotate Tibia

Answer 89

A

Often, acute tears are operatively addressed
DMT’s (degen meniscus tears) MAY be amenable to non-op care
- lg, multi-center study of OP vs. NON-OP for DMT vs. OA (MeTEOR Study)
- 6m after randomization, 30% NON-OP groud had sx
- 94% of OP group had Sx

****REMEMBER WE WANT TO TRY AND AVOID GEN. ANASTHESIA ****

Answer 90

A

NOTE:
- equivalent outcomes in WOMAC scores AND KOOS Pain Scores b/w the 2 methods!!!

Answer 91

A

PHASE I

Answer 92

A

PHASE II

&

PHASE III

Answer 93

A

IF meniscal tear disrupts mechanics of the knee AND pt is not a good candidate for meniscal repair
****DEBRIDEMENT***
- remove as little as poss.
  - down to a stable rim

Answer 94

A

Muscle Strengthening and Joint Mobility
Ambulation
Return to Activity

Answer 95

A

Isometrics, AROM, PF mobs IMMEDIATELY
Soft tissue manip. of portal scars when healed
Progress to PREs when tolerated
consider NMES

Answer 96

A

WBAT IMMED. w/ least restrictive AD
progress to FWB when walking w/out limp
- usually 1-2 wks
  - want NEGATIVE quad lag

Answer 97

A

TM running if…
- quad strength >80%
- NO jt. pain
- trace or less effusion
Lvl Surf. Running, sprints, agility if…
- normal gait on TM
- no reactive effusions after TM running or any progress. of activity
Return to full activity (usually about 6 wks) if…
- quad strength >90%
- HOP Tests if returning to lvl I or II sports

Answer 98

A

considered when lesion is in area of good vascularization
- IF tear w/in 3mm of periphery
  - vascular
- IF 3-5mm from periphery
  - gray zone
- IF >5mm from periphery
  - avascular

Answer 99

A

see table

Answer 100

A

Mods. of Sx tech’s to enhance healing in this area used:
- Fibrin clot
- Rasping of synovial fringe
- Creating vascular access channels

Answer 101

A

30 repairs in pts 40+

26 pts asymptomatic; had NO further Sx after mean of 34 mos

see pics for Rehab program + Conclusions

Answer 102

A

71 knees of indiv’s <19yo
75% had NO sx’s and showed no signs of clinical failure @ follow-up (18-51 mos)

see pics for Rehab Program followed:

Answer 103

A

HOOP STRESS!!!
- disrupting root can cause meniscal extrusion in WB
- AFTER repair—WB can sig. stress repair
  - shown in Biomech. studies not clinical studies
HS’s attach to medial meniscus****
- contraction causes post. glide

Answer 104

A

preserve meniscal tissue at all costs
Goal of Rehab:
- prevent excess WB and compression that has pot. to disrupt graft or transplant
protocols based on type of meniscal lesion, concomitant proc’s, stage of degen.
- Peripheral tears progressed quicker vs. central tears****
SPECIFIC ROM & Heckman et al strongly recommend patellar mobs in ALL directions!!!
- can always mobilize patella!!!

Answer 105

A

Cartilage is like a sponge
- Load ON==
  - push BAD stuff OUT
- UNLOAD==
  - GOOD stuff comes IN

Answer 106

A

SELF-lubricating
Load Applied=== Fluid RELEASED
Load Released===Fluid ABSORBED
Lack of intermittent loading REDUCES lubrication process

Answer 107

A

Reduced Nutrition
- == degen changes
Reduced Lubrication
- == INCs friction b/w jt surfs
- == degen changes
LOW coeff. of friction

Answer 108

A

*Actually has ability to bear VERY LG LOADS
Damage to collagen fiber network
Proteoglycan wash out
Loses ability to respond to compressive AND shear forces

Answer 109

A

Occurs when loads applied @ FAST RATE
Cart. becomes stiffer
now unable to deform and redistribute loads fast enough

Answer 110

A

see pics for REVIEW

Answer 111

A

Tissue Stress= Load/Area of Load Application

Too MUCH or Too LITTLE stress may be harmful to bio. tissue
Window of Adequate Stress that maintains health of biologic tissue

Answer 112

A

FORCE components
- current or prev. injury
- Magnitude of Load
  - body mass
  - activity surface
  - foot wear
  - AD (grad. use)
- Muscle and motor strength
Area of Force Application components
- Loading rate
- Joint mobility
- Joint alignment

Answer 113

A

Degen of Art. Cart.
80% indiv’s 65+
Females>Males
- 70% vs. 30%
Risk Factors:
- age, gender
- occup/rec. activity
- obesity***
- LE malalign.
- QUAD WEAKNESS
- Prev. structural damage to knee****

Answer 114

A

***Typ. stiffness in morning that resolves w/in 30 mins**** CARDINAL SIGN
Pain w/ prolonged sitting bc no cart. nutrition
creak/crack/crunch (crepitus)
Occ. pain @ night
diff’s on stairs
- bc poor eccentric control

Answer 115

A

Pain w/ WB
Loss of Jt Mobility====CAPSULAR PATTERN
- Flex > Ext ***************
poss. effusion
Quad weakness and/or inhibition
- remember quad strength super important in obstructive lung diseases too!!!!!!
Osteophyte formation

Answer 116

A

6 Criteria

Age >50yrs
Stiffness >30mins
Crepitus
Bony tenderness
Bony enlargement
No palpable warmth

Answer 117

A

Knee Pain and @ least 5 out of 9 criteria

Age >50yrs
Stiffness >30mins
Crepitus
Bony tenderness
Bony enlargement
No palpable warmth
Erythrocyte Sedimentation Rate <40
Rheumatoid Factor <1:40
Synovial Fluid signs of OA

Answer 118

A

Knee Pain and @ least 1 of 3 Criteria

Age >50yrs
Stiffness >30mins
Crepitus
Osteophytes

Answer 119

A

Look @ picture specifically @:

Osteophyte formation

Sclerotic (hardening) subchondral (below cart.) bone

Narrowing of jt. space (loss of art. cartilage)

Answer 120

A

Alter Joint Stress by Minimizing Loads and Maximizing Area of Load Application

Joint/Tissue Stress==Load/Area of Load Application

mm strength and jt. mobility
Wt Control: diet+exercise
AD’s
proper foot wear+orthotics
modif. of act. surfs
minimize impact loading

Answer 121

A

separation of fragment of art. cart. from the underlying subchondral bone from the epiphysis
- Cart. pulls off of bone==> delaminates
  - *NOTE: different from OCD which is seperation of the ACTUAL BONE FRAGMENT from the subchondral region
Result from:
- prolonged, repetitive loading OR traumatic, high impact loading
  - typ shearing injury to WB area of bone
  - seperation of cartilage in the Weakest zone
    - *tidemark area*

Answer 122

A

pt age
- INC age==INC likelihood (bc degen.)
Presence of meniscal tear
ACL Injuries (following are presented w/ cum. loading w/ shearing forces:
- 2-5yrs after ACL w/out repair, odds were 2.2x higher of having subsequent art. cart. injury vs. in first year
- after 5 yrs odds inc’d to 5.9x
- Retrospective study showed prevalence of art. cart. lesions w/ ACL injury to be 19%
- Large study of pts undergoing arthroscopy 60% were found to have chondral lesions
Clinical exam may be inconclusive w/ pts presenting w/ non-specific complaints of jt pain or swelling

Answer 123

A

OC lesion occurs on relocation
Med border of patella compresses against lat. fem. condyle as it is reduced by quads. contraction
Combo of compression + shear cause OC fx of either the lat. fem. condyle OR med. inf. patellar surf.

Answer 124

A

During displace. of femur, ant tibial spine may contact med. fem. condylar surf. ==== causes lesion
Lat. fem. condyle can also be injured by forceful compression + shear that occurs when femur and post-lat. tibia collide during relocation of a “giving way” episode

Answer 125

A

Defect in subchondral region w/ partial OR complete separation of bone fragment
Overlying art. cart. may remain intact
Prognosis depends on age and WB surf. affected AND the condyle

Answer 126

A

COMMON older children/young adult MALES
no hx traumatic event
accumulative trauma/stress mech.
phys. active adolescent OR
rel. sedentary, overweight
non-local knee pain WORSE w/ jumping/WB
intermitt. effusion w/ pain
catching/locking/giving way IF loose body present
Laxity test NORMAL
affected fem. condyle tender
forcible compression on affected side==Crepitus

Answer 127

A

Rel good healing pot. IF physeal plates NOT YET CLOSED + lesion stable
- improved if art. cart. over lesion INTACT
WB restricted 6-8wks
- some evidence for casting <12yo
PT works on strength + ROM DURING pd of NWB
sx follows pts for 6mos before return to high impact act.
IF UNSTABLE LESION OR CLOSED PHYSEAL PLATES====Sx Repair
- == fragmental separation
PT Role==Recognize when present and refer out

Answer 128

A

Abrasion arthroplasty
Micro-Fx
- promotes blood supply + bone healing
Mosaicplasty (OATS)
Autologous (from self) Chondrocyte (cartilage cells) Transplantation w/ Periosteal Graft
Re-align. proc’s

Answer 129

A

written by physicians for PT’s

Answer 130

A

subchondral bone abraded to create bleeding in lesion site
Fibrin clot forms in lesion
Fibrin clot facilitates mesenchymal cells to form fibrocart. in the defect
- Mesenchymal Cells:
  - stem cells found in bone marrow that are important for making and repairing skeletal tissues: cartilage, bone, and fat found IN bone marrow

Answer 131

A

Sm. holes punctured in subchondral bone
Stem cells from bone marrow migrate into lesion site
Stem cells become chondrocyte-producing cells that eventually synthesize fibro-cart. in the lesion site

*NOTE: athletes + older adults PRIOR to TKA will use.

Answer 132

A

Hyaline cart. grafts w/ underlying subchondral bone harvested from NWB site
Grafts press-fitted into lesion site
SMALLER lesions get Autologous (from self) grafts
LARGER lesions get Allografts (from cadaver)

Answer 133

A

Fibrocartilage is WEAKER

Hyaline Cartilage is STRONGER

Answer 134

A

Autologous (self) chondrocytes (cart. cells) from biopsy (taken from YOU) grown in culture
Cultured chondrocytes injected INTO lesion site
Periosteal graft fixed OVER lesion site
- to keep them in there***
Stims formation of more hyaline-like (STRONGER) cartilage in lesion

Answer 135

A

Another Pic of procedure

Answer 136

A

Closing Wedge
Opening Wedge
Mechanical Axis shifted AWAY from affected compartment
- totally re-align joint
- arthrokinematics changed

Answer 137

A

Pd of NWB/PWB 6wks
- aquatics + de-weighing devices for progressive WB
Controlled Jt. Mob. Acts.
- EARLY MOTION GOOD
- Motion combining compression + shear NOT GOOD
  - EX. loading jt thru range
- DO use passive, AAROM, NWB AROM
Intermittent loading > static loading
- loading should be compressive w/out shear
Resistance Ex.
- brief, intermittent isometrics holding only few secs/rep > sustained iso’s
  - iso’s avoids compression combined w/ shear
- IF resistance ex’s w/ motion— use arcs of motion that do NOT engage lesion
  - MOST lesions engaged b/w 20-70deg knee flex.
- NMES to INC quad strength

Answer 138

A

Tables 1 & 2