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OCS prep > Knee meniscal issues > Flashcards

Knee meniscal issues Flashcards

1
Q

T or F

Meniscectomy does not impact risk of knee OA development

A

False. It does

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2
Q

What are 6 primary functions of the meniscus?

A
  • load transmission; spreads loading over a larger area
  • shock absorption
  • joint stability
  • joint nutrition
  • joint lubrication
  • proprioception
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3
Q

What portion of the menisci have a blood supply?

How does the rest of the meniscus get nutrition?

A
  • the outer 10-30% has a blood supply in an adult

- diffusion of synovial fluids

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4
Q

Menisci are made up of ___% water

A

65-70%

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5
Q

Menisci are thick _____ and thin ______

A

thicker peripherally, thinner centrally

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6
Q

Describe the following for the lateral meniscus:

  • shape
  • relative size
  • relative mobility
  • muscle attachments?
  • ligament attachments?
A

o Shape: 4/5s of a circle
o Smaller and more mobile than the medial (~10 mm of movement)
o Muscle attachment: directly popliteus muscle aids in stability
- attached to LCL

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7
Q

Describe the following for the medial meniscus:

  • shape
  • relative size
  • relative mobility
  • muscle attachments?
  • ligament attachments?
A

o Shape: “C-shaped”
o Larger and less mobile (~2 mm of movement)
o Muscle attachment: indirectly w/ the semimembranosus
o More attachments to the joint capsule, limiting translation and mobility compared to the lateral side
- attached to MCL

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8
Q

Does the lateral or medial femoral condyle rotate more?

A
  • lateral needs to rotate a bit more
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9
Q

What nerve innervates the menisci?

A
  • common peroneal n (reccurent peroneal branch)
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10
Q

The anterior/posterior horns are stressed in what positions?

A
  • extremes of flexion and extension
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11
Q

T or F;

PTs can consistently differentiate between acute vs chronic meniscal tears

A
  • F
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12
Q

____% of pts with symptomatic OA also had meniscal tears

A
  • 91%
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13
Q

Is the medial or the lateral meniscus more often injured?

A
  • medial
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14
Q

The lateral meniscus has a higher incidence of injury in what population?

A
  • younger/athletic
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15
Q

Is gender associated with meniscal injury?

A
  • yes; more often in females
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16
Q

What are the characteristics of most meniscal injuries? (4)

A
  • closed-chain
  • high shear forces
  • more often non-contact
  • generally with a foot planted and twisting
17
Q

The medial meniscus often is injured at the same time as what other two structures?

A
  • MCL

- ACL

18
Q

Is an acute dx of meniscal tear right after injury typically valid?

A
  • if just clinical exam, no. Too much pain, swelling, irritability to differentiate structures at that point.
19
Q

What should be done with palpation of the joint line when examining for a suspected meniscal tear?

A
  • palpate w/ medial/lateral rotation, tibfem loading and ER/IR
20
Q

Should you be able to differentiate between the joint line and meniscus itself with palpation?

A
  • yes
21
Q

What are 3 standard provocation tests for meniscal tear?

A
  • McMurray’s
  • Thessaly
  • Apley’s compression
22
Q

What 2 ROMs should Thessaly be done at?

A
  • 5* and 20* flx
23
Q

Is examining dynamic control more or less of a concern in younger patients w/ meniscal defects?

A
  • less of a concern. With chronic degenerative tears, some stability is lost, thus dynamic stability will be more important to quantify on exam
24
Q

Do you expect quad lag with older patients with chronic knee pain?

A
  • yes. quad weakness is common with chronic knee pain, often overtly demonstrated w/ quad lag
25
Q

What are the criteria for the Ottawa knee rules for imaging after acute traumatic injury? (6)

A

o Over the age of 55
o Unable to take more than 4 steps immediately after injury or in the ED
o Isolated patellar tenderness (w/o other bony tenderness)
o Tenderness of fibular head
o Unable to flex knee to 90*

26
Q

What type of imaging is most sensitive to rule out meniscal injury?

A
  • MRI
27
Q

T or F

There is a relatively high rate of meniscal tears in asymptomatic individuals

A
  • T; usually older adults
28
Q

What are the general recommendations for management of acute meniscal injury?

A
  • relative rest; activity limitation
  • RICE
  • gentle ROM and isometrics after 72 hours
29
Q

What are the primary considerations for therex with meniscal injury? (2)

A
  • limit excessive end range flexion; especially with high load
  • minimize tibial rotation
30
Q

Is it ok to be loading the meniscus during it’s recovery?

A
  • yes; regular force on the meniscus is necessary for proper healing
31
Q

What’s the minimum length of time recommended for a meniscal return to activity program?

A
  • 6 weeks; can be longer
32
Q

What is the goal of management for chronic meniscal tears?

A
  • improving motor control and motor stability to decrease stress on the meniscus
33
Q

At 2 years, is TKA better than PT for pts with OA, or with OA and meniscal tears?

A
  • nope. Not according to medbridge
34
Q

A meniscal tear in the “white white zone” has a (good/poor) prognosis for healing?

A
  • poor; avascular region
35
Q

What test has the highest sensitivity to rule out medial meniscal tear?

A
  • joint line sensitivity
36
Q

What special test can be used to indicate which meniscus is injured?

A
  • McMurray’s; pain with medial tibial rotation is associated with lateral meniscal injury, medial tibial rotation assocaited with lateral meniscal injury

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