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MSK II - EXAM 3 KNEEEEEEE > Knee- Meniscus and OA > Flashcards

Knee- Meniscus and OA Flashcards

1
Q

What is the meniscus made of?

A

fibrocartilage = stabilizer

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2
Q

What is the prevalence of meniscus injuries?

A
  • 2nd MOST common knee injury
  • Medial > lateral meniscus
  • posterior > anterior horn
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3
Q

What are risk factors for an acute meniscus injury?

A

all WBing sports

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4
Q

What are risk factors for a degenerative meniscus injury?

A
  • greater the age, esp > 60 yrs. of age
  • biological male > female
  • work related kneeling/swatting/stair climbing
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5
Q

What is a risk factor for both acute and degenerative meniscus injuries?

A
  • greater time elapsed from any knee injury
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6
Q

What is a menisci?

A

nearly circular wedge-shaped fibrocartilage disk(s) on tibial plateau

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7
Q

What is the meniscus attached to the tibia by?

A

coronary ligaments

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8
Q

What are the functions of the menisci?

A
  • stability > shock absorption
  • deepen the joint surface for stability
  • outer 1/3 is mostly type I collagen, inner 1/3 is mostly type II collagen
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9
Q

What is the unique about the medial meniscus?

A
  • more O shaped
  • torn more frequently
  • attachment to MCL
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10
Q

What is unique about the lateral meniscus?

A
  • more C shape
  • greater mobility without ligamentous attachment
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11
Q

What are symptoms of a meniscus tear?

A
  • joint space/line pain with possible leg referral
  • limited and painful motion
  • WBing limitations with possible catching or locking
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12
Q

What is the onset of a mensicus tear if acute?chronic?

A
  • if acute = trauma reported
  • if chronic = then gradual and unknown, typically in an older individual without or with a prior injury
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13
Q

What will we observe with a meniscus tear?

A
  • possible swelling
  • potential asymmetrical and antalgic gait
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14
Q

What will we find with ROM with a meniscus tear?

A

limited and painful motion

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15
Q

What will we find with resisted testing/MMT with a meniscal tear?

A
  • potentially weak and painful
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16
Q

What will we find with stress tests with a meniscus tear?

A

possibly painful with compression

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17
Q

What are some special tests for meniscus tears?

A
  • meniscal CPR
  • McMurray’s
  • Ege’s
  • Thessaly’s
  • Apley’s
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18
Q

What are signs of meniscus tears in muscle activity and palpation?

A
  • m. activity/MMT = inhibited quads
  • palpation - joint line tenderness (min to no support)
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19
Q

What percentage of those 20-68 yo had a meniscal abnormality on a MRI?

A

98%

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20
Q

What is the PT rx for meniscus tears?

A
  • POLICED
  • AD to minimize/avoid limping
  • JM
  • MET
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21
Q

What are JMs for with meniscal tears?

A
  • pain modulation via descending pathways
  • meniscal integrity
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22
Q

What is MET for with meniscal tears?

A
  • primarily for stabilization and meniscal integrity
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23
Q

What has mod support for strength with meniscal tears?

A

NMES

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24
Q

What can MET do for degenerative tears of the meniscus?

A
  • equally effective as sx for improved pain
  • less anxiety and depression vs sx
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25
Q

What is a partial meniscectomy?

A
  • removal of tear
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26
Q

What are post-op aspects of a partial meniscectomy?

A
  • no immobilization
  • earlier WBing
  • return to play within 2-6 weeks
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27
Q

What is a meniscal repair?

A
  • sutured
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28
Q

What are the post-op aspects of a meniscal repair?

A
  • primarily with tears in outer 1/3 due to blood supply
  • immobilization and/or limited ROM initially
  • TTWB for 4-6 weeks
  • return to play in ~ 12 weeks
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29
Q

What should we know about surgery for degenerative tears vs sham sx?

A
  • sx no better at 2, 6, or 12 months vs sham sx without ARJC
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30
Q

Should those with with degenerative tears of the meniscus and age related joint changes have surgery?

A
  • STRONG RECOMMENDATION AGAINST SX
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31
Q

What is the etiology of Baker’s Cyst?

A
  • often age-related joint changes
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32
Q

What are the pathomechanics of a baker’s cyst?

A
  • fluid filled cyst due to persistent and excessive inflammation
  • subsequent weakening of capsule and herniation of fluid
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33
Q

Baker’s cysts are asymptomatic until what?

A

significant effusion

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34
Q

What can a baker’s cyst mimic?

A

degenerative meniscus tear

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35
Q

What will ROM be with a baker’s cyst?

A

limited and painful

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36
Q

What should we know about resisted/MMT into flexion with a baker’s cyst?

A

PAINFUL

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37
Q

Where can we palpate for a baker’s cyst?

A

popliteal protrusion just near the medial gastroc head

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38
Q

What is the PT rx for a Baker’s cyst?

A
  • like degenerative meniscal tear
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39
Q

What is a precaution with baker’s cyst PT?

A

forceful activity, like all herniations

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40
Q

What is the prognosis of a baker’s cyst?

A
  • difficult to manage in active individuals
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41
Q

What is a complication of a baker’s cyst?

A

rupture may occur and mimic gastoc tear

42
Q

What is the MD rx for a baker’s cyst?

A

aspiration and/or surgical repair

43
Q

Where are age-related joint changes MOST common in the knee?

A
  • medial femoral condyle and patella articular surface
44
Q

What percentage of knee scopes show age-related joint changes?

45
Q

What population has the greatest prevalence of age-related joint changes of the knee?

A

elite level sports

46
Q

Is there similar prevalence in non-elite athletic and non-athletic populations?

47
Q

What are risk factors for age-related joint changes of the knee?

A
  • older age
  • previous joint injury, especially meniscus
  • increasing BMI
  • occupational activity (deep squats or stairs with or without loads)
  • quad weakness
  • NOT just exposure to sport or physical activity which may even be protective
48
Q

What is the onset of age-related joint changes in the knee?

A

gradual and unknown onset of pain that is worse with WBing

49
Q

What is severity of age-related joint changes in the knee associated with?

A
  • bone edema with subarticular bone attrition
  • synovitis
50
Q

What is severity of symptoms of age-related joint changes in the knee NOT associated with?

A

osteophytes or reduction in joint space on imaging

51
Q

What kind of pain does age-related joint changes in the knee have the potential to become?

A

nociplastic pain

52
Q

What relieves the pain with age-related joint changes in the knee?

53
Q

What are some symptoms of age-related joint changes in the knee?

A
  • stiffness < 30 min after prolonged positions
  • limited and painful motion
54
Q

What will we observe with age-related joint changes in the knee?

A
  • antalgic/asymmetrical gait
55
Q

What will we find with ROM with age-related joint changes in the knee?

A

limited and painful, possible capsular pattern of restriction of flex>ext

56
Q

What will we find with combined motions with age-related joint changes in the knee?

A

consistent block

57
Q

What will we find with stress tests with age-related joint changes in the knee?

A

distraction likely relief of pain, compression likely painful

58
Q

What will we find with accessory motion with age-related joint changes in the knee?

A

hypomobile

59
Q

What kind of special tests can we do for age-related joint changes in the knee?

A
  • possible positive meniscal tests
  • impaired walking distance and gait velocity with 6 MWT and TUG tests
60
Q

What muscle groups can be inhibited with age-related joint changes in the knee?

A
  • quads
  • hip abductors
61
Q

Where will there be TTP with age-related joint changes in the knee?

A

joint line tendereness

62
Q

What is the PT rx for age-related joint changes in the knee?

A
  • POLICED
  • STM may help
  • modalities
63
Q

How can STM help with age-related joint changes in the knee?

A
  • massage improved pain and function but less than JMs
  • better than usual care when individualized with JM
64
Q

What modalities are useful with age-related joint changes in the knee?

A
  • CPM (weak support)
  • Estim (MAY help)
  • electromagnetic devices (MAY help)
  • US (short term pain relief and function)
  • accupuncture (MAY help)
65
Q

What is the efficacy of dry needling for age-related joint changes in the knee?

66
Q

What should we know about orthotics/braces for age-related joint changes in the knee?

A
  • lateral heel wedges not recommended
  • unloader knee brace may be helpful
67
Q

What can we use an AD for with age-related joint changes in the knee?

A
  • to minimize/avoid limping
68
Q

Are JM helpful for age related joint changes in the knee?

A

May be helpful
- better when individualized
- greater immediate pain and functional benefits vs massage

69
Q

Where can we do JM with age related joint changes in the knee?

A

locally at the knee and distally as well in the ankle

70
Q

When is there an immediate change with JM for age related joint changes in the knee?

A

in ext ROM when combined with STM and MET

71
Q

Do JM provide pain relief or functional benefits for age related joint changes in the knee?

A

short term pain and functional benefits

72
Q

When is there long term pain relief with JM for age related joint changes in the knee?

A

long term and greater pain relief with equal or greater functional gains when added to exercise

73
Q

Why is some of the support inconclusive for JM for age related joint changes in the knee?

A

due to not being individualized or combined with MET

74
Q

What kind of evidence is there for MET for age related joint changes in the knee?

A

strong supporting evidence

75
Q

What does MET do for age related joint changes in the knee?

A

Increases anti-inflammatory markers and chondroprotective properties

76
Q

What are long term benefits of MET for age related joint changes in the knee?

A

pain and function
- better when individualized

77
Q

What muscles should be targeted with age related joint changes in the knee?

A
  • quads
  • hip exercises for anti-gravity muscles
78
Q

What kind of support is there for NMES with age related joint changes in the knee?

79
Q

What additional exercises are useful for age related joint changes in the knee?

A
  • aerobic exercises helped pain and disability
  • aquatic exercises helped disability
  • yoga and tai chi compliment traditional exercise
  • coordination and balance activities help pain and function
80
Q

What are some other PT rx for age related joint changes in the knee aside from MET?

A
  • dietary modifications
  • wt management
  • pt education and self management
81
Q

What should we know about pt education for age related joint changes in the knee?

A

STRONGLY RECOMMENDED

** ex. pillow under knees when sleeping to help with CPP, dont “hang out” in knee extension

82
Q

What should we know about frequency of sessions for age related joint changes in the knee?

A

12 PT sessions over a year better than 12 sessions over 9 weeks

  • both focuses on knee but also included adjacent joints
83
Q

What should we know about non-inpatient costs in the year prior to a TKA?

A

> 50% costs associated with
- injections
- PT
- orthotics
- prescriptions

84
Q

How can we reduce cost of patients before TKA?

A

if only CPG treatments utilized, costs could be decreased by 45%

85
Q

What should we know about PT/MD rx in the year prior to TKA as a big picture?

A
  • Often over utilization of ineffective interventions and inefficient use of visits
86
Q

What should we know about NSAIDs for age related joint changes in the knee?

A
  • strong support
  • more effective than tylenol
  • includes topical application
87
Q

What is the support for Tylenol for age related joint changes in the knee?

A

strong support

88
Q

What should we know about injections for age related joint changes in the knee?

A
  • cortisone has inconclusive support and possible short term relief
  • hyaluronic acid (synvisc) claims to mimic synovial fluid, strong evidence AGAINST using
89
Q

What should we know about narcotics for age related joint changes in the knee?

A

adverse effects and NOT effective

90
Q

What should we know about platelet rich plasma for age related joint changes in the knee?

91
Q

What is the recommendation for arthroscopy or “cleaning” for age related joint changes in the knee?

A
  • strong recommendation against in nearly all patients with age related joint changes
  • NO. clinically important benefits vs placebo with pain function or quality of life
92
Q

What should we know about PT only vs TKA for age related joint changes in the knee?

A
  • when a TKA is needed it is best but with greater potential of adverse events
  • timing of TKA influences outcomes (dont wait too long or other bodily areas and function may suffer)
93
Q

What is a TKA in comparison to a PKA?

A

total knee replacement vs partial knee replacement

  • TKA is more common, increasing prevalence
94
Q

What is the recommended prior rehab to a TKA?

A
  • 1-2 sessions and cost reduction vs no pre-op PT
  • AD training
  • Planning for recovery, initial HEP
  • expectation management
95
Q

What are the benefits of rehab prior to a TKA?

A
  • better quality of life with 8 weeks of exercise 5x/wk prior to sx
  • 3x/wk for 4–8 weeks increased strength and function for individuals with severe OA
  • 3 wk program accelerated functional recovery after TKA
96
Q

What is removed, cut, done during a TKA?

A
  • incise capsule
  • collaterals remain and possibly the PCL
  • ACL always removed
  • forceps adjacent structures
  • knee dislocated
  • add prosthetic
  • close capsule
  • full range under anesthesia
97
Q

What is the benefit with early rehab within 24 hours of a TKA vs 48-72 hours?

A
  • decreases mean hospital stay and number of sessions
  • greater progress with ROM/strength
  • faster autonomy and normal gait and balance with TKA
98
Q

What are some variables of early and intense rehab?

A
  • higher intensity
  • spread visits over a longer duration
  • single limb training
  • higher level of functional exercises
99
Q

What is a pro of earlier and intense rehab?

A
  • better quad activity and function out to 1 year
  • no additional adverse side effects
100
Q

What are ROM goals with a TKA?

A
  • 0 degrees ext (1-2 weeks)
  • 110 degrees flexion (6weeks) and 120 degrees overall

MSK II - EXAM 3 KNEEEEEEE (6 decks)

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