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OCS prep (TQ) > Knee pain and mobility impairments CPG > Flashcards

Knee pain and mobility impairments CPG Flashcards

1
Q

How often are knee injuries meniscal injuries?

A
  • a lot. 2nd most common knee injury
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2
Q

What is an additional concern for structural damage following an ACL tear?

A
  • meniscal injury. Occurs in conjunction w/ ACL tear ~22-86% of the time.
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3
Q

What are the general demographics/types of traumatic meniscal tears?

A
  • occurs w/ younger populations

- more often longitudinal or radial tears

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4
Q

What are the general demographics/types of degenerative meniscal tears?

A
  • occurs w/ older populations

- more often horizontal, flap or complex tears, meniscal maceration or destruction

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5
Q

What is the general prevalence of articular cartilage lesions?

A
  • based on knee arthroscopy, 60-70%
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6
Q

Is articular cartilage damage usually due to a contact or non-contact mechanism? Is it traumatic?

A
  • unclear. Traumatic, non-contact thought to be between 32-58%, so non-contact mechanisms aren’t uncommon
  • yeah…usually traumatic with a known MOI, I’d guess
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7
Q

Where are cartilage lesions most often found in the knee?

A
  • medial femoral condyle

- patella

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8
Q

What other injuries are most likely to occur in conjunction w/ an articular cartilage lesion?

A
  • ACL tear or medial meniscal tear

- more specifically, 2nd ACL injury or partial meniscectomy

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9
Q

Meniscal injuries account for ~ what proportion of all knee injuries?

A
  • ~25%
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10
Q

Is there a gender association with meniscal tears?

A
  • sort of. May be more likely in girls than boys that are in high school sports
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11
Q

Are older or younger individuals more likely to have a meniscal tear? What are the age cutoffs?

A
  • Older folks have a higher rate of meniscal injury
  • 2x increased rate between 35-55yo
  • 3x increased rate at 55yo and older
  • above numbers are one study, so take it with a grain of salt
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12
Q

Is there an association between age and lateral vs medial meniscal injury?

A
  • lateral is more often in younger patients

- medial is more likely in older patients

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13
Q

Is there an association between age and having a meniscectomy vs a repair?

What are the age cutoffs?

A
  • yes
  • those over 45yo are more likely to have a meniscectomy
  • those under 35 are more likely to have a meniscal repair
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14
Q

What is the prevalence of meniscal lesion in athletes?

A
  • between 17%-59%, with some of those being asymptomatic
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15
Q

Should meniscal injury be managed surgically?

A
  • there’s probably a range.
  • However, outcomes are generally similar for those who get surgery compared to those who manage it non-operatively
  • Non-surgical management is associated with similar to better outcomes in knee strength and perceived knee function in the short-term and intermediate time frames when compared to APM
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16
Q

Will people with meniscal injury have normal knee function after management (whether surgical or non-surgical)?

A
  • outcomes are generally satisfactory, but pts will generally report lower knee function compared to the general population
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17
Q

What is the expected course in the short and long term following APM?

A
  • poor proprioception, strength, and self-reported outcomes are expected for the first 6 months
  • most impairments/limitations resolve within 2 years.
  • however even out 4 years, will still report slightly lower knee function and QoL compared to healthy controls
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18
Q

Are there predictors for return to sport rates?

A
  • yes
  • demographics (age and eliteness of athlete), meniscal tear location, physical impairements, and functional levels from functional testing are assocaited
  • lateral tears return faster than medial tears
  • elite/competitive athletes return faster than recreational ones
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19
Q

Is there an advantage to meniscal repair vs APM in younger patients?

A
  • looks like it. younger patients who have a repair have similar to better reported function and activity levels than those with APM
20
Q

What are the expectations for return to sport for athletes following APM?

A
  • Elite and competitive athletes, as well as athletes under 30yo typically return to sport w/in 2 months after APM
  • Athletes over 30yo are likely to return w/in 3 months after APM
21
Q

What has better outcomes; Osteochondral autograft transplantation (OAT) or autologous chondrocyte implantation (ACI)?

A
  • athletes who undergo OAT have generally higher function and return to activity compared to both ACI and microfracture
22
Q

T or F;

There are higher rates of failure/complication in ACI compared to other procedures

A
  • T
23
Q

After an ACI, can a pt expect to be able to return to sport?

A
  • yes, but rate of return after ACI is often a bit delayed
24
Q

What pts are more appropriate for microfracture procedures?

A
  • those with smaller articular cartilage lesions, and lower demand sports
  • those returning to higher demand sports have higher rates of failure
25
Q

What are risk factors for acute meniscal injury?

A
  • cutting and pivoting sports
26
Q

What are some risk factors for both future medial and lateral meniscal injury?

A
  • increased age

- delayed ACL reconstruction

27
Q

What are risk factors for medial meniscal tears?

A
  • female sex
  • older age
  • higher BMI
  • lower physical activity
  • delayed ACL reconstruction
28
Q

What are risk factors for failure with articular cartilage repair surgeries?

A
  • female sex
  • older age
  • higher BMI
  • longer symptom duration
  • previous procedures/surgeries
  • lower self-report knee function
29
Q

What outcome measures are appropriate for use with meniscal and cartilage lesions?

A
  • for knee specific issues should use:
    • IKDC 2000
    • KOOS
    • may use the Lysholm as well with some caveats
  • for activity/participation level
    • may use Tegner scale or Marx activity rating scale
  • SF-36 and EQ-5D can be used for health measures
  • KQoL-26 may be used for knee quality of life
30
Q

Should clinicians use physical performance measures for pts w/ knee meniscus or articular cartilage issues?

A
  • technically no. Hop tests, etc, “may” be used.
  • If you’re looking to quantify asymmetry, or pain/disability/lack of function with improvement with specific tasks, then they’re ok to do, they just have weak evidence for support
31
Q

What are the general diagnostic criteria for the clinical diagnosis of an articular cartilage lesion? How certain is it?

A
  • Low level of certainty

o Acute trauma with hemarthrosis (0-2 hours) (associated with osteochondral fracture)
o Insidious onset aggravated by repetitive impact
o Intermittent pain and swelling
o History of “catching” or “locking”
o Joint-line tenderness

32
Q

What factors compose the Meniscal Pathology Composite Score? How many are recommended to have present to classify someone with meniscal pathology?

A
  • hx of catching or locking
  • pain with forced hyperextension
  • pain with maximum passive knee flexion
  • joint line tenderness
  • pain or audible click with McMurray’s
  • greater than 3 are recommended
33
Q

What are the currently recommended criteria for dx of meniscal pathology?

A
  • knee pain
  • hx of catching or locking
  • twisting knee MOI
  • delayed onset of effusion
  • meniscal pathology composite score of greater than 3 positive findings
34
Q

Is the presence of jointline tenderness more specific/sensitive for the medial or lateral meniscus?

A
  • jointline tenderness is more sensitive for medial meniscal pathology
  • however it’s more specific for lateral meniscal pathology
35
Q

What are the best practice recommendations for activity limitation self-report measures per the CPG for meniscal tears?

A
  • KOOS and IKDC 2000
36
Q

What are the best practice recommendations for physical performance measures for meniscal tears?

A

(early rehab timeframe)

  • 30 sec chair stand test
  • stair-climb test
  • TUG
  • 6MWT

(return to sport)
- single leg hop tests

37
Q

What are the best practice recommendations for physical impairment measures for meniscal tears?

A
  • modified stroke test for effusion assessment
  • assessment of knee AROM
  • maximum voluntary isometric or isokinetic quad strength testing
  • forced hyperextension
  • maximum passive knee flexion
  • McMurray’s
  • joint line tenderness
38
Q

What are the best practice recommendations for activity limitation self-report measures per the CPG for articular cartilage lesions?

A
  • KOOS and IKDC 2000
39
Q

What are the best practice recommendations for physical performance measures for cartilage lesions?

A

(early rehab timeframe)

  • 30 sec chair stand test
  • stair-climb test
  • TUG
  • 6MWT

(return to sport)
- single leg hop tests

40
Q

What are the best practice recommendations for physical impairment measures for cartilage lesions?

A
  • modified stroke test for effusion assessment
  • assessment of knee AROM
  • maximum voluntary isometric or isokinetic quad strength testing
  • joint line tenderness
41
Q

Is progressive early ROM recommended for meniscal or articular cartilage surgery?

A
  • in short yes; has a “may” recommendation
42
Q

Is progressive weightbearing recommended for meniscal or articular cartilage surgery?

A
  • yes following meniscal repair, with weak evidence support
  • yes following just matrix-supported autologous cartilage implantation (MACI) surgery, with moderate support. No other surgical types noted.
43
Q

Is progressive return to activity recommended for meniscal or articular cartilage surgery?

A
  • yes following meniscal repair with moderate evidence
  • “may need to delay” return to activity with articular cartilage surgery, but really not enough research to support specific recommendations
44
Q

Is supervised rehabilitation recommended for meniscal or articular cartilage surgery? What would it consist of?

A
  • yes, but only APM is mentioned.

- recommends that exercise happen in clinic, as well as for HEP with education to support independence

45
Q

Is therex recommended for meniscal or articular cartilage surgery? What would it consist of?

A
  • yes for both

(should consist of)

  • progressive ROM
  • progressive strengthening of HIP and KNEE
  • NM re-ed
46
Q

Is NMES recommended for meniscal or articular cartilage surgery? What are the expected outcomes?

A
  • yes, but just for meniscal procedures

- to improve quad strength, functional performance, and knee function

OCS prep (TQ) (27 decks)

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