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ORTHO 560 > knee pathologies > Flashcards

knee pathologies Flashcards

1
Q

what is the MOI of patellar dislocations?

A

traumatic or autraumatic

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2
Q

what generally is seen in the case of a traumatic patellar dislocation?

A 
high level of pain
c/o hearing a sound
rotation of knee on a fixed foot
direct trauma
knee flexed and varus stress
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3
Q

what generally is seen in the case of a atraumatic patellar dislocation?

A

-hyperlaxity of genu recurvatum leading HE of the knee
patella altra
increased Q angle
previous Hx of dislocations

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4
Q

on which side is the paterlla generally dislocated on?

A

lateral side

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5
Q

what is the pain site for patellar dislocations?

A

severe pain around the patella

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6
Q

if dislocation is not reduced, where is the patella generally located w/ flexed knee?

A

on the outside

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7
Q

is there presence of swelling w/ patellar dislocations?

A

yes, immediate, especially if traumatic

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8
Q

how is ROM in patellar dislocation?

A

aprehension w/ knee flexion and extension or w/ lateral patellar glide

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9
Q

how is RISOM w/ patellar dislocation?

A

ms inhibition, pain w/ quad contraction

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10
Q

how is palpation of patellar dislocation?

A

apprehension

pain on the medial border of the patella and medial PF ligament

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11
Q

what special tests can be used to detect patellar dislocation?

A

moving patellar apprehension test

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12
Q

when can the moving patellar apprehension test be performed?

A

once reduces, not immediately post injury

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13
Q

what tests/methods are use to diagnose patellar dislocations?

A

xray, CT, MRI which are used to R/O #

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14
Q

what may lead to recurrence of patellar dislocations?

A

patella alta
shallow groove
torn ligament

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15
Q

how is patellar dislocation treated?

A

conservative Rx for > 3 months
extension splint for ~2 weeks
increase in quad str
improvement of proprioception

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16
Q

what is the PFPS?

A

pain in the anterior knee

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17
Q

who is most likely to be affected by PFPS?

A

women

teens

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18
Q

what is the etiology of PFPS?

A

multifactorial

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19
Q

what are predicitors for poorer outcomes w/ PFPS?

A

Longer duration of Sx prior to Rx
overall poorer function
worse pain

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20
Q

are specific tests used to diagnose PFPS?

A

no, most test have low accuracy for PFPS

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21
Q

What are the criteria for diagnosis of PFPS?

A

The presence of retropatellar or peripatellar pain
AND
Reproduction of retropartellar or peripatellar pain w/ squatting, stair climbing, prolonged sitting, other functional activities loading the PFJ in a flexed position
AND
Exclusion of all other conditions that may cause AKP including tibiofemoral pathologies

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22
Q

how are PFP classified

A 
in 4 sub categories
1. overuse/overload
 w/o other impairments
2. ms performance deficit
3. mvmt coordination deficit
4.mobility impairments
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23
Q

when are overload/overuse PFPS observed?

A

When pt present w/ Hx of increase load magnitude or frequency

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24
Q

when are muscle performance deficit PFPS observed?

A

When pt presents w/ decrease strength in hip ms or quadriceps

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25
Q

when are coordination derficits in PFPS observed?

A

-pt is asked to perform SL squat and dynamic knee valgus can be observed and isnt related to a decrease in strength

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26
Q

how to differentiate knee valgus due to decrease in strenght vs coordination?

A

MMT testing: test hip abd/ER and no weakness but still see dynamic knee valgus then it a motor control issue

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27
Q

when can mobility impairement for PFPS be observed?

A

pt presents w/ increased foot mobility and/or decreased flexibility in one of the following muscles; gastroc, soleus, lateral retinaculum, ITB

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28
Q

why will hypermobility of the foot lead to PFPS?

A

due to overpronation of the foot

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29
Q

why will hypomobility of the foot lead to PFPS?

A

decreased flexibility of the muscles in the involved area

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30
Q

what are the most important risk factors for pt w/ PFPS?

A
  • physically active
  • weak quad esp in military populations
  • quad athrophy?
  • dynamic knee valgus
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31
Q

what factors can be associated w/ the development of PFP?

A 
age
body mass
height
BMI
static Q angle in NWB and WB
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32
Q

what factors may lead to abnormal patellar tracking and hence PFPS?

A

Abnormal alignment of LE
Stiffness, tightness of structures around the patella
Weakness of structures around the patella and in the LE kinetic chain

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33
Q

what are possible anatomical factors which may lead to PFPS?

A 
Femoral anteversion (hip section)
Knee valgus
Tibia ER or tibial tubercle laterally positioned
Patella alta
Shallow groove (lower lateral groove)
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34
Q

what dynamic factors leading to possible PFPS can be Rx w/ physio

A

-increase dynamic knee valgus by increase add/IR of the hip and abd/ER of the knee during WB

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35
Q

what may cause the increased dynamic knee valgus in the knee?

A

weak hip extension, abd, ER
decreased hip ER rom
LE motor control deficits
foot hyperpronation

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36
Q

what is FPPA?

A

Frontal plane projections; 2d surrogate for a 3d measure of hip add, IR, knee ABD, ER

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37
Q

FPPA is the angle b/w which two lines

A

ASIS to midpoint of TF joint and midpoint of TF joint to midpoint of ankle mortise

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38
Q

when measuring FPPA changes from what to what are assessed?

A

change in FPPA from start position to the point of peak knee flexion

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39
Q

what is considered as dynamic valgus w/ a change in FPPA

A

more than 10 degrees in the positive direction

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40
Q

what is considered as dynamic varus w/ a change in FPPA

A

more than 10 degrees in the negative direction

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41
Q

what happens if there is less than 10 degree change in FPPA in either directions (+/-)

A

no change

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42
Q

what muscles stiffness may be associated w/ PFPS?

A

rectus femoris
ITB
hamstring
calf

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43
Q

what stiff muscle will lead to an excessive superior force on the patella esp w/ knee flexion

A

rectus femoris

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44
Q

what stiff ms will cause excess lateral force on the partella and can ER the tibia

A

ITB

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45
Q

what stiff ms will cause knee flexion and thus increase the pressure at the PF joint?

A

hamstring and calf

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46
Q

what happens in the event of a tight calf?

A

decreased DF in the midstance leading to increased foot pronation and thus to compensate increase in knee valgus and will pull the patella laterally

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47
Q

what happens if the lateral retinaculum of the knee is tight?

A

pulls the patella laterally and wiull change the tracking of the patella and cause changes in force where they shouldnt be present

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48
Q

what is the MOI for PFPS?

A

AKP w/ activity associated w/ increased load that the PF joint

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49
Q

what is the pain site for PFPS?

A

Ant knee pain, retropatellar and peripatellar pain

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50
Q

what is the pain type associated w/ PFPS

A

may c/o catching sensation but usually poorly defined pain quality

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51
Q

what is the pain pattern associated w/ PFPS?

A

activities causing an increase in load at the PF joint, especially w/ flexed knee position will lead to increase pain

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52
Q

what are general observations associated w/. PFPS?

A 
quad Athrophy
foot hyperpronation
FH anteversion
knee valgus
patellar position; lateral shift or patella Alta
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53
Q

what functional tests may be performed to assess for PFPS

A

SL squat, step downs, or lateral stepdowns and FPPA can be assessed andf look for signs of hyperpronation
full squat to assess for pain in flexion and at EOR
trendelenberg to detect glute med weakness to assess for tension on ITB

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54
Q

how is the knee ROM in PFPS?

A

Generally not an issue, if tight anterior structures, knee flexion may be limited

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55
Q

how is hip ROM w/ PFPS?

A

decrease hip ER is possible

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56
Q

how is PROM of the patella?

A

glides will be Ax for stiffness
medial glide might be decreased due to increased stiffness of ITB or lateral retinaculum
inferior glide might be decrease due to stiffness of rectus femoris

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57
Q

how is RISOM w/ PFPS?

A 
weakness of hip extensors
hip abductors
hip ER
knee extensors
hipSIT
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58
Q

how is palpation w/ PFPS?

A

Assess for pain around the patella

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59
Q

what can be observed w/ flexibility Ax in PFPS

A 
Stiffness Ax
hamstring 90-90 or SLR
gastroc and soleus w/ DF  in wb w/ knee straight or bent
rectus fem w/ modified thomas test
ITB w/ ober's or modified thomas test
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60
Q

what are special tests that can be performed top assess for PFPS?

A

Patellar tilt test where the lateral aspect of the patella can not go beyond the horizontal

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61
Q

what is suggested CPG for overuse or overload PFPS?

A

Eccentric step down test

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62
Q

what are the suggested CPGs for muscle performance deficits in PFPS?

A

hipSIT and MMT of thigh ms

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63
Q

what are the suggested CPGs for mvmt coordination deficits in PFPS?

A

dynamic valgus on lateral step down test

frontal plane valgus in SL squat

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64
Q

what is the suggested CPG for hypomobility in PFPS?

A

patellar tilt test
flexibility test: HS, gastroc, soleus, ITB, quads
ROM: hip IR/ER

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65
Q

what is the suggested CPG for hypermobility in PFPS?

A

foot mobility test

foot posture index

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66
Q

what are some self reported outcome measures

A

VAS or NPRS for pain
validated questionaires s/a anterior knee pain scale, PF pain and OA subscale of knee injuries and OA outcome scores
ENG and pierrynosku questionnaire

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67
Q

what is the goal of Rx for PFPS?

A

decrease compression on PF joint during daily activities

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68
Q

how can compression on the PF joint be decreased?

A

decrease in jt rxn force
decrease in pain, irritation and inflammation
center the patella w/in the trochlea

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69
Q

is PFPS a self limiting condition

A

no

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70
Q

education about what is essential in PFPS?

A 
load management
BW management
importance of adherence to active Rx
evidence regarding Rx options
kinesiophobia
education to improve compliance and adherence
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71
Q

what may be used for pain management in cases of PFPS?

A
  • Reduction and removal of aggravating factors/activities
  • taping for ST correction of patella position and decrease in PF stress
  • foot orthosis in cases of hyperpronation
  • biophysical agents
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72
Q

what are the CPGs associated w/ foot orthosis in the case of PFPS?

A
  • Prescribed in pts w/ greater than normal pronation allowing for ST reduction in pain
  • prescribed w/ exercise program
  • NSAIDS
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73
Q

which biophysical agents should not be used to reduce pain in pts w/ PFPS?

A 
US
phonophoresis
iontophoresis
estim
laser
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74
Q

which biophysical agents should be used to reduce pain in pts w/ PFPS?

A 
US
IF
TENS
ice
IFC
75
Q

what other factors may need to be adressed to manage pain in PFPS?

A

MS Stretching as needed
stretching of stiff retinaculum if needed
ms strengthening of hip E, ABD, ER in WB, of knee E/F in wb and NWB

76
Q

what are the CPGs suggested for ms strengthing in the case of ms strengthening rehab?

A

exercise program should combine hip targetted str exercises and knee targetted STR exercises
target hip ms in the posterolateral chain
knee exercises for F/E in NWB also

77
Q

how to treat for gait and mvmt retraining in the case of PFPS?

A
  • work on aligment of the LE in WB exercises
  • reduce FPPA
  • gait and running retraining
78
Q

what is the purpose of knee orthosis in pts w/ PFPS?

A 
Maintain medial glide C shaped lateral buttress
decrease lateral patellar displacement
increase contact surface area
decrease PFK stress
increase proprioception of the knee
79
Q

should knee orthosis be used for PFPS?

A

based on CPGs no

80
Q

should combined interventions be used for PFPS?

A

YES
superior outcomes compared to no Rx
exercises is generally always combined w/ other interventions

81
Q

what are the Rx recommendations based on overuse/overload stage of PFPS?

A
  • Taping

* Activity modifications/relative rest

82
Q

what are the Rx recommendations based on Ms performance deficit stage of PFPS?

A
  • Hip and glute ms str

* Quad str

83
Q

what are the Rx recommendations based on coordination deficit stage of PFPS?

A

gait and mvmt retraining

84
Q

what are the Rx recommendations based on hypomobility deficit stage of PFPS?

A

Patellar retinaculum/ST mobilizations
Ms stretching: HS, gastroc, soleus, quad, ITB
Hip ER vs IR ROM exercises

85
Q

what are the Rx recommendations based on hypermobility deficit stage of PFPS?

A

Foot orthosis
Taping
Short foot ms str/extrinsic ms str

86
Q

can surgery be used as Rx for PFPS?

A
  • not recommended due to poor surgical outvcomes

- done only if consevrative Rx has failed multiple times

87
Q

what surgical procedures are generally done in the case of PFPS if Sx is done?

A

chondroplasty or lateral retinaculum release

88
Q

what is baker’s cyst generally associated w/?

A

intra-articular pathology where a mass of synovial fluid accumulates

89
Q

what is the baker’s cyst generally connected w/?

A

knee joint capsule and SM or medial head of gastroc bursae

90
Q

what can baker’s cyst minic?

A

DVT due to increase leg warmt, leg girth and pain

91
Q

what pain pattern is associated w/ baker’s cyst?

A

pain EOR knee flexion

92
Q

how is palpation of baker’s cyst?

A

swollen and tender mass on posterior knee

93
Q

what is the MOI for MCL sprains in the knee?

A

valgus stress on partially flexed knee; can occur w/ contact or non contact injuries
or
rotation on a fixed foot

94
Q

where is the pain in a MCL sprain?

A

medial knee pain over MCL

95
Q

what is the pain pattern for an MCL sprain?

A

pain w/ valgus
pain w/ side to side cutting action
instability if grade 2+

96
Q

what is a grade 1 sprain?

A

no or minimal swelling, firm EF, reproduction of pain, localized POP

97
Q

what is a grade 2 sprain?

A

swelling, normal EF, gaping, reproduction of symptoms. POP

98
Q

what is a grade 3 sprain?

A

swelling, lig stress test; soft EF, gapping, possible reproduction of symptoms, POP

99
Q

how to control pain and swelling w/ conservative Rx for MCL sprain?

A 
crutches initially for NWB/PWB/WB
pain freee rom
STR in painfree rom
proprioception
NM training
functional activities and exercises
hinged knee brace in severe injuries for 2-4 weeks
100
Q

optimal MCL healing generally takes how long to heal?

A

4-6 weeks but can extend to 3 months

101
Q

which b/w MCL or LCL sprain is more common in the knee?

A

MCL more than LCL

102
Q

what is the MOI of an LCL sprain in the knee

A

varus stress

ER of flexed knee over a fixed foot

103
Q

where is the pain site in LCL sprain in the knee?

A

over the LCL

104
Q

what is the pain pattern associated w/ LCL sprain of the knee?

A

pain w/ varus stress

unstable if over grade 2

105
Q

what is the most common ligament sprain and most serious

A

ACL sprain

106
Q

what is known as the common triad?

A

MCL, medial meniscus and ACL tears

107
Q

what are the MOI for ligament sprain?

A

accelerations/deceleration
ER of the knee on a fixed foor w/ knee flexed to 10-30 degree + in a valgus position
knee in HE
Valgus/varus stress eg ski fall

108
Q

in what postion is considered to be the point of safety

A

hip in slight flexion, knee flexed, neutral tibial rotation, and feet in controled balance

109
Q

what is considered to be the point of no return

A

hip in Adduction and IR
knee decreased flexion and valgus (femur more add, tibia abd)
one foot out of control, unbalanced (hyperpronated)

110
Q

a pt w/ an ACL sprain will likely complain of what?

A

that they feel that the knee is giving way

111
Q

can the pt continue playing sport immediately post injury?

A

large amount of swelling inhibits from returning

112
Q

how is the pain site w/ ACL sprain?

A

widespread around the knee, pain more locaized to posterolateral joint if secondary to stretch of lateral capsule

113
Q

how is the pain type for ACL sprain?

A

instability

114
Q

how is the pain pattern for ACL sprain?

A

Pain w/ knee flexion and extension

Limited by swelling/hemiarthrosis

115
Q

what is generally seen w/ observation post ACL sprain?

A

large, tense effiusion and hemarthrosis

VMO athrophy is possible

116
Q

how is ROM w/ acl sprain?

A

limited ROM from swelling

117
Q

how is RISOM post ACL sprain?

A

in acute cases weakness due to ms inhibition

118
Q

how to best diagnose for ACL sprain?

A

ligament stress test optimal if performed within 1H of injury

119
Q

what ligament stress tests can be done to Ax for ACL sprain?

A

lachman test: + if complete tear
ant. drawer test: + not painful thus based on EF and gap
lever’s sign: + for complete tear
pivot shift test: + only if intact MCL and ITB and near full knee E

120
Q

in ACL sprains, what are Xrays used for?

A

to r/o avulsion # of the ligament and # of tibial platea

121
Q

is MRI needed to confirm ACL sprain?

A

not always needed only if diagnosis is left unclear,

can also see bone marrow lesion over lateral femoral condyle and other injuries

122
Q

how to manage ACL sprains?

A

conservative of surgically

123
Q

Treatment to manage ACL sprain depends on what factors?

A

pts age; generally younger opt for surgical
degree of instability and activities performed by pt
social factors; $, time off work availible to pt
willingness to partake in rehab
any abnormalities

124
Q

what is a consequence of repeated events of the knee giving way post ACL sprain?

A

increases the risk for OA

125
Q

what can arthroscopy help assess in the case of conservative Rx?

A

level of instability
washout of the hemiarthosis
assess and treat other injuries

126
Q

what are the aims in conservative Rx?

A

Decrease pain and swelling
Improve ROM and Gait
Improve strength/power/proprioception
derotation of the knee w/ braces

127
Q

when is surgical process used for ACL tears

A

in the case of important tear size

128
Q

how does ACL surgical procedure look like?

A

3 small incision are done around the knee
remnants of the torn ACL gets removed, tunnels drained through femur and tibia and graft is passed through and then fixed in place

129
Q

what is a BTB graft?

A

central 1/3 of the patellar tendonj is removed w/ a small block of bone at either end of the ligament, this portion of the tendon will regrow over time

130
Q

what is the downfall to a BTB graft

A

results in problems of the tendon s/a PFPS or patellar tendinopathy

131
Q

what is the most common type of graft for ACL rupture?

A

hamstring tendon graft

132
Q

what is an advantage of using hamstring tendon autograft for ACL repair

A

tendon is long and can be doubled up, and wont predispose to patellar tendiopathy

133
Q

what is a challenge of hamstring tendon autograft?

A

More challenging to anchor in femur and tibia since no blocks of bone at each end

134
Q

if there an autograft that is more beneficial than another

A

no it really depends on the clinical course of the rupture however in patellar tendon graft more pts experienced anterior knee pain w/ kneeling and w/ hamstring autograft more pts have decreased EOR knee flexion power

135
Q

what is an allograft?

A

graft taken from a cadaver

136
Q

what is the general timeline for ACL reconstruction?

A

-wait until swelling has decreased, near full ROM and normal gait
if MCL has been torn ~6 weeks post tear

137
Q

what is the pre-op management of ACL tears?

A
  • reduce pain w/ police and modalities
  • full ROM
  • STR and proprioception
  • education about hospital protocols
  • knee brace fitting
138
Q

what are the post op management for ACL tears?

A

-WB status

CKC vs OKC

139
Q

what is the WB statis in the case of meniscal repair w/ Sx?

A

WB only restricted at first

140
Q

what is the WB statis in the case of ACL repair w/ Sx?

A

WBAT

141
Q

what is the aim for the 2 first week post knee surgery

A

focus on regaining rom in extension and ensure proper quad activation

142
Q

what is better suggested b/w OKC and CKC post surgery for the knee

A

no or minimal difference b/w both

143
Q

what is the procedure post op for ACL repair?

A

similar to conservative Rx
depends on surgeon’s guidelines
criteria based rather than time based

144
Q

what are the CPGs for ACL reconstruction rehab?

A

-immediate mobilization and supervised program: STR, HEP, NM ex’s
-early WBAT w/in 1st week
WB and NWB concentric and eccentric exercises w/in 4-6 weeks 2-3x/week for 6-10 months

145
Q

what is the MOI of a PCL sprain?

A

direct blow to anterior, proximal tibia w/ knee in a flexed position
knee in full flexion
HE of the knee

146
Q

what is the pain site

A

poorly defined pain, especially posteriorly

147
Q

what can be observed w/ PCL sprain

A

swelling but less than w/ ACL

148
Q

what special tests can be performed for PCL sprain?

A

brush test might be positive if sufficent effusion
posterior drawer test +
posterior sagittal test +

149
Q

what treatment is used for PCL sprain?

A

conservative w/ comprehensive rehab and significant quad STR

150
Q

what is a longitudinal meniscal tear?

A
  • Degenerative from repeated trauma

* Often bilateral and may be asymptomatic

151
Q

what is a bucket handle meniscus tear?

A

traumatic tear
Medial:lateral meniscus (3:1)
Often associated w/ ACL tears and locked knee
Specify it it remains stuck in a “locked” position
More often posterior horn

152
Q

what is a radial meniscus tear

A

Traumatic usually
Middle 1/3 of the menisucus
Lateral > medial meniscus

153
Q

what is a parrot beak tear a progression of

A

progression of a radial meniscal tear

154
Q

what is a flap meniscus tear?

A

a tear that is either displaced or undisplace, usually traumatic and can progress to being other types of tears

155
Q

what is a horizontal cleavage tear of the mensicus

A

• Type of tear that can be seen by doing a cross section of the meniscus

156
Q

what factors may increase risk of meniscal tears?

A
  • age, work related kneeling and squatting for degenerative tears and climbing stair can all lead to degenerative tears
    cutting and pivottinh sports
    acl reconstruction due to increased knee laxity
157
Q

how can meniscal tear occur from a twisting movement

A

rotation about a fixed foot

158
Q

under valgus stress what meniscus is affected? how?

A

medial

hit from the side bringing knee into a valgus position

159
Q

under varus stress what meniscus is affected? how?

A

lateral meniscus; hit knee into varus position

160
Q

what are MOI of meniscal tears

A 
twisting injury
valgus
varus
HE of knee
HF of knee
161
Q

which mensicus is more commonly injured

A

medial more than lateral

162
Q

symptoms associated to small meniscal tear

A

degenerative usually or after minimal trauma in elderly

delayed symptoms

163
Q

symptoms associated w/ more severe meniscal tears

A 
more pain
effusion w/in 6-24H
decreased EOR flexion and extension
intermittent locking
may unlock spontaneously
often associated w/ MCL/ACL tears
164
Q

where is the pain site of a meniscal tear?

A

along the joint line either medial or lateral depending on meniscus affected

165
Q

what is the pain type for meniscal tear?

A

c/o catching sensation in case of flap or intermittent locking

166
Q

what is the pain pattern associated w/ meniscal tear

A

w/ EOR knee flexion or extension

167
Q

is there significant swelling w/ meniscal tears

A

no

168
Q

what functional tests can be performed for meniscal tears

A

squatting pain w/ post horn tear

169
Q

how is ROM w/ meniscal tear

A

decreased and painful in flexion and extension due to torn flap of effusion

170
Q

how is palpation of a meniscal tear?

A

•Joint line pain on palpation knee b/w 45-90 degree flexion

171
Q

what special tests can be performed for meniscal tear

A

brush test for effusion
McMurray test if pain or audible crick will be +
tessaly test if pain or discomfort or sens of locking

172
Q

what is the best imagery technique for meniscus tears

A

MRI

173
Q

what criterias are looked at in the meniscal pathology composite score

A 
Hx of catching or locking
pain w/ forced HE
pain w/ max passive flexion
joint line tenderness
pain w/ audiable crick w/ McMurray's manoeuver
174
Q

what is the conservative Rx suggested for meniscal tear?

A 
option unless locking of the knee
better results w/ smaller tears
manage pain  and swelling
increase pain free ROM
increase STR, proprioception, NM control
return to functional activities
175
Q

what are the 2 surgical repair option for meniscal tears

A

meniscal repair or menisectomy

176
Q

what is the success rate in meniscal repairs?

A

higher in young populations and if in vascularized zones of the meniscus

177
Q

how is meniscal repair accomplished

A

Use sutures or tacks to repair the damaged meniscus
Punch an arrow though the damaged part of the meniscus
• The arrow is biodegradable (after 6 months)
• Anchor the 2 torn edges together while tear heals

178
Q

what is the process of a menisectomy

A

-straight forward

179
Q

when are menisectomy generally performed

A

degenerative flaps, horizontal cleavage, complex meniscal tears

180
Q

what is the effect of removal of the meniscus on compressive stress

A

16-34% loss of meniscus increases compressive stress by 350%

181
Q

what happens to the knee when meniscus is removed?

A

loosens up and instability may lead to OA

182
Q

how rapidly can pt return to activity post menisectomy

A

~4 weeks

183
Q

what rehab is needed prior to surgery post op for meniscus

A

decrease pain and swelling
maintain or increase STR of quad, HS, hip abd, hip E
increase proprioception and NM control
protect for further dsamage; education

184
Q

what rehab is needed post op for meniscus

A 
~3-6 weeks for menisectomy WBAT
~3-8 months for meniscal repair prgression over a 4-6 week period, can go over 90 degree knee flexion for the first 4 weeks
POLICE
pain free rom w/ HEP and mobilization
STR w/in availible range
proprioception

ORTHO 560 (7 decks)

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