knee pathology and rehabilitation Flashcards
definition: unable to get full terminal knee extension due to delayed firing of the quadriceps muscles
Quad Lag
What patient population commonly presents with quad lag? Why?
a. TKA
b. weakness of the quadriceps and swelling
What is the prime knee extensor muscle?
rectus femoris
What is the only muscle crossing the anterior axis of the knee?
Quadriceps femoris
What improves leverage of extensor force? How does it do this?
a. patella
b. increases the distance of the quadriceps tendon from the knee joint axis
The physiological advantage of the quads rapidly diminish during the last ____ degrees of EXT due to shortened length (decreased mechanical advantage)
15 degrees
What are the primary flexors of the knee?
Hamstrings
What is the prime function of the gastrocnemius?
Supports the posterior capsule of the knee and avoid hyperEXT (CKC support)
What does the popliteus do?
Knee FLX
supports posterior capsule
Acts to unlock the knee (Screwhome mechanism)
What does the pes anserine do?
Provides medial stability to the knee
affects ROT of the tibia in CKC
Normal gait cycle is about ___-___ degrees of knee FLX.
0-60
What controls the amount of knee flexion during initial contact?
Quadriceps
What normally controls the forward swinging leg during terminal swing?
Hamstrings
You need ___-___ degrees of knee FLX with stairs.
80-100 degrees
What can you see with climbing stairs with a knee pathology?
Hip hiking and circumduction
Referred pain to the anterior aspect of the knee can be from the ___ nerve roots.
L3
Referred pain to the posterior aspect of the knee can be from the ______ nerve roots.
S1 and S2
AROM of the knee is (less/more) than the PROM. Why?
a. less
b. due to joint distention, stiffness, pain, weakness, and reflex inhibition
(CKC/OKC) exercises tend to be less stressful in early management of knee pathology.
CKC
OKC exercises provides less resistance and has less discomfort at (lower/higher) velocities
higher velocities
What does an osteotomy of the tibia provide?
- correcting joint deformity
- redistributing WB forces
- reduces pain
When is knee surgery indicated?
When conservative management cannot control pain and effusion with knee arthritis
definition: shaving of the patellar cartilage
arthroscopic chondroplasy
definition: scraping to the posterior of the patella w/ chondromalacia to induce inflammation/bleeding
Abrasion arthroplasty
How long can a TKA be cemented for?
10-15 years
Why would a cementless arthroplasty require longer periods of immobilization?
to allow bone growth
What muscles should you look to strengthen during the maximum-protection phase of rehab for TKA?
quads, hamstrings, and gastrocnemius
Is vigorous passive stretching appropriate during early post-operative periods?
NO
When can you start performing mobilizations to the patella after a TKA?
2-3 days post-op (may be difficult with staples)
What does WB progression depend on after TKA?
Type of prosthesis
Type of Fixation
What type of WB is almost always indicated after a TKA?
WB as tolerated
With patellectomy, there is a lot of strength lost with what motion?
Knee EXT
The peak torque of quadriceps muscles occur between ___-___% of knee FLX
50-70% (usually about 66)
Patellar compression increases with knee FLX at approx. ____ degrees when WB
45 degrees
What is the normal female Q angle?
17-18 degrees
What is the normal male Q angle?
13-14 degrees
There is usually ___ tract with a grater Q angle
Lateral
Lateral fixation of the patella is provided by what?
IT band, lateral retinaculum
Patellar function is opposed by the medial pull of what?
VMO
The ______ fixates the patella inferiorly.
patellar ligament
The ___ fixates the patella superiorly.
Quadriceps tendon
Where in the knee ROM does the apex of the patella have contact?
20 degrees
Where in the knee ROM does the central portion of the patella have contact?
45 degrees
Where in the knee ROM does the base of the patella have contact?
90 degrees
Where in the knee ROM does the odd facet of the patella have contact?
135 degrees
There is no release of synovial fluid until ____ degrees or more of knee FLX.
135 + degrees
definition: Imbalance in the biomechanics of the PF joint causing breakdown or degeneration in the articular cartilage
patellofemoral dysfunction (patellofemoral pain syndrome)
What is the most common type of knee pathology? What population does it affect more?
a. patellofemoral dysfunction
b. females and/or those with larger Q angles
What are possible causes of patellofemoral dysfunction?
- Larger Q-angle
- Poor VMO control
- Strength
- Recruitment
- Tight lateral retinaculum
- Patella position (tilt, rotation)
- Increased femoral anteversion
- Patella alta or baja (Salvati’s technique: patella tendon - length/patella length should equal 1.00)
- Hamstring and extensor mechanism/tightness
- ITB tightness
What are symptoms of patellofemoral pain?
- Anterior knee pain
- Crepitus (grating sensation, may or may not be painful)
- Giving way sensation which is NOT reflective of a locking mechanism but reflexive inhibition of quads
- INSIDIOUS onset of sx
- Usually BILATERAL
- Increased pain with stairs, greater descending
- Pain may be increased following sitting (positive theater sign)
- Possibly increased swelling
definition: A type of PFD with softening and fissuring of the undersurface of the patella
chondromalacia patella
What facet of the patella is most commonly affected with chondromalacia patella?
Medial facet
chondomalacia patella may be asymptomatic until _____ increases
pressure
What are the s/s of synovitis due to patellofemoral dysfunction?
- pain in retropatellar region and possibly peripatellar or medial patellar region
- Condition is worse with squatting, stairs (descending)
- May present with crepitus
- Usually MINIMAL swelling
- Might find lateral tracking patella, tilted, rotated, patella alta, or baja
What is the treatment of PFD?
- decrease effusion
- increase flexibility of tight structures
- possibly orthotics (control of foot PRON and abnormal motion)
- strengthening
- surgery (patellar shaving, patellar chondroplasty, patellar realignment, patellectomy) – RARE
train hip ER/posterolateral hip
(concentric/eccentric) control has been shown to play an important role in PF function
eccentric control