Knee Pathology - Muscle, Cartilage, Bone, Other Flashcards
Grade 1 Muscle Strain
Pain: none or mild
ROM deficit: mild
Grade 2 Muscle Strain
Pain: moderate
ROM deficit: moderate
Grade 3 Muscle Strain
Pain: none or severe
ROM deficit: severe
Maybe palpable defect
T/F: Quad strains are less common, and typically Grade 1-2
True
Hamstring strain MOIs (2)
- High speed running, eccentric contraction in swing phase (often Biceps Femoris).
- Hip flex + knee ext (often SemiMembranosus).
Hamstring strain (running MOI) presentation
SLR deficit
Knee flex strength deficit
Hamstring strain (hip flex/knee ext MOI) presentation
Painful area closer to ischial tuberosity
Hamstring strain - factors associated with longer recovery time
Proximal injury, closer to ischial tub.
Increased length/area of injury.
T/F: a second hamstring injury usually is not as bad as the first
FALSE!
2nd usually worse
What type of exercise is good for preventing recurrent hamstring strains?
Eccentric
Meniscus injury usually occurs along with what other injury?
ACL
Meniscus injury: acute/traumatic MOI
Weight-loaded + rotation (pivoting & cutting)
Menscus injury: degenerative MOI
long-term loading
Medial Menscus injury: MOI
Valgus, tibial ER
Lateral Menscus injury: MOI
Varus, tibial IR
Most common type of tear with acute/traumatic menscus injury
Vertical
Most common types of tears with degenerative menscus injury (3)
Horizontal
Complex
Maceration
Meniscus injury: what are the 3 types of surgeries? Considerations for each type?
- Meniscectomy: ideally want to avoid, increases risk of OA.
- Repair: preferred approach, preserves meniscus.
- Transplant: typically for younger/athletes with extensive damage & want to avoid meniscectomy.
What part of the meniscus has the greatest blood supply?
Outer 3rd
Articular Cartilage Defect (ACD): risk factors (3)
- Hx of knee injury/surgery
- High BMI
- Sports - jumping, pivoting, cutting
Articular Cartilage Defect (ACD): insidious MOI
prior hx of knee injury/surgery
Articular Cartilage Defect (ACD): traumatic MOI
Fall on knee
Severe ACL or MCL injury
Articular Cartilage Defect (ACD): clinical presentation
Hemarthrosis if acute/traumatic.
Agg = repetitive impact.
Articular Cartilage Defect (ACD): palliative surgical options
Debridement/Chondroplasty - not trying to fix anything, just remove the bad junk. Either to manage pain or prepare for ACI procedure.
Articular Cartilage Defect (ACD): repair surgery - what is it & why is it not the best option?
Microfracture - make the bone bleed, it clots, stem cells develop into cartilage.
Not durable - develops into fibrocartilage instead of articular. Fibrocartilage is weaker and will break down over time.
Articular Cartilage Defect (ACD): restorative surgery options (3)
Implantation (ACI)
Autograft (OATS)
Allograft (OCA)
Implantation (ACI) procedure for ACD
implant pt’s own chondrocytes, develops into hyaline cartilage.
Good for filling large defects, BUT hyaline weak.
Autograft (OATS) procedure for ACD
implant pt’s own cartilage, a bunch of tiny plugs.
BUT graft never fully fills in, holes remain.
Allograft (OCA) procedure for ACD
fills hole with 1 big plug, BUT body may reject (just like any transplant surgery)
Post-op ACD procedure: WB restrictions for patellofemoral
NWB in extension
Post-op ACD procedure: WB restrictions for tibiofemoral
Avoid WB in 30-70 (example: we could do knee extensions to 20)
Osgood-Schlatter: what is it?
apophysitis of tibial tuberosity
Osgood-Schlatter: MOI
repetitive loading
Osgood-Schlatter: clinical presentation
Tenderness at tibial tubercle.
Pain with quad resistance.
Agg = squatting.
Tightness in quads, hams, gastroc.
T/F: after Osgood-Schlatter, it is best to hold off on return to sport until it resolves completely
FALSE - pain can continue for years, regardless of activity
Osteochondritis Dessicans: what is it?
bone-cartilage unit detaches (often lateral aspect of medial condyle)
Osteochondritis Dessicans: MOI
repetitive microtrauma
Osteochondritis Dessicans: when is fixation indicated as a treatment option?
if only 1 piece detached
Patellofemoral Instability: what is it?
recurrent sublux or dislocation of patella out of trochlear groove
Patellofemoral Instability: risk factors (5)
- Dysplastic trochlea
- Patella alta
- Tight lateral retinaculum
- Insufficient medial stabilizers (medial PF ligament, VMO)
- Abnormal Q-angle
Patellofemoral Instability: MOI
forceful quad contraction
Patellofemoral Instability: rehab treatment
Taping
Strength
Movement patterns
Patellofemoral Instability: surgical options & indications (4)
- Medial PF Ligament Reconstruction - if torn.
- Lateral Retinacular Release - if due to tight retinaculum.
- Trochleoplasty - to fix shape of groove if dysplastic trochlea.
- Medialization of Tibial Tuberosity - changes the line of pull of quad on patella.
Fat Pad Syndrome: what is it?
Inflamed infra-patellar fat pad
Fat Pad Syndrome: MOIs
Direct trauma
OA
Effusion
Fat Pad Syndrome: presentation
Tenderness of patellar tendon in extension.
Pain with quad activation.
Hypertrophy of fat pad (maybe).
Plica Syndrome: presentation
Gradual onset.
Intermittent pain (often medial condyle)
Catching.
Clicking/popping with flex/ext.
Reflex inhib.
Agg = flexion.
ITB Friction Syndrome: presentation
Gradual onset (hip or knee pain).
May be d/t training errors (example increasing running mileage suddenly).
T/F: stretching the ITB helps to lengthen it
FALSE - focus on strengthening & stretching the surrounding muscles instead.
