Knee Pathology - Muscle, Cartilage, Bone, Other

Question 1

Grade 1 Muscle Strain

Answer 1

Pain: none or mild
ROM deficit: mild

Question 2

Grade 2 Muscle Strain

Answer 2

Pain: moderate
ROM deficit: moderate

Question 3

Grade 3 Muscle Strain

Answer 3

Pain: none or severe
ROM deficit: severe
Maybe palpable defect

Question 4

T/F: Quad strains are less common, and typically Grade 1-2

Answer 4

True

Question 5

Hamstring strain MOIs (2)

Answer 5

1. High speed running, eccentric contraction in swing phase (often Biceps Femoris).
2. Hip flex + knee ext (often SemiMembranosus).

Question 6

Hamstring strain (running MOI) presentation

Answer 6

SLR deficit
Knee flex strength deficit

Question 7

Hamstring strain (hip flex/knee ext MOI) presentation

Answer 7

Painful area closer to ischial tuberosity

Question 8

Hamstring strain - factors associated with longer recovery time

Answer 8

Proximal injury, closer to ischial tub.
Increased length/area of injury.

Question 9

T/F: a second hamstring injury usually is not as bad as the first

Answer 9

FALSE!
2nd usually worse

Question 10

What type of exercise is good for preventing recurrent hamstring strains?

Answer 10

Eccentric

Question 11

Meniscus injury usually occurs along with what other injury?

Answer 11

ACL

Question 12

Meniscus injury: acute/traumatic MOI

Answer 12

Weight-loaded + rotation (pivoting & cutting)

Question 13

Menscus injury: degenerative MOI

Answer 13

long-term loading

Question 14

Medial Menscus injury: MOI

Answer 14

Valgus, tibial ER

Question 15

Lateral Menscus injury: MOI

Answer 15

Varus, tibial IR

Question 16

Most common type of tear with acute/traumatic menscus injury

Answer 16

Vertical

Question 17

Most common types of tears with degenerative menscus injury (3)

Answer 17

Horizontal
Complex
Maceration

Question 18

Meniscus injury: what are the 3 types of surgeries? Considerations for each type?

Answer 18

1. Meniscectomy: ideally want to avoid, increases risk of OA.
2. Repair: preferred approach, preserves meniscus.
3. Transplant: typically for younger/athletes with extensive damage & want to avoid meniscectomy.

Question 19

What part of the meniscus has the greatest blood supply?

Answer 19

Outer 3rd

Question 20

Articular Cartilage Defect (ACD): risk factors (3)

Answer 20

1. Hx of knee injury/surgery
2. High BMI
3. Sports - jumping, pivoting, cutting

Question 21

Articular Cartilage Defect (ACD): insidious MOI

Answer 21

prior hx of knee injury/surgery

Question 22

Articular Cartilage Defect (ACD): traumatic MOI

Answer 22

Fall on knee
Severe ACL or MCL injury

Question 23

Articular Cartilage Defect (ACD): clinical presentation

Answer 23

Hemarthrosis if acute/traumatic.
Agg = repetitive impact.

Question 24

Articular Cartilage Defect (ACD): palliative surgical options

Answer 24

Debridement/Chondroplasty - not trying to fix anything, just remove the bad junk. Either to manage pain or prepare for ACI procedure.

Question 25

Articular Cartilage Defect (ACD): repair surgery - what is it & why is it not the best option?

Answer 25

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.

Question 26

Articular Cartilage Defect (ACD): restorative surgery options (3)

Answer 26

Implantation (ACI) Autograft (OATS) Allograft (OCA)

Question 27

Implantation (ACI) procedure for ACD

Answer 27

implant pt's own chondrocytes, develops into hyaline cartilage. Good for filling large defects, BUT hyaline weak.

Question 28

Autograft (OATS) procedure for ACD

Answer 28

implant pt's own cartilage, a bunch of tiny plugs. BUT graft never fully fills in, holes remain.

Question 29

Allograft (OCA) procedure for ACD

Answer 29

fills hole with 1 big plug, BUT body may reject (just like any transplant surgery)

Question 30

Post-op ACD procedure: WB restrictions for patellofemoral

Answer 30

NWB in extension

Question 31

Post-op ACD procedure: WB restrictions for tibiofemoral

Answer 31

Avoid WB in 30-70 (example: we could do knee extensions to 20)

Question 32

Osgood-Schlatter: what is it?

Answer 32

apophysitis of tibial tuberosity

Question 33

Osgood-Schlatter: MOI

Answer 33

repetitive loading

Question 34

Osgood-Schlatter: clinical presentation

Answer 34

Tenderness at tibial tubercle. Pain with quad resistance. Agg = squatting. Tightness in quads, hams, gastroc.

Question 35

T/F: after Osgood-Schlatter, it is best to hold off on return to sport until it resolves completely

Answer 35

FALSE - pain can continue for years, regardless of activity

Question 36

Osteochondritis Dessicans: what is it?

Answer 36

bone-cartilage unit detaches (often lateral aspect of medial condyle)

Question 37

Osteochondritis Dessicans: MOI

Answer 37

repetitive microtrauma

Question 38

Osteochondritis Dessicans: when is fixation indicated as a treatment option?

Answer 38

if only 1 piece detached

Question 39

Patellofemoral Instability: what is it?

Answer 39

recurrent sublux or dislocation of patella out of trochlear groove

Question 40

Patellofemoral Instability: risk factors (5)

Answer 40

1. Dysplastic trochlea 2. Patella alta 3. Tight lateral retinaculum 4. Insufficient medial stabilizers (medial PF ligament, VMO) 5. Abnormal Q-angle

Question 41

Patellofemoral Instability: MOI

Answer 41

forceful quad contraction

Question 42

Patellofemoral Instability: rehab treatment

Answer 42

Taping Strength Movement patterns

Question 43

Patellofemoral Instability: surgical options & indications (4)

Answer 43

1. Medial PF Ligament Reconstruction - if torn. 2. Lateral Retinacular Release - if due to tight retinaculum. 3. Trochleoplasty - to fix shape of groove if dysplastic trochlea. 4. Medialization of Tibial Tuberosity - changes the line of pull of quad on patella.

Question 44

Fat Pad Syndrome: what is it?

Answer 44

Inflamed infra-patellar fat pad

Question 45

Fat Pad Syndrome: MOIs

Answer 45

Direct trauma OA Effusion

Question 46

Fat Pad Syndrome: presentation

Answer 46

Tenderness of patellar tendon in extension. Pain with quad activation. Hypertrophy of fat pad (maybe).

Question 47

Plica Syndrome: presentation

Answer 47

Gradual onset. Intermittent pain (often medial condyle) Catching. Clicking/popping with flex/ext. Reflex inhib. Agg = flexion.

Question 48

ITB Friction Syndrome: presentation

Answer 48

Gradual onset (hip or knee pain). May be d/t training errors (example increasing running mileage suddenly).

Question 49

T/F: stretching the ITB helps to lengthen it

Answer 49

FALSE - focus on strengthening & stretching the surrounding muscles instead.