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NMSK1 - physio 1 > Knee soft tissue injuries > Flashcards

Knee soft tissue injuries Flashcards

1
Q

what are examples of traumatic knee injuries?

A
  • ACL
  • PCL
  • MCL
  • PLC (post lateral corner)
  • meniscus
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2
Q

what are the roles or functions of the ACL?

A
  • primary stabiliser of the knee
  • controls medial rotation of the tibia on the femur
  • resists anterior movement of the tibia on the femur
  • aids to restrict hyperextension of the knee
  • guides the knee locking mechanism
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3
Q

what is an ACL injury classified into?

A
  • partial or complete tear
  • the ACL is designed to withstand a certain level of force - if the threshold is met the ligament can rupture
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4
Q

what is epidemiology?

A

how often diseases or conditions occur in different groups of people and why

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5
Q

what are 5 variables that predict return to sport after an acl injury?

A
  • age at injury
  • competitive athlete status
  • time of surgery
  • cartilage surgery
  • cartilage lesion - damage to cartilage tissue
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6
Q

how do ACL injuries happen?

A

1.** non contact-** changiung direction rapidly, landing after a jump, deceleration
2. contact - tackles, collisions, direct blow to the knee

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7
Q

what other structures can an ACL tear occur in association with & what term describes this?

A
  • medial collateral ligament
  • medial meniscus
  • called the uphappy triad
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8
Q

what are the** intrinsic risk factors** for acl injury?

intrinsic - factors about us

A
  • age
  • high BMI
  • gender - female more likely
  • ethnicity- white more likely
  • anatomy - variation?
  • previous acl injury
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9
Q

what are examples of modifiable risk factors for ACL injury?

A
  • high BMI
  • poor fitness ;level
  • reduced hip strength
  • neuromuscular control
  • biomechanics - faulty
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10
Q

what are the signs & symptoms of ACL injury?

A
  • patient describes a pop or crack at the time of injury
  • unable to continue playing on
  • able to walk after - if complete tear- nociceptors have been disrupted and person cant feel pain as much
  • larger amount of swelling within hours
  • haemarthrosis - bleeding in the joint
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11
Q

what would be signs of ACL injury during subjective exam?

A
  • if patient says they are in pain and knee is swollen
  • if patient has difficulty moving knee
  • if the patient has a event or MOI in patients medical history
  • if the patient describes the knee as a feeling of ‘giving way’
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12
Q

what might you notice in a physical examination of someone with an ACL injury?

A
  • haemarthrosis - bleeding in a joint
  • reduced ROM of knee
  • antalgic gait (abnormal shortened stance phase as they dont want to place weight on injured leg)
  • positive stability tests eg anterior drawer test and lachman’s test
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13
Q

what stability test is the most sensitive and specific test for ACL & what signifies a positive test?

A

Lachmans test
* positive - lack of end feel and anterior movement of tibia on femur

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14
Q

on physical examination of a patient with a suspected ACL injury, should you do a posterior or anterior drawer test first?

A
  • posterior drawer test first always !
  • As we want the knee to be in neutral
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15
Q

why are females more likely to tear their ACLs?

A
  • different biomechanics
  • anatomical hormonal differences
  • difference in neuromuscular control
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16
Q

how do the greatest ACL strains occur?

A
  • combined loading pattern - frontal and transverse plane movements with anterior tibial shear (force)
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17
Q

what are the options for reconstruction of the ACL (surgical options)?

A
  • allograft - donor tissue from cadaver
  • autograft- graft from the injured patients body - either from** hamstring or patella tendon **
18
Q

compare bone patella tendon bone vs hamstring grafts as a surgical method

A
  1. PBTB- most commonly used, **good healing **as bone is stronger and heals fast, lower re-rupture rate, strongest graft
    2.     hamstring - second most commonly     used, semitendinous muscle used, used in younger patients, not as strong as BPTB graft, smaller graft scar
19
Q

what are the goals for post-operative rehab for ACL tear?

months 4-5 and months 5-6

A
  1. months 4-5 - normalise knee ROM, optimise strength and focus on basic foundational movement patterns
  2. months 5-6- progress strength, flexibility, neuromuscular control, endurance, running on level surfaces
20
Q

what are the most effective components in warm up to focus on to prevent ACL injury & how long should you do this for?

A
  • balance work
  • biomechanical training - focusing on hip, knee and ankle
  • strength training - hamstrings, quads and glutes
  • pylometrics
  • 10-15 mins - 2-3 times a week
21
Q

is the PCL often injured with other ligaments?

A
  • yes - often injured with other ligaments
22
Q

what is the MOI of a PCL injury?

A
  • direct blow to anterior tibia with flexed knee
  • hyperextension injury
  • fall onto flexed knee
  • tibia falls back on femur
23
Q

what are the signs and symptoms of a PCL injury during a subjective exam?

A
  • posterior knee pain going into calf
  • feeling of instability of the knee
  • unable to play or peform
  • difficulty walking
  • descent on stairs - pain and difficulty (as knee is partially flexed)
24
Q

what are the signs and sympotoms of a PCL injury during a physical exam?

A
  • swelling
  • posterior sag sign- tibia sagging in relation to the femur
25
Q

what does a positive sag test look like?

A
  • tibia subluxes posteriorly when the PCL is ruptured
26
Q

what is the active quadriceps test for pcl injury?

A
  • Patient lying in supine with knee and hip flexed
  • patient contracts quads with the physio stabilising the ankle and providing reisstance
  • contraction draws the tibia anteriorly in a PCL deficient knee
27
Q

what is the posterior drawer test?

A
  • patient lying in supine with knee flexed
  • physio sits on patients foot
  • physio places hand on tibial tuberosity and pushes tibia back after picking up soft tissue slack
  • positive test - if there is excessive posterior translation or movement
28
Q

in what cases might surgery be recommended for PCL injury?

A
  • if other structures involved
  • grade III tear detected
  • significant rotatory instability of knee
29
Q

what are the roles of the medial collateral ligament?

A
  • stabilises the medial aspect of the knee
  • restricts rotation and valgus (knees pointing inward) stresses
  • note the MCL merges with the medial meniscus
30
Q

describe the signs and symptoms of a MCL tear grade I

A
  • pain and tenderness on palpation +
  • valgus stress testing is painful
  • minimal swelling
  • minimal loss of rom
  • reduced strength
  • patient may or may not have difficulty weight bearing
31
Q

Describe MCL tear grade II

A
  • pain and tenderness on palpation ++
  • valgus stress painful but lax (loose) but definite end point
  • effusion - fluid in capsule
  • loss of ROM
  • reduced strength
  • difficulty weightbearing
  • will feel unstable
  • brace is indicated
32
Q

what does the management (conservative) of MCK grade I-II involve?

A
  • POLICE
  • modified rest
  • protected weightbearing
  • brace
  • taping
  • progressive, outcome based rehab
  • proprioception and sport specific training
33
Q

describe a grade III MCL tear

A
  • usually torn from femoral attachment
  • patient will report floppy or wobbly knee
  • immediate pain at the time of injury but may settle as the fibres are torn
  • may have initial swelling - can settle quickly as fluid escapes through torn capsule
  • gross laxity (looseness) on testing
34
Q

what is the management for MCL grade III

A
  • POLICE
  • modified rest
  • protected WB
  • locked brace for 6 weeks
  • surgeons discretion to increase range of motion
35
Q

what is a good test for MCL injury?

A

valgus stress test
* knee in flexion - physio holding it - applyoing medial force from the lateral part of knee
* positive test - increased laxity and pain

36
Q

Describe an LCL injury and the roles of the lcl

A
  1. roles - stabilises lateral aspect of knee
  2. injuries - less common than ACL and MCL, injury is due to excessive or direct varus stress on kne
37
Q

what is the varus stress test?

A
  • test used to detect LCL injury
  • patient in supine with knee flexed to 20-30 degrees and physio holds leg
  • physio applies force on the medial side of knee
  • pain and laxity - potential positive
38
Q

what is a PLC injury?

A
  • traumatic inury with lateral instability, PCL and ACL injury
  • surgery generally indicated
  • many are missed - always assess
39
Q

what does the MOI of a PLC injury involve?

A
  • blow to anteromedial knee
  • **varus blow to flexed knee **
  • contact or non contact hyperextension
  • external rotation twisting injury
  • knee dislocation
40
Q

how can meniscal injuries occur?

A
  • forceful rotation or twisting of knee on a planted foot
  • often associated with ligament injury eg MCL and medial meniscus
41
Q

what are the main tests for meniscus tear?

A
  • mcmurrays test
  • apleys test
  • palpation of medial or lateral joint line
42
Q

what does the mc murray test involve - lateral vs medial menisci and what does a posiitve test signify??

A
  • patient lying supine
  • put patient knee into flexion and tibia in internal rotation (lateral meniscus0
  • then put patient knee into full flexion and externally rotate the knee for medial mensicus
  • ensure physios hand is on the joint capsule to palpate any cracks or pops
  • positive test - audible clicks with pain

NMSK1 - physio 1 (36 decks)

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