Knee + thigh injuries

Question 1

ACL Onset/MOI

Answer 1

• sudden - audible pop

Valgus + ER force when foot planted

Question 2

ACL subjective

Answer 2

• immediate, deep pain
• ceasing of activity
• ‘giving way’
• irritable

Question 3

ACL physical

Answer 3

• acute haemoarthrosis
• antalgic gait
• <WB, F/E ROM
• Knee held in slight F, X fully E

Question 4

ACL specific tests

Answer 4

• +ve Lachman’s
• +ve anterior draw

Question 5

ACL Mx

Answer 5

• conservative if no sporting demands otherwise surgical reconstruction

Question 6

MCL onset/MOI

Answer 6

• sudden
• strong valgus force in closed kinetic chain
  -> foot PG w/ 90 degree KF - direct blow to lateral knee

Question 7

MCL subjective / agg + easing

Answer 7

• localised pain
• aggravated by walking, valgus stress, tib. ER + knee E
• ease w/ rest + ice

Question 8

MCL physical

Answer 8

• TOP MJL
• no swelling
• knee E painful

Question 9

MCL specific tests

Answer 9

Valgus stress test +ve (lax, painful)

Question 10

PCL onset/MOI

Answer 10

sudden

direct blow to ant. tibia while knee flexed

Question 11

PCL subjective

Answer 11

poorly localised pain

Question 12

PCL physical

Answer 12

Minor swelling

Question 13

PCL specific tests

Answer 13

+ve posterior draw

Question 14

PCL Mx

Answer 14

10 weeks w/ reconstruction similar to ACL

Question 15

Patellar tendinopathy onset/MOI

Answer 15

gradual overuse, common in jumping sports

Question 16

Patellar tendinopathy subjective/agg/ease

Answer 16

• superficial pain over patella
• agg = jumping, hopping
• ease = rest, ice

Question 17

Patellar tendinopathy physical

Answer 17

• knee ROM normal
• quads weakness in severe cases for RSC
• Thickening of tendon
• decline squats increases pain
• taping helps less than PFPS

Question 18

Patellar tendinopathy Mx

Answer 18

• local treatment eg. ice
• address contributing fx eg. quads/hs tightness, lower leg biomechanics. PFJ and core stability
• progressive eccentric exercises

Question 19

ITB friction syndrome onset/MOI

Answer 19

• gradual
• inflammation of ITB due to friction on lateral epicondyle during F + E

Question 20

ITB friction syndrome subjective/agg/ease

Answer 20

• runner or cyclist
• i/m pain/ache on lateral femoral condyle
• agg = running or cycling
• ease = avoiding aggravators

Question 21

ITB friction syndrome 24 hr pattern

Answer 21

possible AM stiffness

Question 22

ITB friction syndrome physical examination

Answer 22

• AROM - pain on knee F/E (worse @20-30*)
• PROM usually unremarkable otherwise same as AROM
• TOP superior to joint line
• MMT/MLT show imbalances

Question 23

ITB friction syndrome Mx

Answer 23

• address local symptoms through rolling/stretching etc.
• improve lower limb strength + mechanics to avoid recurrence

Question 24

Knee meniscal injuries onset/MOI

Answer 24

sudden
forceful twist or rotation of knee

Question 25

Knee meniscal injuries subjective/agg/ease

Answer 25

- deep ache inside knee - sometimes mild swelling - presence of catching/locking/clicking !!! - agg = squatting, movements w/ shear force - ease = avoid aggravators

Question 26

Knee meniscal injuries 24hr pattern

Answer 26

possible AM stiffness

Question 27

Knee meniscal injuries physical

Answer 27

- limited swelling - AROM limited to F/E -> click/clunk into flexion - TOP along joint line of affected side

Question 28

Knee meniscal injuries passive accessory movements

Answer 28

combined f/abd or F/add may elicit pain

Question 29

Knee meniscal injuries special tests

Answer 29

McMurray's Thessaly's Appley's

Question 30

Knee meniscal injuries Mx

Answer 30

surgical - often w/ ACL (better healing)

Question 31

Patello-femoral pain onset/MOI

Answer 31

gradual altered PFJ loading + chemical irritation of nerve endings leads to inflammation + synovitis -> muscle strength deficits in glute med, hip ERs etc. or muscle tightness

Question 32

Patello-femoral pain subjective/agg/ease

Answer 32

- anterior (+/- med/lat) knee pain - i/m deepish ache - crepitus - often bilateral - agg = squatting, stairs, sitting, running -> progressively worse w/ activity - ease = decrease PFJ loading

Question 33

Patello-femoral pain 24hr pattern

Answer 33

possible AM stiffness

Question 34

Patello-femoral pain physical

Answer 34

- TOP med/lat to patella facets - MMT/MLT have imbalances b/t muscle groups

Question 35

Patello-femoral pain Mx

Answer 35

- unload painful structures around PFJ / improve lower limb mechanics - hip + knee exercises - taping - foot orthotics