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6 Orthopedics > L9 Knee Conditions > Flashcards

L9 Knee Conditions Flashcards

1
Q

Primary Knee Conditions

A

PFP
Ligament injuries
PF instability
Meniscus
OA

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2
Q

Anterior Knee Pain can be…

A

PFP
Chondromalacia patellae
PF instability

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3
Q

Clinical Findings accompanying anterior knee pain

A

patellar hypo or hypermobility
biomechanical alignmnet issues
foot pronation
chondral lesions
tendon or bursae reactivity
fear/avoidance behaviors

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4
Q

PFP syndrome

A

most common cause of anterior knee pain
common in 12-19 and 50-59
more common in females
episodic, often multiple
has a slow, progressive history

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5
Q

Anterior knee pain patient history

A

superficial or retropatellar pain
aggraved with running, squatting, stairs, sitting
no clear MOI
changes in activity or mode
changes in job
prior knee injury or surgery

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6
Q

Kinetic chain Exam

A

strength of glut max, abductors, ER
foot posture
ability to activate foot core

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7
Q

How is PFP diagnosed?

A

usually a diagnosis of exclusion
no definitive single test, usually testing combined with patient history

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8
Q

Potential Clusters for PFPS

A

pain with resisted knee extension
pain with palpation of posteromedial and posterolateral patella
pain with squatting
pain with anterior step down
hypomobile patellar tilt test

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9
Q

Possible Causes for PFP

A
  1. Overuse/overload without other impairments/pathology
  2. Muscle performance/capacity deficits
  3. Movement coordination deficits
  4. Mobility Impairments
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10
Q

Which muscles show deficits with PFP

A

hip abductors
ERs
extensors
quadriceps

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11
Q

Myths in treatment of PFP

A

adjusting the pelvis will restore normal alignment
taping will help patella track properly
stretching ITB will help patella track
strengthening VMO helps patella to track
RICE will solve it

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12
Q

Interventions for PFP, week 0-4

A

Activity mods, load management
initiation of or alternative exercises
address soft tissue restrictions
taping up to 4 weeks
Foot orthoses up to 6 weeks

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13
Q

PFP Intervention Weeks 4-12

A

Foot orthoses up to 6 wks
Posterolateral hip muscle strengthening
kee, foot muscle strengthening
balance exercises
progressive loading towards functional
gait retraining
progressive/graded return to sport

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14
Q

PFP Intervention weeks 8-12

A

Plyometrics/power training
gait re-training
progressive graded return to sport/activity
education regarding management of recurrence

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15
Q

Pain levels and activity

A

0-3/10 = safe zone
4-5/10 = acceptable
6+/10 = excessive

mild pain during activity is ok as long as it settles in 24 hours

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16
Q

Highest loads required on patella

A

1 leg decline squat

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17
Q

Lowest load required on patella

A

walking

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18
Q

Manual therapy for PFP

A

talocrural joint posterior glides
patellofemoral glides
talonavicular glides
soft tissue mobs

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19
Q

Talocrural joint post glides

A

loss of ankle DF due to limited joint play/glide
may present itself during squatting, step downs

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20
Q

Patellofemoral glides

A

assess and treat relevant directions

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21
Q

Talonavicular glides

A

dorsal if there is a rigid flatfoot deformity

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22
Q

Soft tissue mobs for PFP

A

TFL
vastus lateralist
retinaculum
scar tissue

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23
Q

Peak muscle activation from these groups causes PFP

A

hip adductors
hip IR

24
Q

PFPS return to running

A

Easier impact and quicker cadence can improve pain and knee function without significantly altering kinematics

25
Poor outcome for PFPS associated with
longer duration of S/S before intervention overall lower levels of physical function worse pain negative psychological stresses articular surface of patellar findings are not strongly associated with outcomes
26
Overall summary for PFP
keep the pt active, progressively load and address kinetic chain contributions while monitoring pain
27
RF for ACL Injury
Female when younger, Male when older quad to hamstring deceleration strength ratio landing biomechnics higher BMI smaller femoral notch previous ACL injury higher risk sports. soccer, basket, skiing
28
Exam of ACL Injury
Hx: patient reported a pop, shift, giving out. Unwilling to WB, feeling instable, swelling. Observe: lack of full ext during stance phase of gait, lack of flexion during swing, effusion
29
ACL Controveries
Conservative vs surgical graft types bracing return to sport
30
Nonoperative methods for ACL
less complications if meniscus is intact better for sedentary lifestyle requires weight control will have continuous instability neuromuscular reeducation
31
Graft Types
allograft autograft primary repair BEAR procedure
32
allograft
from a cadaver patellar ligament or A/P tibialis tendon
33
Autograft
from the patient semitendinosus patellar quads tendon
34
Primary repair
suture and anchor back to exisiting ACL
35
Prehab/Pre op phase
minimize swelling maximize strength/ROM without pain assess and education about surgery/rehab
36
Surgery phase
stabilize, repair, remove know what tissues were traumatized, repaired, and removed
37
Phase 1 of ACL recovery
recover from surgery control edema and pain protect graft activate quads
38
Phase 2 of ACL recovery
force development and motor control progressive of quad and hamstring loading full ROM global conditioning
39
Phase 3 of ACL recovery
force attenuation and plyometrics assessing and training all 3 planes varying loads and speeds
40
Phase 4 of ACL recovery
return to sport progression sports specific drills return to participation play and performance
41
Phase 5 of ACL recovery
prevention of re-injury long-term self management mitigation of modifiable RF
42
Components of impairment based progression of ACLR rehab
early loading early/frequent education early/frequent testing/retesting individualized adherence resources communication with all members of team
43
Impairment based rehab
you can do "d" once you have been able to accomplish A, B, and C. Being able to D is an essential component of being able to do EFGH
44
Bracing in ACL deficient knee
C grade that clinicians may use functional knee bracing in patients without an intact ACL
45
Bracing in immediate post op phase
patient preferences appear to matter more than biomechanical data
46
Bracing during return to sport phase
patient preferences continue, but required for higher risk sports
47
Return to Sport post ACL
for every 1 mnth delay in RTS, the reinjury rate is decreased by 50%
48
RTS Testing
quad strength single hop for distance triple crossover hop triple hop 6M timed hop KOS-ADLS global rating scale all should be at least 90% or greater than original scoring
49
Improving ACLR Outcomes
protect graft in early stages regaining knee extension AROM psychological readiness building strength early completing POC early Y balance
50
PCL Injury Interventions
protected weight bearing quads rehab
51
PCL Prognosis
return to sport within 4 weeks chronic PCL leads to increased contact pressure in anterior and medial compartments, early onset of degenerative changes
52
MCL Interventions
Grade 1 = quad sets, SLR, cyclling, closed chain exercises. RTS in 5-7 days Grade 2/3 = immobilizer, hinged brace for walking, RTS in 4-8 weeks
53
Posterolateral Corner Injuries
varus and hyperextension stres often accompanies an ACL injury missed PLC injuries are common cause of ACL repair failure
54
PLC consists of
LCL, popliteus tendon and ligment capsule, arcuate ligaments
55
Emergent cases of PLC injuries
vascular damage peroneal nerve palsy (more common, 25%)
56
Presentation of rotary instability
tenderness and swelling in posterolateral corner flexed knee during gait varus thrus during gait avoids hyperextension

6 Orthopedics (17 decks)

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