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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
Q

Poor outcome for PFPS associated with

A

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
Q

Overall summary for PFP

A

keep the pt active, progressively load and address kinetic chain contributions while monitoring pain

27
Q

RF for ACL Injury

A

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
Q

Exam of ACL Injury

A

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
Q

ACL Controveries

A

Conservative vs surgical
graft types
bracing
return to sport

30
Q

Nonoperative methods for ACL

A

less complications if meniscus is intact
better for sedentary lifestyle
requires weight control
will have continuous instability
neuromuscular reeducation

31
Q

Graft Types

A

allograft
autograft
primary repair
BEAR procedure

32
Q

allograft

A

from a cadaver
patellar ligament or A/P tibialis tendon

33
Q

Autograft

A

from the patient

semitendinosus
patellar
quads tendon

34
Q

Primary repair

A

suture and anchor back to exisiting ACL

35
Q

Prehab/Pre op phase

A

minimize swelling
maximize strength/ROM without pain
assess and education about surgery/rehab

36
Q

Surgery phase

A

stabilize, repair, remove

know what tissues were traumatized, repaired, and removed

37
Q

Phase 1 of ACL recovery

A

recover from surgery
control edema and pain
protect graft
activate quads

38
Q

Phase 2 of ACL recovery

A

force development and motor control
progressive of quad and hamstring loading
full ROM
global conditioning

39
Q

Phase 3 of ACL recovery

A

force attenuation and plyometrics
assessing and training all 3 planes
varying loads and speeds

40
Q

Phase 4 of ACL recovery

A

return to sport progression
sports specific drills
return to participation
play and performance

41
Q

Phase 5 of ACL recovery

A

prevention of re-injury
long-term self management
mitigation of modifiable RF

42
Q

Components of impairment based progression of ACLR rehab

A

early loading
early/frequent education
early/frequent testing/retesting
individualized
adherence
resources
communication with all members of team

43
Q

Impairment based rehab

A

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
Q

Bracing in ACL deficient knee

A

C grade that clinicians may use functional knee bracing in patients without an intact ACL

45
Q

Bracing in immediate post op phase

A

patient preferences appear to matter more than biomechanical data

46
Q

Bracing during return to sport phase

A

patient preferences continue, but required for higher risk sports

47
Q

Return to Sport post ACL

A

for every 1 mnth delay in RTS, the reinjury rate is decreased by 50%

48
Q

RTS Testing

A

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
Q

Improving ACLR Outcomes

A

protect graft in early stages
regaining knee extension AROM
psychological readiness
building strength early
completing POC
early Y balance

50
Q

PCL Injury Interventions

A

protected weight bearing
quads rehab

51
Q

PCL Prognosis

A

return to sport within 4 weeks
chronic PCL leads to increased contact pressure in anterior and medial compartments, early onset of degenerative changes

52
Q

MCL Interventions

A

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
Q

Posterolateral Corner Injuries

A

varus and hyperextension stres
often accompanies an ACL injury
missed PLC injuries are common cause of ACL repair failure

54
Q

PLC consists of

A

LCL, popliteus tendon and ligment
capsule, arcuate ligaments

55
Q

Emergent cases of PLC injuries

A

vascular damage
peroneal nerve palsy (more common, 25%)

56
Q

Presentation of rotary instability

A

tenderness and swelling in posterolateral corner
flexed knee during gait
varus thrus during gait
avoids hyperextension

6 Orthopedics (17 decks)

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