Lecture 7B Flashcards
What kind of force causes:
Injury to MCL
Valgus Force
What kind of force causes:
Unhappy triad : ACL/MCL/Medial meniscus
and the posteromedial capsule
Valgus force
What movement commonly causes injury to ACL and sometimes PCL
can be accompanied by meniscus injuries
hyperextension
What are the common mechanisms of injury to the PCL?
Flexion w/ posterior translation
Classic dashboard injury
What kind of force causes injury to the LCL and postero-lateral capsule
Varus force
Hear a pop
Rapid swelling (0-2 hours)
hx of knee giving way
loss of end range ext
MOI: deceleration/acceleration w/ valgus force near extension
acl tear
What clinical tests are best to do IN THE CLINIC for ACL injuries
Lachman’s
Anterior drawer
cruciate ligaments limit __________
Collateral ligaments limit __________
IR
ER
What is a segond fracture
ACL tear causes avulsion of the lateral tibial plateau due to excessive internal rotation
concurrent bone bruising is most common over the ___________ condyle
heals slowily
usually accompanies what injury
lateral femoral
ACL tear
How do you decide whether or not someone can cope without an ACL or whether they require surgery
Use multiple outcome measures, no single outcome measure is sufficient
post-ACL tear: Individuals with highest pre-injury activity level have a ___________ probability of returning to their preinjury activity level
lower
what % of ACL injuries can compensate well without surgery
1/3
1/3 could return to activity with bracing, strengthening, and activity modification
1/3 would not return to sport without surgery
Inclusion criteria for people who don’t need ACL surgery
isolated ACL injury
Non-repairable meniscal injury
no other ligamentous damage
full and pain free ROM
no knee joint effusion
MVIC of quad is 70% of uninvolved
What criteria is used to identify people who will benefit from no surgery and just rehab after an ACL tear
Single hop test of 80% equivelant to other side
No more than 1 episode of giving way since time of injury
KOS ADL scale and sports activity scale of 80%+
Global Rating scale 60%+
patients are more likely to receive a surgery for ACL if they have
a ____ level of activity
more episodes of giving way
_______ KOS-ADL score
__________ score on the international knee documentation committee Subjective knee form 2000
_____ limb symmetric index on the 6m timed hop test and on quadricep strength index
Higher
Lower
Lower
Lower
fall with hyperflexed knee and ankle plantarflexion
loss of knee ext with ROM testing or gait
PCL injury
What are the 3 clinical tests for PCL tear
Posterior Drawer
Posterior sag sign
positive valgus stress test at 0 degrees
What special test is best for MCL
Valgus stress test at 20-30 knee flexion
grade 1- 2mm joint space opens on CONTRALATERAL SIDE
grade 2- 3-5mm
grade 3- 5-10mm
T or F, the MCL does well non-operatively
T
Pt has MCL injury with boney avulsion, ACL tear
3 months of no progress and still has instability with varus force
operative MCL injury
What clinical test is best for LCL injuries
Varus Stress test at 30 degrees knee flexion
Anteriomedial stability resists what direction of force?
anterior and ER
anterolateral stability resists what direction
anterior and IR
Posteriomedial stability resists what force
posterior and IR force
posterolateral stability resists what force?
posterior and ER force
Excessive valgus force with tibial ER motion causes what injury
anteromedial rotary instability
Excessive valgus force with tibial IR motion will cause what kind of injury
Anterolateral rotary instability
What kind of drawer test is best for anterolateral instability?
What about anteromedial?
Anterior drawer with IR
Anterior Drawer with ER
Traumatic forcing knee into ext and tibial IR causes….
Ext + ER causes….
Posterio-medial instability
Posterio-lateral instability
What test is best for posteromedial instability
postero-lateral instability
posterior drawer with IR
Dial test/Posterior drawer test with ER of 15
MOI for: Posterolateral corner injury
direct hit on proximal tibia with extended knee
posterior force on a flexed knee with tibia ER
Posterolateral corner injury grades of 1, 2, 3
which requires surgery
grade 2 or more
What population is ACL tear the most common in
young female athletes
What interventions have strong evidence for ACL tear?
A level - Therex, NMES, NM education
B- Immediate immobilization, cryotherapy, supervised rehab
C- CPM, Knee bracing, early weight bearing
What level of evidence: Programs should use ACL injury prevention program prior to athletic training sessions in games, especially female athletes, those under 18, soccer players
Grade A
What level of evidence: Programs should incorporate multiple components of control, strength, plyometrics in training
A
History of catching/locking
forceful twist MOI
joint line tenderness
Meniscal injury
What variables help predict meniscal injuries
- Catching/locking
- forceful twist, especially medial
- joint line tenderness
- forceful hyperextension or max flexion
- McMurrays test
4+ predict 81%
What’s the difference betwen an articular cartilage injury and a meniscus injury
Meniscus has delayed effusion, Articular cartilage has immediate hemarthrosis
Articular cartilage injury has pain that is intermittent
What interventions have strong evidence for Meniscus and articular cartilage injuries
B level: Progressive knee motion
progressive WB
therex
NMES
T or F: the diagnosis of Osteoarthritis of the knee should be made by radiographs alone
F
Altman’s criteria for knee OA
50+
Knee crepitus
Boney enlargements
boney tenderness
morning stiffness less than 30 mins
No palpable warmth
What is kellgren-lawrence scale for knee OA
Ranks radiographs by how bad the osteoarthritic changes look
T or F: Manual therapy + exercise was proven to be better for knee OA than exercise alone
T
How can hip mobs benefit knee OA patients?
short term increase in knee ROM and decreased pain
so if they have a hip issue pull on their hip! (after asking contras)
CPR for knee OA patients who would benefit from hip mob
pain with ipsilateral hip distraction
ipsilateral knee flexion passive ROM is under 122
ipsilateral hip IR is less than 17
pain or paresthesia in ipsilateral hip or groin
ipsilateral anterior thigh pain
What relationship does BMI have to OA patients
BMI has a strong relationship to pain and function in patients with knee OA
What are the 4 components of OA treatment
Exercise!
Weight control!
Mob and exercise for knee ROM
Check hip
What impairments are associated with PFPS
Dc quad strength
dc flexibility
dc coordination
control of femurtibia rotation, overpronation, patellar positions
how much increased wb compression does the knee experience with walking?
running?
walking +25-50% bodyweight
running 5-6x bodyweight
What gender experiences PFPS more
women
What 3 areas of the body can cause PFPS
abnormal femur/tibia motion
controlling hip and pelvic motion
ankle/foot motion
Pt has been sitting for over 30 mins and experiences pain after getting up
PFPS!!!!!!!!!!!!
What test will patients with PFPS have the most pain on?
Step down test
What are the 5 critera for lumbopelvic manip for Tx of PFPS
side to side diff of hip IR 14+
Ankle DF over 16
Navicular drop over 3mm
No self reported stiffness in sitting 20+ mins
Squatting reported as most painfu lactivity
atleast 3/5 gets you a 94% probability
