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CATA 263 > lecture 9: conditions of the knee > Flashcards

lecture 9: conditions of the knee Flashcards

1
Q

what are the two joints that make up the knee

A

tibiofemoral joint

proximal tibiofibular joint

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2
Q

what type of jointt is the tibiofemoral joint and explain what that means

A

synovial hinge

=flexion and extension

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3
Q

what type of joint is the tibiofibular joint and explain

A

plane synovial joint

=gliding up and down,ant and posterior

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4
Q

what is the primary function of the proximal tibiofibular joint

A

dissipate the torsional stress applied to tthe ankle

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5
Q

what are some ligaments of the knee joint

A 
menisci 
PCL
ACL
meniscofemoral 
lateral coll. and medial collacteria
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6
Q

what is the mainn weight bearing bone of the body

A

tibia

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7
Q

what percentage of weight does the tiba bear

A

80%

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8
Q

how much weight percentage does the fibula hold

A

15-20%

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9
Q

if you injury your tibia, can you walk on it and why

A

no t usually because it bears most the weight

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10
Q

which fracture is longer to heal and why (tibia or fibula)

A

tibia because you cannot walk on it which takes longer to recover

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11
Q

can you usually still walk with fibula fracture

A

yes

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12
Q

true or false: the knee usually compensates for other strucures? explain

A

true because there are so many msucles (from ankle and hip) that cross in that area which makes the knee compensate for if thre is any weakeness anywhere

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13
Q

if there is knee nerve damage, you will only feel it in the knee?

A

no because the nevre at the knee splits meaning yoy can feel symptoms in other places

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14
Q

what are the knnerves that pass posterior to the kneeS

A

sciatic (tibial and common fib)

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15
Q

what are the nerves that pass anterior to the knee

A

saphenous, deep and superficial peroneal

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16
Q

what are the functions of the meniscus

A

Absorption and dissipation of forces. Improve joint congruency and the stability of the joint.

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17
Q

since the meniscus is mostly water it helps with …

A

lubrification

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18
Q

what percentage of the meniscus is water

A

74%

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19
Q

with WB movements, what happens to the fluid in the meniscus

A

most of the fluid is pushed in the joint to promote gliding and lubrification.

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20
Q

the meniscus is thicker on the medial or lateral aspect

A

thicker on lateral

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21
Q

is there more movement on the medial or lateral side of the meniscus

A

mor emovement laterally

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22
Q

where are both horns of the menisucs attached to

A

are attached to the tibial plateau and linked together with the transverse ligament.

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23
Q

how are the two meniscus attached to each other

A

trhoug hthe traverse ligament

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24
Q

where is the medial meniscus attached to

A

medial meniscus is attached to the MCL and the semimembranosus muscle.

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25
Q

where is the lateral menisucs connected to

A

The lateral meniscus is connected to the PCL and popliteus muscle.

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26
Q

which meniscus is more easily injured

A

medial

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27
Q

what is the function of bursae

A

Reduce friction between two structures.

q

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28
Q

the post bursea comminicates with what

A

with the joint capsule

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29
Q

how can the bursae be inflammed

A

with intracapsular injuries

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30
Q

the fluids in the bursae are influenced by what

A

postition of the joint

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31
Q

the postiion of the joint affects what in the bursa

A

fluid

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32
Q

if there is flexion of the knee, what happens to the bursa

A

fluid will be pushed posteriorly

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33
Q

if there is extension of the kne, where will the fluid in bursea be pushed

A

extension will push fluids anteriolrly

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34
Q

true or false; a brusea cannot rupture

A

false it can rupture with traumatic events

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35
Q

what are the structures that provide dynamic stability to the posterolateral knee

A

include the iliotibial band, long and short heads of the biceps femoris muscle, and the lateral head of the gastrocnemius muscle.

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36
Q

the include the iliotibial band, long and short heads of the biceps femoris muscle, and the lateral head of the gastrocnemius muscle provide STATIC stability

A

false, dynamic

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37
Q

the posterolateral corner of the knee is very stable/unstable

A

stable

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38
Q

Anatomic components comprising the posterolateral corner of the knee serve to provide what to the poserolotaral corner

A

both dynamic and static stability to the posterolateral corner

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39
Q

the structures of the posterolateral prevent what movements

A

preventing hyperextension, tibial external rotation and varus angulation.

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40
Q

the ligaments in the posterolateral corner provide dynamic or static stability

A

stabtic

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41
Q

what are the primary ligaments that provide static sttability to the knee

A

lateral collateral ligament, popliteus tendon, and popliteofibular ligament.

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42
Q

what are the secondary static stabilizers of the posterolateral corner

A

lateral capsule ligament, the coronary ligament and the fabellofibular ligament.

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43
Q

a medial collateral ligament sprain creates what type of instability

A

straight medial instability

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44
Q

what structues are damaged in a medial collateral lgiament sprain

A

MCL damaged, potentially the posteromedial capsule and PCL

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45
Q

in a medial collateral ligament sprain there will be varus or valgus insptabilt

A

valgus

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46
Q

what is the MOI of medial collateral lig sprain

A

valgus force inn weight bearing psotitionn

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47
Q

what is more common MCL or LCL sprains

A

MCL more common

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48
Q

what type of isntability arrises from LCL

A

straight lateral instability

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49
Q

tension on lateral comparment causes what in LCL sprains

A

Tension on lateral compartment, damage to LCL, lateral capsule ligaments and potential PCL

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50
Q

why is LCL sprain rare

A

, since biceps femoris, IT band and popliteus provide strong stability

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51
Q

what type of isntability do you have in ACL tear

A

sraight anterior disability

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52
Q

what are the forces associated with ACL tear

A

Cutting, decelerating, change of direction, and landing

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53
Q

when you have an ACL tear what is the motion of the bones

A

Tibial plateaus subluxes anteriorly on the femur

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54
Q

there is a higher rate of ACL tears in women or men

A

in women

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55
Q

what ratio is important in ACL tears and explain

A

Quad to hamstring ration (lack of eccentric hamstring)

=your must have a good ration to provent anterior translation of the tibia (caused by the quads)

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56
Q

true or false; the middle of the ACL isnt painful but sides are

A

rtue

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57
Q

for ACL sprain, it can be non traumatic?

A

true

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58
Q

what are the SS for ACL tear

A 
Popping, tearing sensation- 80% of patients
Rapid swelling
Hamstring spasm
Pain deep in the knee
Feeling of “giving away”
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59
Q

what symtpom is common is 80% of patients with ACL tear

A

poppint, tearing senstaion

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60
Q

what is the main MOI for PCL tear

A

knee hyper flexion

Posterior glide of the tibia on the femur

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61
Q

why is the PCL harder to tear

A

it is thicker and more solid

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62
Q

what is the difference in ACL vs PCL tear

A

for PCL you need direct contact to push it posteriorly to tear whereas ACL does not need to be traumatic.

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63
Q

what is the role of the hamstrings in ACL tears

A

quads pulls on tibia forward threfore the hamstrings need to be strong to combat that
(to protect against anterior glide)

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64
Q

in the acute phase of ligament sprains, what is the mamangement

A 
PEACE & LOVE
Early strengthening
Maintain full ROM
Swelling management
Proprioception
Pain management
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65
Q

what is needed before going into surgery for lig sprains

A

they need to maintain full ROM

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66
Q

the treatment for MCL is usually conservative or invasive

A

conservative

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67
Q

what is the healing process ofr MCL

A

4-6 monthos

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68
Q

why is bracing sometimes recommeded for MCL tear

A

to help with fear but not necsessary since the muscles around it should stabilze it with rehabilitation

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69
Q

for MCL sprain, do they usually operate

A

no

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70
Q

if you completely tear your MCL, will there be laxity still

A

yes

71
Q

when do you use surgery for PCL

A

surgery for severe tears

72
Q

true or false: you can use bracing for PCL

A

true it might help with fear

73
Q

what is the rehab time for PCL

A

6 montsh

74
Q

is the treatment for LCL conservative or invase

A

conservation

75
Q

what needs to be streignthed after LCL injury

A

biceps femoris, IT band and popliteus strengthening

76
Q

ACL tear is usually surgical repair or conservattive

A

surgical repair

77
Q

what is the rehab period for ACL

A

6 months

78
Q

true or false, the quicker you get out of rehab for acl, the less likely you are to get injured

A

false, Every extra month of rehab decreases the risks of re-injury

79
Q

anteromedial rotary instability is caused by what moement of the bones

A

anterior external rotation of the medial tibial condyle on the femur

80
Q

true or false:

A

Instabilities are not necessarily unidirectional.

81
Q

what are the strucutes associated to anteromedial rotary instability

A

medial compartment ligaments and oblique popliteal

82
Q

anteromedial rotary instabiltiy is accentuated by what

A

Accentuated by medial meniscus tear and ACL (unhappy triad)

83
Q

what is the unhappy triad

A

ACL, MCL and medial meniscus

84
Q

what is the movement of bones in anterolateral rotatry instability

A

anterior internal subluxation of the lateral tibial condyle on the femur

85
Q

what strucures are usually damaged in anterolateral rotary instability

A

ACL main ligament damaged, IT and lateral capsule ligaments as well

86
Q

which type of instability is the most rate

A

posteromedial

87
Q

why is the posteromedial rotaary rare

A

beacuse of amount of muscles in this area

88
Q

what is the movement of bones in posteromedial rotary instab./

A

The medial tibial plateau shifts posteriorly on the femur and opens medially

89
Q

what are the structures injuryed in posteromedial roray instab.

A

Superficial MCL, posteromedial capsule, oblique popliteal ligament, both cruciate ligaments*** severe injury

90
Q

what are some of the muscles in the posteromedial area

A

sartorius, gracilis semi tend and mem and medial gastroc

91
Q

what is the MOI for posterolotary rotary isntabi

A

Sudden anteromedial force that brings the knee joint from full knee extension into hyperextension, combined with varus moment

92
Q

what structutes are usually injured in posterolateral rotary instab

A

PCL, arcuate-popliteal complex, posterolateral capsule and LCL

93
Q

when injuring one quadrant, you should only focus on rehabingt that 1 quadrant?

A

no , also strngthing and rehab oppsotie quadrant

94
Q

what are the 3 types of acute/traumatic meniscus tears

A

longitudinal
radial
horizontal

95
Q

what are the three types of chronic/degenerative mendiscus tears

A

bucker handle
parrot beak
flap

96
Q

a longitunial tear may lead to

A

buckle handle

97
Q

a radial tear may lead to

A

parrot beak

98
Q

a horizontal tear may lead to

A

flap tear

99
Q

what type of tear can lock the knee joint

A

flap tear

100
Q

what is the percetttage of colalgen 1 in meniscus

A

75% type 1 collagen

101
Q

whatt are the functions of the mensicus

A

Distribute load (90% in knee flexion/ 50% in knee extension)
Joint lubricant
Deepens the articulation
Increases stability
Limits femoral translation on tibial plateau

102
Q

what is the load distribution for menisucs

A

90% in knee flexion/50% in knee extension

103
Q

explains why deepending the articulation of the knee is good

A

increases stability

limits femoral translation on tibial plateau

104
Q

what is the medial attachement of menisuc

A

MCL

105
Q

what is the lateral attachement of the meniscus

A

meniscofemoral ligament

106
Q

what is the anterior attachement of he meniscus

A

ACL, transverse ligament (between both meniscus) and the patellomeniscal ligament (thickening of the anterior capsule)

107
Q

what is the posterior attachment of the meniscus

A

PCL, semimembranosus muscle (medial) and popliteus (lateral).

108
Q

what influecnes the movement of the medial meniscus and why

A

the semimembranosus by constaction

109
Q

the blank meniscus is less mobile

A

medial

110
Q

what is the different in medial vs lateral transltation

A

medial : 2-5 mm
lateral 9-11 mm
AP plane

111
Q

what forces cause meniscal tears

A

compression, tensile, shearing with rotation (on femor on fixed tibia)

112
Q

why is medial more injured than lateral menisuc

A

due to decrased mobility

113
Q

meniscus tears can be acute trauma only

A

false, also degenratice

114
Q

what are the 3 knee injury classifcationns

A

red/red
red/white
white/white

115
Q

which classification is the best to heal and why

A

red/red

most vasculature so more blod

116
Q

which classifcation is the worst to heal

A

white white

no blood supply

117
Q

describe the locationn of meniscus tear inn red red

A

Occur in the vascularized outer third of the meniscus

118
Q

describe the lcoatinn of red white tear

A

Occur in the middle-third of the meniscus where the vascular supply is predominately located at the outer edge of the tear

119
Q

decrsibe the locationn of the white white tear

A

Occur in the inner third and where no blood supply exists.

120
Q

what is healinng of the menisuc tear based on

A

type of tear and severity

121
Q

which heals are easier to heal, lonngitudinnal or radial

A

lonngituinal

122
Q

traumatic and acute or chronnic and degenrative have higher healing rates

A

traumatic and acute

123
Q

what it the MOI for meniscus tear

A

cutting or shearing forces

compressio

124
Q

true or false: you will feel dull pain at the time of injury for mensicus tear

A

false, sharp

125
Q

where will you feel pain with a mensicus tear

A

pain along the cpllataeral lig

pain with rotationn and extreme flexionn

126
Q

is there more or less swelling in menisuc vs acl

A

lesss joint effusion for menisum (less blood supply

127
Q

will your knee by givibg out with menisuc tears

A

yes

128
Q

what is managemnt for menisuc tears

A 
PEACE & LOVE
Pain management
Swelling management
Gait retraining
Proprioception
Maintain ROM
Standard of care is the conservative management
Surgery has a greater chance of leading to degenerative arthiritis
129
Q

why is the menicus healing usually done conservatively

A

because

Surgery has a greater chance of leading to degenerative arthiritis

130
Q

what are the cases where we would do surgery on the minsucs

A

tear geater than 1cm less than 4 cm
if its a long tear (vertical) vs a horsonntal
if it occurs in the red red rad

131
Q

where will you feel pain for patellofemoral pain syndorm

A

pain in the patellofemoral joint (feel clicking)

132
Q

what is patellogemoral syndrom

A

when the patella is not follownig its usually track in the groove

133
Q

what can patellofemoral pain symdrome be cauesd be

A 
muscle imbalacnes (quads)
malalighments
134
Q

what are the signs are symptoms for patellogemoral

A

Anterior knee pain, dull and achy
Increases with squatting, sitting in tight space and descending stairs
Point tenderness over lateral facet of patella
Crepitus

135
Q

when dopes pain get worse for patellofemoral pain symdrome

A

incraeses with squating, knee flexion (sitting) and descing stairs

136
Q

what is chondromalacia patiella

A

degeneration of the articular cartilage of the pate;;a

137
Q

what facets are most affects wtith chondromallacia patiella

A

medial and lateral facets

138
Q

what are the forcest that cause chondromalacia patiella

A

shearing and compressire

139
Q

what ate the 4 stages of chondromalacia patella

A

1) articular cartilage
2) fissures
3) fibrulations
4) exposes bone

140
Q

patellar instabilities and discolations are more common laterally or medially

A

lateally

141
Q

what are the 4 causes of patellar dispplacement

A
  • muscle imblances
  • bony deformation
  • cutting motion
  • q angle
142
Q

explain q angle

A

angle between your patella and your quads

+ q angle= more valgus

143
Q

what is patella plica

A

sydrome where synoval lining folds into knee joint cavity

144
Q

how can the synovial lining become inflammed for patella plica

A

repreatd direct blows to capsule or repeating stresses as it passese over femoral condyles

145
Q

whay is the patella plica impinged from

A

patellogemoral joint

146
Q

true or false: patella plica is aggravted by quad exercises

A

true

147
Q

what are thr 4 signs are symptoms of patella plica

A
  • movie like going signs (bilateral stiffness caused by knee flexion for too long)
  • sharp pain for 8-10 steps (max stretched and impiged within patellofem joint)
  • pseudol locking meniscus tears)
  • pop or snap in knee extension
148
Q

what2 syndromes have movie going synfomr

A

patella plica syndrome

patellofemoral pain syndomr

149
Q

what ia patellar tendinitis (jumpers knee)

A

Inflamed/irritated tendon from repetitive or eccentric knee extension activities

150
Q

jumpers knee (patellar tendinitis) is caused by extrincis or intrinnsic factors

A

both

151
Q

where will you feel pain in patellar tendinitis

A

at the patellar tendon (sharp or achy)

152
Q

what is the complication that patellar tendinitus can lead to

A

patella tendon rupture or patellar avulsion

153
Q

what are two common conditions that cause bone defromation of the knee in kids

A

osgood schlater

sining larsen johanson

154
Q

what is osgood slater disease

A

traction type injury to the tibial apophysis where patella tendon meets tibial tubuercle (muscles full on it)

155
Q

who is more likely to get osgood slater

A

women 8-13
men 10-15
=near growth spurts

156
Q

what is the main obivious sign of osgood slaters

A

enlarged and prominent tibial tuberly

157
Q

true or false: there wont be any pain for osgood slaters

A

false, during activtiy

158
Q

what van you wear to relieve pain from osgood slaters

A

tendon straprs which creates new point of muscle insertion ehile on

159
Q

what singing larson johanson syndrome

A

ssimilar to osgood

however it is deformtion/excessive strain on the inferior patella pile (at origin or patella tendon)

160
Q

which ager is more likely to get sinding larsenjohanson

A

kids 8-13 bones are growing

161
Q

osgood slater is an injury to where

A

tibial apopyshysis (where tendon meets tubercle)

162
Q

sining larsen johanson is an injury to where

A

closer to the patella

the patella tendon origion

163
Q

what is IT band frcition syndrome

A

IT moves ove lateral condyle of femur

becomes irritated gfrom snapping force

164
Q

when is IT band friction syndrome paricularly intense

A

durinng strike through contact (mid foot stance)

first 30 degrees from flexion to extension

165
Q

what part of the knee will be inn painnn

A

lateral aspect of the knee )2-3 cm above joint line)

and may raidate to thigh or distal tiabial attachment

166
Q

what are some intrinsic factors that cnan cause IT band frctiin syndrome

A

Intrinsic factors- muscle weaknesses/imbalance, genu valgum, leg length discrepancy, tightness in gluteals/TFL

167
Q

true or false: training errors can have an effect on IT band friction

A

true

168
Q

what is the management for ALL TENDINOUS PATHLOGIES

A

Pain management
Isometric strength
Eccentric strength

Gradual re-exposure to mechanical stress (hydrotherpay)
Biomechanical analysis (running, gait and other functional movements)
169
Q

chondral and osterochondral fractures involve what

A

articulat cartilage and bone att the jpint

170
Q

what makes up 75% of the lesions in chondral and osteogchondra fractions

A

femoral

171
Q

what is the MOI for chondral and osteroxhonrdral factures

A

compression with shearing

rotaion

172
Q

when will you get locking in chondral anf osteochondril fractures

A

if the joint fisplaces (osteochondritis dissecans)

173
Q

what are the strectures intra artticulr/capsular that cause the most swelling

A

ACL
PCL
medial and latt meniscus

174
Q

what are the strucures that cause swelling in the extrecapsular

A 
patellar lig
patellar retinatum
MCL
LCL
popliteal lig
anteriolat lig

CATA 263 (17 decks)

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